Neurological Complications in Childhood Cancer Survivors
Table of Contents
Neurological Complications in Childhood Cancer Survivors
Brain and Spinal Cord Late Effects After Childhood Cancer Treatment
Cancer treatments may harm the body's organs, tissues, or bones and cause health problems later in life. These health problems are called late effects. Brain and spinal cord late effects are more likely to occur after treatment for certain childhood cancers. Learn how childhood cancer treatment may cause central nervous system issues later in life.
Brodmann Areas of the Infant Brain
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About
From Birth to Adulthood
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From Birth to Adulthood
Your brain is not a static organ. The nerve cells that make up the bulk of this 3-pound marvel are constantly changing, growing, making new connections and eventually dying throughout your lifetime. Newborn At birth, a baby’s brain weighs less than a pound, about a third of what it will become in adulthood. But it’s busy, making the right connections to ensure that the newborn can start to take in and understand her surroundings. Each nerve cell may make as many as 10,000 links to other nerve cells in the brain. We make the most new connections between nerves during our first months and years of life. Child Infants are born with more brain nerve cells than they will ultimately need, so during childhood, the overabundant growth is pruned back. The ‘use it or lose it’ principle guides this nerve cell sculpting, as connections that are used more frequently are kept, while rarely used circuits are gradually turned off. Teenager Adolescence involves a further refining of the brain’s sculpting process. During the teen years, connections in the prefrontal cortex, which regulates judgment, decision-making and impulsivity are further trimmed down, setting the stage for more mature thinking in adulthood. Young adult The brain’s nerve cell network is at its prime during this time, passing messages along well-established networks to ensure an accurate and efficient flow of activity. Familiar connections hum with practiced efficiency, while new circuits are also formed as the brain continues to adapt and learn from the environment. Adult Even the adult brain isn’t finished growing yet; even with 100 billion nerve cells, new nerve cells continue to grow, specifically in the hippocampus, a region responsible for creating and storing memories. Old age Eventually, as with all of our cells, brain nerve cells begin to deteriorate, and when they do, brain function suffers. As we age, once robust networks of nerve cells start to weaken and connections get lost. The result? It gets harder to remember things and keep track of people, objects and events.
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Which Childhood Cancers Are More Likely to Cause Brain and Spinal Cord Late Effects?
Brain and spinal cord late effects are more likely to occur after treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause brain and spinal cord late effects:
Acute lymphoblastic leukemia (ALL).
Acute myeloid leukemia (AML).
Brain and spinal cord tumors.
Head and neck cancers, including retinoblastoma.
Hodgkin lymphoma.
Non-Hodgkin lymphoma.
Osteosarcoma.
Soft tissue sarcoma.
Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version - National Cancer Institute
What Types of Childhood Cancer Treatments Increase the Risk of Brain and Spinal Cord Late Effects?
Radiation to the brain increases the risk of brain and spinal cord late effects.
The risk of health problems that affect the brain or spinal cord increases after treatment with the following:
Radiation to the brain or spinal cord, especially high doses of radiation. This includes total-body irradiation given as part of a stem cell transplant.
Intrathecal or intraventricular chemotherapy.
Chemotherapy with high-dose methotrexate or cytarabine that can cross the blood-brain barrier (protective lining around the brain). This includes high-dose chemotherapy given as part of a stem cell transplant.
Surgery to remove a tumor on the brain or spinal cord.
When radiation to the brain and intrathecal chemotherapy are given at the same time, the risk of late effects is higher.
The following may also increase the risk of brain and spinal cord late effects in childhood brain tumor survivors:
Being about 5 years old or younger at the time of treatment.
Being female.
Having hydrocephalus and a shunt placed to remove the extra fluid from the ventricles.
Having hearing loss.
Having cerebellar mutism following surgery to remove the brain tumor. Cerebellar mutism includes not being able to speak, having trouble swallowing and eating, loss of coordination and balance, mood swings, being irritable, and having a high-pitched cry.
Having a personal history of stroke.
Seizures.
Central nervous system late effects are also affected by where the tumor has formed in the brain and spinal cord.
Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version - National Cancer Institute
Health Effects
Normal Pressure Hydrocephalus
Image by Nevit Dilmen
Normal Pressure Hydrocephalus
Hydrocephalus _ Animated MRI Images from a patient with normal pressure hydrocephalus
Image by Nevit Dilmen
What Are the Neurological Complications in Childhood Cancer Survivors?
Late effects that affect the brain and spinal cord may cause certain health problems.
Childhood cancer survivors who received radiation, certain types of chemotherapy, or surgery to the brain or spinal cord have an increased risk of late effects to the brain and spinal cord and related health problems. These include the following:
Headaches that may go away after vomiting.
Loss of balance, lack of coordination, or trouble walking.
Dizziness.
Seizures.
Loss of the myelin sheath that covers nerve fibers in the brain.
Movement disorders that affect the legs and eyes or the ability to speak and swallow.
Nerve damage in the hands or feet.
Stroke. A second stroke may be more likely in survivors who received radiation to the brain, have a history of high blood pressure, or were older than 40 years when they had their first stroke.
Daytime sleepiness.
Hydrocephalus.
Loss of bladder and/or bowel control.
Cavernomas (clusters of abnormal blood vessels).
Back pain.
Survivors may also have late effects that affect thinking, learning, memory, emotions, and behavior.
New ways of using more targeted and lower doses of radiation to the brain may lessen the risk of brain and spinal cord late effects.
Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version - National Cancer Institute
Symptoms
Migraine vs. Headache
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Migraine vs. Headache
Do you have a migraine or a headache? Sensitivity to light and sound with pain on one side, could be a migraine. Sinus pressure is usually a headache, but could lead to migraine.
