Treatment for these and other childhood cancers may cause lung late effects:

• Hodgkin lymphoma.
• Wilms tumor.
• Cancers treated with a stem cell transplant.

The risk of health problems that affect the lungs increases after treatment with the following:

• Surgery to remove all or part of the lung or chest wall.
• Chemotherapy. In survivors treated with chemotherapy, such as bleomycin, busulfan, carmustine, or lomustine, and radiation therapy to the chest, there is a high risk of lung damage.
• Radiation therapy to the chest. In survivors who had radiation to the chest, the damage to the lungs and chest wall depends on the radiation dose, whether all or part of the lungs and chest wall received radiation, whether the radiation was given in small, divided daily doses, and the child's age at treatment.
• Total-body irradiation or certain types of chemotherapy before a stem cell transplant.

The risk of lung late effects is greater in childhood cancer survivors who are treated with a combination of surgery, chemotherapy, and/or radiation therapy. The risk is also increased in survivors who have a history of the following:

• Infections or graft-versus-host disease after a stem cell transplant.
• Lung or airway disease, such as asthma, before cancer treatment.
• An abnormal chest wall.
• Smoking cigarettes or other substances.

Lung late effects and related health problems include the following:

• Radiation pneumonitis (inflamed lung caused by radiation therapy).
• Pulmonary fibrosis (the build-up of scar tissue in the lung).
• Other lung and airway problems, such as chronic obstructive pulmonary disease (COPD), pneumonia, pneumothorax, cough that does not go away, and asthma.

These and other signs and symptoms may be caused by lung late effects or by other conditions:

• Dyspnea (shortness of breath), especially when being active.
• Wheezing.
• Fever.
• Chronic cough.
• Congestion (a feeling of fullness in the lungs from extra mucus).
• Chronic lung infections.
• Feeling tired.

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 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.

These and other tests and procedures may be used to diagnose lung late effects:

• Physical exam and health 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.

Childhood cancer survivors with lung late effects should take care to protect their health, including:

• Not smoking. Self-help programs and counseling are available to those who want to quit.
• Getting vaccines for flu and pneumococcus.