Late Effects of Treatment for Childhood Cancer - Respiratory System

Lung late effects are more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause lung late effects:
  • Hodgkin lymphoma
  • Wilms tumor
  • Cancers treated with total-body irradiation (TBI) or certain chemotherapy drugs before a stem cell transplant.

Certain chemotherapy drugs and radiation to the lungs increase the risk of lung late effects.

The risk of health problems that affect the lungs increases after treatment with the following:
  • Surgery
  • Certain chemotherapy drugs, such as bleomycin, busulfan, lomustine, dactinomycin, or doxorubicin.
  • Radiation therapy
  • Total-body irradiation (TBI) or certain chemotherapy drugs before a stem cell transplant.
The following types of treatment are most likely to cause late effects:
  • Chemotherapy drugs that are more likely to damage the lung.
  • Higher doses of radiation
  • Radiation to a large part of the lung or the whole lung.
  • Radiation that is not given in small, divided daily doses.
The risk of lung late effects may be increased in childhood cancer survivors who have a history of the following:
  • Infections
  • Lung disease, such as asthma, before cancer treatment.
  • Cigarette smoking.

Late effects that affect the lungs may cause certain health problems.

Lung late effects include the following:
  • Radiation pneumonitis (inflamed lung caused by radiation therapy).
  • Pulmonary
  • Lung disease.

Possible signs and symptoms of lung late effects include trouble breathing and cough.

These and other signs and symptoms may be caused by lung late effects or by other conditions:
  • Dyspnea
  • Wheezing when you breathe.
  • Fever
  • Dry cough.
  • Congestion (a feeling of fullness in the lungs from extra mucus).
  • Feeling tired.
  • Weight loss for no known reason.
Talk to your child's doctor if your child has any of these problems. Lung late effects in childhood cancer survivors may occur slowly over time and or there may be no symptoms. Sometimes lung damage can be detected only by imaging or pulmonary function testing. Lung late effects may improve over time.

Certain tests and procedures are used to detect (find) and diagnose health problems in the lung.

These and other tests and procedures may be used to detect or diagnose lung late effects:
  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Pulmonary function test (PFT): A test to see how well the lungs are working. It measures how much air the lungs can hold and how quickly air moves into and out of the lungs. It also measures how much oxygen is used and how much carbon dioxide is given off during breathing. This is also called lung function test.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of lung late effects. If tests are needed, find out how often they should be done.

Health habits that promote healthy lungs are important for survivors of childhood cancer.

Childhood cancer survivors with lung late effects should take care to protect their health, including:
  • Not smoking.
  • Quitting smoking.
  • Getting vaccines for flu and pneumococcus.