Complications of Cancer

Side Effects

Cancer treatments can cause side effects—problems that occur when treatment affects healthy tissues or organs. Side effects vary from person to person, even among those receiving the same treatment. Some people have very few side effects while others have many. The type of treatment(s) you receive, as well as the amount or frequency of the treatment, your age, and other health conditions you have may also factor into the side effects you may have.

Before you start treatment, ask your health care team what side effects you are likely to have. Learn about steps you can take, as well as supportive care that you will receive, to lessen side effects during and after treatment. Speak up about any side effects you have and changes you notice, so your health care team can treat or help you manage them.

Common side effects caused by cancer treatment include:

Source: NCI (NIH)1

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Physical Health Concerns

Cancer survivors have a higher risk of having their first cancer come back, getting a new cancer, and having other health problems due to—

What Can Be Done?

After treatment ends, cancer survivors should get follow-up care—routine checkups and other cancer screenings. Follow-up care can help find new or returning cancers early and look for side effects of cancer treatment.

Photo of a man and a woman hiking outdoors

Survivors also can lower their risk of getting a new or second cancer by living a healthy lifestyle by—

  • Avoiding tobacco.
  • Limiting alcohol use.
  • Avoiding too much exposure to ultraviolet rays from the sun and tanning beds.
  • Eating a diet rich in fruits and vegetables.
  • Keeping a healthy weight.
  • Being physically active.

Source: CDC Features2

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Living with cancer increases your risk for complications from influenza (“flu”). If you have cancer now or have had cancer in the past, you are at higher risk for complications from the seasonal flu or influenza, including hospitalization and death.

Source: CDC Features3

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People with cancer may have other conditions caused by the cancer or its treatment.

Source: NCI (NIH)4

Increased Risks from Cancer

Osteoporosis, Osteopenia, Bone Loss: Other health problems that increase their risk for bone loss. If you have one of the following health problems, talk to your doctor about your bone health.

Source: NIAMS (NIH)5

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Second Cancers: Second Cancers

Key Points

  • Childhood cancer survivors have an increased risk of a second cancer later in life.
  • Certain genetic patterns or syndromes may increase the risk of a second cancer.
  • Patients who have been treated for cancer need regular screening tests to check for a second cancer.
  • The kind of test used to screen for a second cancer depends in part on the kind of cancer treatment the patient had in the past.

Source: NCI (NIH)6

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Second Cancers: Childhood cancer survivors have an increased risk of a second cancer later in life.

A different primary cancer that occurs at least two months after cancer treatment ends is called a second cancer. A second cancer may occur months or years after treatment is completed. The type of second cancer that occurs depends in part on the original type of cancer and the cancer treatment. Benign tumors (not cancer) may also occur.

Second cancers that occur after cancer treatment include the following:

Source: NCI (NIH)7

Complications for Cancer

Depression: It is common to feel sad or discouraged after a heart attack, a cancer diagnosis, or if you are trying to manage a chronic condition like pain. You may be facing new limits on what you can do and feel anxious about treatment outcomes and the future. It may be hard to adapt to a new reality and to cope with the changes and ongoing treatment that come with the diagnosis. Your favorite activities, like hiking or gardening, may be harder to do.

Temporary feelings of sadness are expected, but if these and other symptoms last longer than a couple of weeks, you may have depression. Depression affects your ability to carry on with daily life and to enjoy work, leisure, friends, and family. The health effects of depression go beyond mood—depression is a serious medical illness with many symptoms, including physical ones.

Source: NIMH (NIH)8

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Infertility: Does cancer treatment affect fertility?

Cancer treatments can affect fertility in both men and women. For example, chemotherapy can affect a woman's fertility by damaging her eggs or affect a man's fertility by damaging his sperm. Some radiation treatments and some surgeries can also damage eggs, sperm, or reproductive organs. Methods exist for preserving fertility before cancer treatment. Whether fertility preservation is an option for a given patient depends on the type of cancer and whether treatment has to be started right away. You should talk to your health care provider about your options.1

To learn more about fertility preservation, visit the section called What is fertility preservation?