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What Are the Signs and Symptoms of Brain and Spinal Cord Late Effects in Childhood Cancer Survivors?
Possible signs and symptoms of brain and spinal cord late effects include headaches, loss of coordination, and seizures.
These signs and symptoms may be caused by brain and spinal cord late effects or by other conditions:
Trouble speaking or swallowing.
Trouble with having the eyes work together.
Numbness, tingling, or weakness in the hands or feet.
Being unable to bend the ankle to lift the foot up.
Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body).
Unusual sleepiness or change in activity level.
Unusual changes in personality or behavior.
A change in bowel habits or trouble urinating.
Increase in head size (in infants).
Sudden confusion or trouble speaking or understanding speech.
Sudden trouble seeing with one or both eyes.
Sudden severe headache for no known reason.
Other signs and symptoms include the following:
Problems with memory.
Problems with paying attention.
Trouble with solving problems.
Trouble with organizing thoughts and tasks.
Slower ability to learn and use new information.
Trouble learning to read, write, or do math.
Trouble coordinating movement between the eyes, hands, and other muscles.
Delays in normal development.
Social withdrawal or trouble getting along with others.
Talk to your child's doctor if your child has any of these problems.
Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version - National Cancer Institute
Diagnosis
Spine and Spinal Cord and Doctor's exam
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Spine and Spinal Cord and Doctor's exam
Spine and Spinal Cord and Doctor's exam
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How Are Brain and Spinal Cord Problems Diagnosed in Childhood Cancer Survivors?
Certain tests and procedures are used to diagnose health problems in the brain and spinal cord.
These and other tests and procedures may be used to diagnose brain and spinal cord 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.
Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam. In some cases, a more complete exam may be done by a neurologist or neurosurgeon.
Neuropsychological assessment: A series of tests to examine the patient's mental processes and behavior. Areas that are checked usually include:
Knowing who and where you are and what day it is.
Ability to learn and remember new information.
Intelligence.
Ability to solve problems.
Use of spoken and written language.
Eye-hand coordination.
Ability to organize information and tasks.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of brain and spinal cord late effects. If tests are needed, find out how often they should be done.
Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version - National Cancer Institute
Anxiety
Lethargic Boy
Image by Shlomaster/Pixabay
Lethargic Boy
Little boy with anxiety
Image by Shlomaster/Pixabay
Anxiety and Depression in Childhood Cancer Survivors
Survivors of childhood cancer may have anxiety and depression related to their cancer.
Survivors of childhood cancer may have anxiety and depression related to physical changes, having pain, the way they look, or the fear of cancer coming back. These and other factors may cause problems with personal relationships, education, employment, and health, and cause thoughts of suicide. Survivors with these problems may be less likely to live on their own as adults.
Follow-up exams for childhood cancer survivors should include screening and treatment for possible psychological distress, such as anxiety, depression, and thoughts of suicide.
Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version - National Cancer Institute
Post-Traumatic Stress Disorder in Childhood Cancer Survivors
Some childhood cancer survivors have post-traumatic stress disorder.
Being diagnosed and treated for a life-threatening disease may be traumatic. This trauma may cause post-traumatic stress disorder (PTSD). PTSD is defined as having certain behaviors following a stressful event that involved death or the threat of death, serious injury, or a threat to oneself or others.
PTSD can affect cancer survivors in the following ways:
Reliving the time they were diagnosed and treated for cancer, in nightmares or flashbacks, and thinking about it all the time.
Avoiding places, events, and people that remind them of the cancer experience.
In general, childhood cancer survivors show low levels of PTSD, depending in part on the coping style of patients and their parents. Survivors who received radiation therapy to the head when younger than 4 years or survivors who received intensive treatment may be at higher risk of PTSD. Family problems, little or no social support from family or friends, and stress not related to the cancer may increase the chances of having PTSD.
Because avoiding places and persons connected to the cancer may be part of PTSD, survivors with PTSD may not get the medical treatment they need.
Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version - National Cancer Institute
Social Problems
Gray Matter
Brainstem
Cerebellum
Hippocampus
White Matter
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Brain Growth from Birth to 14 Months
Interactive by TheVisualMD
Gray Matter
Brainstem
Cerebellum
Hippocampus
White Matter
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2
3
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5
Brain Growth from Birth to 14 Months
Explore the brain at four different ages at birth and at 3, 7, and 14 months of age. Views from multiple angles reveal the intricate structure of many of the internal components of the baby brain. Brain growth in an infant`s first year of life is nothing short of remarkable: the brain uses 60% of the total energy consumed by the infant and nearly triples in size.
Interactive by TheVisualMD
Social Problems in Childhood Cancer Survivors
Adolescents who are diagnosed with cancer may have social problems later in life.
Adolescents who are diagnosed with cancer may reach fewer social milestones or reach them later in life than adolescents not diagnosed with cancer. Social milestones include having a first boyfriend or girlfriend, getting married, and having a child. They may also have trouble getting along with other people or feel like they are not liked by others their age.
Cancer survivors in this age group have reported being less satisfied with their health and their lives in general compared with others of the same age who did not have cancer. Adolescents and young adults who survived cancer need special programs that give psychological, educational, and job support.
Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version - National Cancer Institute
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Neurological Complications in Childhood Cancer Survivors
Cancer treatments may harm the body's organs, tissues, or bones and cause health problems later in life. These health problems are called late effects. Brain and spinal cord late effects are more likely to occur after treatment for certain childhood cancers. Learn how childhood cancer treatment may cause central nervous system issues later in life.