Key Points for This Section

Testicles Childhood cancer survivors may have late effects that affect the testicles. Certain factors increase the risk that testicular late effects will occur. Testicular late effects may be caused by treatment for certain childhood cancers. Ovaries Childhood cancer survivors may have late effects that affect the ovaries. Certain factors increase the risk that ovarian late effects will occur. Uterus Childhood cancer survivors may have late effects that affect the uterus. The risk of uterine late effects may be increased in women who received radiation therapy to the abdomen. Ovarian and uterine late effects may be caused by treatment for childhood osteosarcoma and other childhood cancers. Reproduction Childhood cancer survivors may have late effects that affect pregnancies. Certain stem cell and bone marrow transplants increase the risk of infertility. There are methods that may be used to help childhood cancer survivors have children. Children of childhood cancer survivors are usually not affected by a parent’s prior cancer treatment.

Testicles

Childhood cancer survivors may have late effects that affect the testicles.

Testicular late effects may cause infertility or a low sperm count. Low sperm counts may be temporary or permanent depending on the radiation dose and schedule, the area of the body treated, and the age when treated.

Certain factors increase the risk that testicular late effects will occur.

The risk of testicular late effects may be increased in childhood cancer survivors who received either of the following:

• Chemotherapy with alkylating agents, such as cyclophosphamide, procarbazine, and ifosfamide.
• Radiation therapy to the abdomen.

Testicular late effects may be caused by treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause testicular late effects:

• Acute lymphoblastic leukemia (ALL).
• Osteosarcoma.
• Hodgkin lymphoma.
• Sarcoma.

Ovaries

Childhood cancer survivors may have late effects that affect the ovaries.

Ovarian late effects may include the following:

• Infertility.
• Irregular menstrual periods.
• Ovarian failure.
• Early menopause.

Certain factors increase the risk that ovarian late effects will occur.

The risk of ovarian late effects may be increased in childhood cancer survivors who received any of the following:

• Chemotherapy with alkylating agents, such as cyclophosphamide, mechlorethamine, procarbazine, and ifosfamide.
• Radiation therapy together with alkylating agents.
• Treatment at an older age.

Uterus

Childhood cancer survivors may have late effects that affect the uterus.

The uterus may become less elastic and grow to a size that is smaller than normal. This can cause an increased risk of miscarriage and premature birth. Growth of the fetus within the uterus may also be affected.

The risk of uterine late effects may be increased in women who received radiation therapy to the abdomen.

Ovarian and uterine late effects may be caused by treatment for childhood osteosarcoma and other childhood cancers.

Reproduction

Childhood cancer survivors may have late effects that affect pregnancies.

Late effects on pregnancies include increased risk of the following:

• Miscarriage.
• Ending the pregnancy for medical reasons.
• Low birth-weight babies.
• Early labor.
• Premature delivery.
• Abnormal position of the fetus.
• Birth defects.

For male survivors of childhood cancer, there is an increased risk that their children may be stillborn.

Certain stem cell and bone marrow transplants increase the risk of infertility.

Stem cell and bone marrow transplants that include total-body irradiation (TBI), cyclophosphamide, or busulfan may damage the ovaries. Problems with the ovaries, fertility, and the ability to carry a baby to term may occur.

There are methods that may be used to help childhood cancer survivors have children.

The following methods may be used so that childhood cancer survivors can have children:

• Freezing the eggs or sperm before cancer treatment in patients who have reached puberty.
• In vitro fertilization (IVF).

There is a risk that there may be cancer cells in the saved eggs, sperm, or embryo. This risk is highest in patients who had cancer of the blood, testicles, or ovaries.

Children of childhood cancer survivors are usually not affected by a parent’s prior cancer treatment.

Survivors of childhood cancer may wonder if their children will have birth defects, inherited diseases, or cancer. There is a small increase in the risk of birth defects in the children of females who received radiation therapy to the lower back, but most children of childhood cancer survivors are born healthy.