Source: NICHD (NIH)9

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Depression: Key Points

Source: NCI (NIH)10

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Suicide Risk: Suicide Risk in Patients with Cancer

Key Points

  • It's common for cancer patients to feel hopeless at times.
  • Risk factors for suicide may be related to the cancer or other conditions.
  • An assessment is done to find the reasons for hopeless feelings or thoughts of suicide.
  • Controlling symptoms caused by cancer and cancer treatment is an important goal in preventing suicide.
  • Losing a loved one to suicide is especially hard for the family and friends.

It's common for cancer patients to feel hopeless at times.

Cancer patients sometimes feel hopeless. Although few cancer patients are reported to die by suicide, talk with your doctor if you feel hopeless or have thoughts of suicide. There are ways your doctor can help you. Getting treatment for major depression has been shown to lower the risk of suicide in cancer patients.

Source: NCI (NIH)11

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Cardiopulmonary syndromes: Cardiopulmonary syndromes are conditions of the heart and lung that may be caused by cancer or by other health problems. Five cardiopulmonary syndromes that may be caused by cancer are covered in this summary:

Source: NCI (NIH)12

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Late Effects: General Information about Late Effects

Key Points

  • Late effects are health problems that occur months or years after treatment has ended.
  • Late effects in childhood cancer survivors affect the body and mind.
  • There are three important factors that affect the risk of late effects.
  • The chance of having late effects increases over time.
  • Regular follow-up care is very important for survivors of childhood cancer.
  • Good health habits are also important for survivors of childhood cancer.

Late effects are health problems that occur months or years after treatment has ended.

The treatment of cancer may cause health problems for childhood cancer survivors months or years after successful treatment has ended. 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.

Treatments that may cause late effects include the following:

Doctors are studying the late effects caused by cancer treatment. They are working to improve cancer treatments and stop or lessen late effects. While most late effects are not life-threatening, they may cause serious problems that affect health and quality of life.

Late effects in childhood cancer survivors affect the body and mind.

Late effects in childhood cancer survivors may affect the following:

  • Organs, tissues, and body function.
  • Growth and development.
  • Mood, feelings, and actions.
  • Thinking, learning, and memory.
  • Social and psychological adjustment.
  • Risk of second cancers.

There are three important factors that affect the risk of late effects.

Many childhood cancer survivors will have late effects. The risk of late effects depends on factors related to the tumor, treatment, and patient. These include the following:

  • Tumor-related factors
  • Type of cancer.
  • Where the tumor is in the body.
  • How the tumor affects the way tissues and organs work.
  • Treatment-related factors
  • Type of surgery.
  • Chemotherapy type, dose, and schedule.
  • Type of radiation therapy, part of the body treated, and dose.
  • Stem cell transplant.
  • Use of two or more types of treatment at the same time.
  • Blood product transfusion.
  • Chronic graft-versus-host disease.
  • Patient-related factors
  • The child's gender.
  • Health problems the child had before being diagnosed with cancer.
  • The child’s age and developmental stage when diagnosed and treated.
  • Length of time since diagnosis and treatment.
  • Changes in hormone levels.
  • The ability of healthy tissue affected by cancer treatment to repair itself.
  • Certain changes in the child's genes.
  • Family history of cancer or other conditions.
  • Health habits.

The chance of having late effects increases over time.

New treatments for childhood cancer have decreased the number of deaths from the primary cancer. Because childhood cancer survivors are living longer, they are having more late effects after cancer treatment. Survivors may not live as long as people who did not have cancer. The most common causes of death in childhood cancer survivors are:

  • The primary cancer comes back.
  • A second (different) primary cancer forms.
  • Heart and lung damage.

Studies of the causes of late effects have led to changes in treatment. This has improved the quality of life for cancer survivors and helps prevent illness and death from late effects.

Regular follow-up care is very important for survivors of childhood cancer.

Regular follow-up by health professionals who are trained to find and treat late effects is important for the long-term health of childhood cancer survivors. Follow-up care will be different for each person who has been treated for cancer. The type of care will depend on the type of cancer, the type of treatment, genetic factors, and the person's general health and health habits. Follow-up care includes checking for signs and symptoms of late effects and health education on how to prevent or lessen late effects.

It is important that childhood cancer survivors have an exam at least once a year. The exams should be done by a health professional who knows the survivor's risk for late effects and can recognize the early signs of late effects. Blood and imaging tests may also be done.

Long-term follow-up may improve the health and quality of life for cancer survivors. It also helps doctors study the late effects of cancer treatments so that safer therapies for newly diagnosed children may be developed.

