Late Effects

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Late Effects

Surviving a brain tumor is a cause for celebration and is an ongoing process.  A difficult passage in your life has passed and you have triumphed.  However, residual side effects of the tumor and its treatment, known as “late effects” may stay with you.  Preparation and awareness can help to keep this possibility in perspective, and not allow it to cast a shadow over the future.

 

Most late effects are determined by the course of treatment followed, not by the tumor itself. Chemotherapy, radiation and surgery can all result in late effects.  While most studies of late effects focus on child survivors, the same symptoms may surface in adults as well.  A symptom is considered a late effect if it occurs five years or more after treatment is completed.

  • Chemotherapy late effects: The effects and late effects of chemotherapy are generally determined by which agents are used in the treatment. Different chemotherapy treatments have different effects on the patient.
  • Fertility: If the pituitary gland or hypothalamus is involved, survivors should be checked annually for hormone levels and the progress of puberty in children.  An endocrinologist may be consulted if issues arise.
  • Hearing loss: This may occur with certain chemotherapy agents, as well as tinnitus (ringing in the ears). Young children may experience speech delays. Regular audiology testing should be given after treatment, and if necessary, hearing aids can be implemented.
  • Dental issues: Increased risk of cavities, thinning of tooth enamel and problems with roots are likely.  Make regular visits (every six months) to the dentist to keep an eye on things.
  • Radiation late effects: Since radiation therapy is so localized, it can impart a greater number of late effects to the brain than chemotherapy.

Cognitive issues may occur after treatment with radiation.  Memory, motor skills, learning, and behavior are areas that may be affected, depending where in the brain the radiation is directed.  Children who have received radiation therapy may struggle with learning disabilities.

 

Radiation can affect the body’s hormones, particularly the thyroid and reproductive hormones.  Growth hormones in children can also be affected. Survivors should be tested yearly to ensure the thyroid is working properly.

 

Reproductive capabilities may also be affected by radiation to the brain. Adults facing this treatment, who might wish to have children later in life, can explore options for preserving sperm or eggs.

 

There is a risk of hearing loss after radiation therapy if it was directed toward the brainstem or the ear.

 

If the tumor affects the optic nerves, radiation in that area can result in vision loss.  Cataracts may also surface as a late effect after radiation treatment.

 

Radiation therapy brings the greatest risk of late effects to a survivor’s emotional responses and behavior.  Survivors and their families should be vigilant about noticing changes, and should consult their doctor or neuropsychologist for evaluation.

 

Surgery Late Effects

The late effects of surgery are generally confined to the areas where the surgery occurred.

 

Cognitive issues may surface if surgery was located in the cerebral hemisphere, which governs thinking and reasoning. Learning disabilities may appear in child survivors.

 

Surgery near the pituitary gland may affect the production of certain hormones, which may result in growth and reproductive issues, and even osteoporosis. Children who have undergone surgery should be closely monitored through puberty. Adults should also be checked regularly for normal activity in the pituitary and thyroid glands.

 

Emotional and behavioral changes may surface in patients who have undergone brain tumor surgery, depending on the location of the brain tumor. Report any behavioral changes to your physician, and request an evaluation.

 

Whether your treatment is ongoing or completed, you will likely remain in touch with your oncologist and other members of your  care team to monitor your health.  In the long-term you may return to your primary care doctor. If so, make certain all of the information about your tumor and treatments, including risk factors for late effects, are sent from your oncologist to your primary care doctor.  He or she will need that information to properly assess any changes to your health that may arise in later years.