What Are Late Effects of Cancer and Cancer Treatment?

If your child has cancer, you're probably familiar with the short-term effects of the disease and its treatment: pain, nausea, tiredness, skin rashes, and more.

But even when the disease is in remission and your child has been cancer-free for years, long-term side effects may happen. These problems are called "late effects."

About 2 out of 3 cancer survivors will develop at least one late effect at some point. With early diagnosis and proper follow-up care, most late effects can be treated or cured.

What Causes Late Effects?

The cancer itself is not what usually causes the late effects — rather, it's the treatment. Chemotherapy and radiation both work by killing fast-growing cells. Cancer cells are among those, but unfortunately so are lots of other healthy cells.

More research needs to be done to fully understand how late effects happen. Researchers think it is likely that damage to the cells at critical points in a child's development leads to late effects.

Doctors have learned that the types of effects a childhood cancer survivor might have later can depend on:

  • the type of cancer the child had
  • where the cancer was in the body
  • the type and dose of chemotherapy and radiation
  • the age and general health of the child at the time of treatment

What Are the Common Late Effects of Cancer Treatment?

Late side effects include:

Learning problems. Some chemotherapy drugs and/or radiation to the brain may interfere with learning. The problems can range from mild to severe, and may show up during treatment, soon after treatment, or several years later. Common learning problems include problems with memory, processing speed, and multi-tasking.

Abnormal bone growth. Sometimes kids do not grow in the usual timeframe and/or stop growing much earlier than normal. This may be due to radiation treatment, chemotherapy, or a brain tumor or its treatment.

Kids may also be at risk for developing osteoporosis (bone thinning) or scoliosis (a curved spine).

Thyroid problems. The thyroid is a gland of the endocrine system that controls metabolism (chemical reactions in the body's cells). It may be damaged by radiation to the head or neck. The result is typically hypothyroidism (when the thyroid doesn't make enough thyroid hormone), leading to tiredness, weight gain, thinning hair, and dry skin.

Hearing loss. Chemotherapy, radiation to the brain, and even some antibiotics can lead to high-frequency hearing loss (when a person cannot hear high-pitched sounds), tinnitus (ringing in the ears), or dizziness.

Vision problems. Blurred or double vision, glaucoma, or cataracts are more likely in kids who were treated for tumors near the eye or received radiation to the brain.

Dental problems. Short dental roots, delayed teeth, or missing teeth are more common in very young children who've had radiation to the brain and/or chemotherapy with a drug called vincristine. All kids who have had chemo are at risk for tooth decay and gum disease.

Lung, liver, or kidney problems. Childhood cancer treatments have been linked to several types of body organ damage later in life. How serious the organ damage is depends on the type of cancer and treatment.

Heart problems. Kids who had chest radiation and/or chemo with a class of drugs called anthracycline are at higher risk for heart problems up to 20 years or longer after treatment. The severity of the problem depends on how much chemo and/or chest radiation they got and the child's age during treatment. Family genetics, weight, and cholesterol level also play a role in in getting heart problems.

Delayed sexual development and fertility issues. Both chemotherapy and radiation can cause fertility problems. These late effects may be from damage to the endocrine system (which starts the onset of puberty) or to the sexual organs themselves.

Because of the risk, special measures may be taken before or during treatment to protect the reproductive organs. For example, doctors may shield the ovaries and testicles during radiation treatment. Teen boys and girls may be able to bank their sperm and eggs before cancer treatment. The good news is that despite these risks, many childhood cancer survivors can go on to have healthy children of their own.

Increased risk of future cancers. Childhood cancer survivors have a slightly higher risk of developing a second cancer at some point — even if the original cancer doesn't come back. Many things affect this risk, such as the type of the first cancer, the treatments given, and any genetic risks.

What Can We Expect During Remission?

When your child is considered cancer-free and in remission, you may be tempted to stay as far away from doctors and hospitals as you can. But your child needs to be carefully monitored for years to come, even into adulthood. As with any disease, the sooner any possible late effects are caught, the quicker they can be managed.