There may be an increased risk of birth defects in children whose embryos were created in the laboratory and an increased risk of cancer in the children of cancer survivors who had second cancers.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).

An aggressive (fast-growing) type of leukemia (blood cancer) in which too many lymphoblasts (immature white blood cells) are found in the blood and bone marrow. Also called acute lymphocytic leukemia and ALL.

A type of drug that is used in the treatment of cancer. It interferes with the cell's DNA and inhibits cancer cell growth.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

A procedure to replace bone marrow that has been destroyed by treatment with high doses of anticancer drugs or radiation. Transplantation may be autologous (an individual's own marrow saved before treatment), allogeneic (marrow donated by someone else), or syngeneic (marrow donated by an identical twin).

An anticancer drug that belongs to the family of drugs called alkylating agents.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

Treatment with drugs that kill cancer cells.

A drug that is used to treat many types of cancer and is being studied in the treatment of other types of cancer. It is also used to treat some types of kidney disease in children. Cyclophosphamide attaches to DNA in cells and may kill cancer cells. It is a type of alkylating agent. Also called CTX and Cytoxan.

The amount of medicine taken, or radiation given, at one time.

Early stage in the development of a plant or an animal. In vertebrate animals (have a backbone or spinal column), this stage lasts from shortly after fertilization until all major body parts appear. In particular, in humans, this stage lasts from about 2 weeks after fertilization until the end of the seventh or eighth week of pregnancy.

The ability to produce children.

The developing offspring from 7 to 8 weeks after conception until birth.

A cancer of the immune system that is marked by the presence of a type of cell called the Reed-Sternberg cell. The two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats. Also called Hodgkin disease.

A drug that is used together with other drugs to treat germ cell testicular cancer that did not respond to previous treatment with other drugs. It is also being studied in the treatment of other types of cancer. Ifosfamide attaches to DNA in cells and may kill cancer cells. It is a type of alkylating agent and a type of antimetabolite. Also called Ifex.

In the laboratory (outside the body). The opposite of in vivo (in the body).

The inability to produce children.

Transmitted through genes that have been passed from parents to their offspring (children).

Side effects of cancer treatment that appear months or years after treatment has ended. Late effects include physical and mental problems and second cancers.

The active ingredient in a drug that is used to treat some types of cancer and some precancerous skin conditions and is being studied in the treatment of other types of cancer. Mechlorethamine attaches to DNA in cells and may kill cancer cells. It is a type of alkylating agent.

The time of life when a woman’s ovaries stop working and menstrual periods stop. Natural menopause usually occurs around age 50. A woman is said to be in menopause when she hasn’t had a period for 12 months in a row. Symptoms of menopause include hot flashes, mood swings, night sweats, vaginal dryness, trouble concentrating, and infertility.

The monthly cycle of hormonal changes from the beginning of one menstrual period to the beginning of the next.

A cancer of the bone that usually affects the large bones of the arm or leg. It occurs most commonly in young people and affects more males than females. Also called osteogenic sarcoma.

Having to do with the ovaries, the female reproductive glands in which the ova (eggs) are formed. The ovaries are located in the pelvis, one on each side of the uterus.

One of a pair of female reproductive glands in which the ova, or eggs, are formed. The ovaries are located in the pelvis, one on each side of the uterus.

The active ingredient in a drug that is used to treat advanced Hodgkin lymphoma and is being studied in the treatment of other types of cancer. Procarbazine blocks cells from making proteins and damages DNA. It may kill cancer cells. It is a type of antineoplastic agent and a type of alkylating agent.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

A cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.

Refers to a new primary cancer in a person with a history of cancer.

The male reproductive cell, formed in the testicle. A sperm unites with an egg to form an embryo.

A method of replacing immature blood-forming cells that were destroyed by cancer treatment. The stem cells are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells.

One of two egg-shaped glands inside the scrotum that produce sperm and male hormones. Also called testis.

Radiation therapy to the entire body. It is usually followed by bone marrow or peripheral stem cell transplantation.

The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a baby grows. Also called womb.