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Table 16. Female Gonadal Late Effectsa
Late Effects
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Causative Treatment
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Signs and Symptoms
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Screening and Diagnostic Tests
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Management and Intervention
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aAdapted from Schwartz et al.[37]
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Ovarian failure |
Chemotherapy: Mechlorethamine, cyclophosphamide, procarbazine, busulfan, melphalan, dacarbazine (DTIC), carmustine (BCNU), CCNU, ifosfamide |
Delayed/ arrested/ absent pubertal development including: breasts, female escutcheon, female habitus, vaginal estrogen effect, development of body odor and acne, changes in duration, frequency, and character of menses (cramping), estrogen deficiency: hot flashes, vaginal dryness, dyspareunia, low libido, infertility |
Tanner stage, LH, FSH, estradiol: (1) age 12 yrs, (2) failure of pubertal development, (3) baseline when fully mature, (4) as needed for symptoms, assess basal body temperature (midcycle elevation suggests ovulation), (dehydroepiandrosterone for failure of development) |
Hormone replacement (estrogen), anticipatory guidance regarding symptoms of estrogen deficiency and early menopause, referral to reproductive endocrinology, alternate strategies for parenting, early intervention (hormone replacement may prevent osteoporosis, atherosclerosis) |
Radiation: 4–12 Gy tolerance decreases with increasing age |
Surgery: Oophorectomy or oophoropexy |
Vagina: fibrosis/diminished growth |
Chemotherapy: Actinomycin D and doxorubicin enhance radiation therapy effect) |
Dyspareunia, vaginal bleeding, small vaginal vault |
Pelvic exam (possibly under anesthesia) baseline, during puberty and as needed for symptoms |
Dilations, reconstructive surgery, potential need for cesarean section |
Radiation: >40 Gy |
Uterus: fibrosis/decreased growth |
Radiation: >20 Gy (prepubertal), >40–50 Gy (postpubertal) |
Multiple spontaneous abortions, low birth-weight infants, small uterus |
Pelvic: baseline, puberty, then annually |
Questionable endometrial biopsy, counsel regarding pregnancy |
Ureter: fibrosis |
Radiation: >50–60 Gy |
Frequent UTIs, pelvic hypoplasia, hydronephrosis |
Urinalysis every year (urethrogram) |
UTI prophylaxis |
Urethra: strictures |
Radiation: >50 Gy |
Frequent UTIs, dysuria, stream abnormalities |
Urinalysis every year, (voiding cystogram) |
UTI prophylaxis, surgical intervention |
Surgery: Genitourinary |
References
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Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.
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