After treatment ends, ask the doctor for what's called an "off-treatment summary." This includes all of the information related to your child's cancer diagnosis, treatment, and follow-up care. Follow-up appointments may include regular screenings like blood tests, hearing tests, vision tests, and heart tests (echocardiograms, or EKGs).

It's important that your child follow this schedule. The hospital may have a cancer survivorship clinic to help with this process. Survivorship clinics provide long-term medical services and follow-up care for cancer survivors. The focus is on educating you and your child about the cancer that's now in remission; long-term follow-up recommendations; and ways to live a healthy, happy, long life.

Keep all medical records in a safe place, and help your child begin taking responsibility for managing his or her own health care.

As your child grows, emphasize the importance of regular follow-up care and also a healthy lifestyle that includes a balanced diet and regular exercise. Both can increase your child's chances of staying well in the future.

How Can Parents Help?

Knowing that the cancer might come back can be hard for any childhood cancer survivor. Some kids might not tell their parents about any new symptoms for fear of being sick again.

Reassure your child that no one knows what tomorrow holds and that even if a late effect should appear, it's best to pay attention to symptoms right away. Many late effects are treatable with routine medical care.

Back to Articles

Related Articles

Cancer Center

Visit our Cancer Center for teens to get information and advice on treating and coping with cancer.

Read More

Cancer Center

Cancer is a serious illness that needs special treatment. Find out more about how kids can cope with cancer.

Read More

Childhood Cancer

Different kinds of childhood cancer have different signs, symptoms, treatments, and outcomes. But today, most kids with cancer get better.

Read More

Coping With Cosmetic Effects of Cancer Treatment

It's normal for kids to have hair loss, skin changes, or weight gain during treatment. This article offers tips for helping kids feel better about their appearance.

Read More

Keeping Your Child Healthy During Cancer Remission

Many families with a child in remission feel empowered to make lifestyle changes that could benefit their child's health in the future. Here are some tips.

Read More

Can I Have Children After Cancer Treatments?

When chemotherapy and other treatments attack cancer cells, they can affect some of the body's healthy cells too. As a teen, you'll want to know what this can mean to your fertility.

Read More

Effects of Cancer Treatment on Fertility

While some cancer treatments have little to no effect on reproductive health, others are more likely cause temporary or permanent infertility.

Read More

Side Effects of Chemotherapy and Radiation

Side effects of cancer treatment can include flu-like symptoms, hair loss, and blood clotting problems. After treatment ends, most side effects go away.

Read More

Steroids for Treating Cancer

Unlike the steroids that body builders use, steroids used in cancer treatment are safe and help kids feel better.

Read More

Steroids and Cancer Treatment

If your doctor prescribed steroids as part of your treatment for an illness, don't worry. It's not the illegal, doping scandal kind of steroid. Get the details in this article for teens.

Read More

Cancer Basics

Get the basics on cancer and cancer treatments in this article.

Read More

Cancer: Readjusting to Home and School

If you've just finished a long hospital stay, you may have questions about reconnecting with friends and family. Get answers in this article for teens.

Read More


Chemotherapy is a big word for treatment with medicines used to help people who have cancer. This medicine kills the cancer cells that are making the person sick.

Read More

Stem Cell Transplants

Stem cells can develop into cells with different skills, so they're useful in treating diseases like cancer.

Read More

Dealing With Cancer

It's unusual for teens to have cancer, but it can happen. The good news is that most will survive and return to their everyday lives. Learn about how to cope if you or someone you know has cancer.

Read More

Cancer Center

From treatments and prevention to coping with the emotional aspects of cancer, the Cancer Center provides comprehensive information that parents need.

Read More

Brain and Nervous System Cancers

These cancers are the most common type of cancer in children. When discovered early, they often can be cured.

Read More

Nutritional Needs for Kids With Cancer

Eating as well as possible and staying hydrated can help kids undergoing cancer treatment keep up their strength and deal with side effects. These tips can help.

Read More

Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor. © 1995-2021 KidsHealth®. All rights reserved. Images provided by The Nemours Foundation, iStock, Getty Images, Veer, Shutterstock, and Clipart.com.