Though treatment may last for many months or years, for most children it is successful and they recover from their illness.

However, the rigorous nature of the treatment can leave them with long-term side-effects. Or some families may face the possibility of treatment failing. This section will give you more information about how to cope with these situations.

Long Term Side Effects
Most children will not have any problems as a result of their illness. But there are some long-term problems associated with cancer treatment. These vary depending upon the type of cancer and treatment the child has had. Attendance at a follow-up clinic will help identify and manage any long-term side effects. Not all children treated in the same way will have the same long-term side-effects. It is difficult to accurately predict who will be affected and today's new treatment regimes aim to reduce the incidence of such side-effects.

As many current treatments have only been used since the 1970s, the survivors are in their 30s and any full effects may not yet be known. Below is a list of potential long-term side effects that are known to be caused by certain cancer treatments. Parents can ask their child’s Consultant about these in more detail.

Puberty
Radiotherapy to the brain, abdomen or pelvis (including the testicles or ovaries) can affect puberty. Certain chemotherapy drugs and operations can also do this. In some children the start of puberty may be delayed because of changes to the way their body produces hormones. The child will be monitored at the follow-up clinic for signs of puberty. If it is delayed hormone therapy can be given so that it occurs.

Infertility
Cancer treatment can affect a child’s ability to have children of their own in the future. This is hard to determine until puberty. If the child being treated has already reached puberty they will have hormone tests to see if there is a problem. Boys who have gone through puberty can be given the option of banking their sperm before treatment. Any discussions or decisions made around fertility may be very difficult and there is information available that can help.

Growth and development
Radiotherapy can have effects on growth and development. There are two main ways that this can happen.
Growth hormone is produced by the pituitary gland in the brain. If a child was given radiotherapy to the brain, the production of growth hormone may be affected. The child may therefore not grow properly and may need artificial growth hormone. Radiotherapy may also affect the growth of bones treated by radiotherapy. This may lead to one leg or arm being shorter than the other. A Consultant can give a better idea of what to expect in this situation.

Intellectual development
The majority of children returning to school after treatment experience no long term problems. An exception is children who have been treated for a brain tumour. Their treatment means they are more likely to have 'developed' learning difficulties, which call for special help at school.

It has been suggested that up to 50% of children treated for brain tumours will need some sort of special support when returning to school.¹ Today, if possible, many children under the age of three do not receive radiotherapy if they have a brain tumour. This is because their brains are rapidly developing and are therefore more vulnerable to long term side-effects. Medical professionals are keen to avoid these side-effects as much as possible.

Lengthy periods off school can also mean it is harder for a child to catch up with the other children in the class, even after treatment has ended for some time. Parents can seek advice from a member of their child’s care team who can help arrange for special facilities at school, should they be needed.

Heart and lungs
Both chemotherapy and radiotherapy can alter the way the heart and lungs work. This can continue for some time after treatment and is monitored at the follow-up clinic.

Kidney function
Certain types of chemotherapy drugs can affect the kidneys, but this is not usually severe.

Second cancer
It is possible, although rare, for a child to develop a different cancer later in life because of their initial treatment. The risk of this happening is very low but is more likely with certain types of treatment. Parents can talk to their child's Consultant for further information.

Source: www.clicsargent.org.uk