Good health habits are also important for survivors of childhood cancer.

The quality of life for cancer survivors may be improved by behaviors that promote health and well-being. These include a healthy diet, exercise, and regular medical and dental checkups. These self-care behaviors are especially important for cancer survivors because of their risk of health problems related to treatment. Healthy behaviors may make late effects less severe and lower the risk of other diseases.

Avoiding behaviors that are damaging to health is also important. Smoking, excess alcohol use, illegal drug use, being exposed to sunlight, or not being physically active may worsen organ damage related to treatment and may increase the risk of second cancers.

Source: NCI (NIH)13

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Cancer Late Effects: General Information about Late Effects

Key Points

  • Late effects are health problems that occur months or years after treatment has ended.
  • Late effects in childhood cancer survivors affect the body and mind.
  • There are three important factors that affect the risk of late effects.
  • The chance of having late effects increases over time.
  • Regular follow-up care is very important for survivors of childhood cancer.
  • Good health habits are also important for survivors of childhood cancer.

Source: NCI (NIH)14

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Cardiovascular Late Effects: Cardiovascular System

Key Points

  • Heart and blood vessel late effects are more likely to occur after treatment for certain childhood cancers.
  • Radiation to the chest and certain types of chemotherapy increase the risk of heart and blood vessel late effects.
  • Late effects that affect the heart and blood vessels may cause certain health problems.
  • Possible signs and symptoms of heart and blood vessel late effects include trouble breathing and chest pain.
  • Certain tests and procedures are used to detect (find) and diagnose health problems in the heart and blood vessels.
  • Health habits that promote a healthy heart and blood vessels are important for survivors of childhood cancer.

Source: NCI (NIH)15

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CNS Late Effects: Central Nervous System

Key Points

  • Brain and spinal cord late effects are more likely to occur after treatment for certain childhood cancers.
  • Radiation to the brain increases the risk of brain and spinal cord late effects.
  • Late effects that affect the brain and spinal cord may cause certain health problems.
  • Possible signs and symptoms of brain and spinal cord late effects include headaches, loss of coordination, and seizures.
  • Certain tests and procedures are used to detect (find) and diagnose health problems in the brain and spinal cord.
  • Survivors of childhood cancer may have anxiety and depression related to their cancer.
  • Some childhood cancer survivors have post-traumatic stress disorder.
  • Adolescents who are diagnosed with cancer may have social problems later in life.

Source: NCI (NIH)16

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Mental Health Issues: Mental Health Concerns

Cancer survivors report concerns with depression, anxiety about their cancer returning, and trouble with memory and concentration after cancer treatment. Recent research found that 10% of cancer survivors have mental health concerns, compared with only 6% of adults without a history of cancer.1 Cancer survivors who have other chronic illnesses are more likely to have mental health problems and poorer quality of life.

Fewer than one-third of survivors who have mental health concerns talk to their doctor about them, and many survivors don’t use services like professional counseling or support groups.

What Can Be Done?

  • Survivors should talk to their health care providers about their mental health status during and after treatment.
  • Health care providers can offer cancer survivors mental health screening to check for and monitor changes in anxiety, depression, and other mental health concerns.
  • Psychologists, social workers, and patient navigators can help survivors find appropriate and affordable mental health and social support services in both hospital and community settings.
  • Physical activity has been linked to lower rates of depression among cancer survivors.2

Source: CDC Features17

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Infections: Cancer patients who are treated with chemotherapy are more likely to get infections. Each year in the United States, 60,000 cancer patients are hospitalized because their low white blood cell count led to a serious infection. One in 14 of these patients dies.

The immune system helps your body protect itself from getting an infection. Cancer and chemotherapy can damage this system by reducing your number of infection-fighting white blood cells, a condition called neutropenia. An infection can lead to sepsis, the body’s overwhelming and life-threatening response to an infection.

Find out from your doctor when your white blood cell count is likely to be lowest, since this is when you’re most at risk for infection. This usually occurs between 7 and 12 days after you finish each chemotherapy dose, and may last as long as one week.

Source: CDC Features18

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Oral Candida: Studies have documented clinical evidence of oral candidiasis in nearly 20% of cancer patients.

Source: CDC19

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Secondary lymphoedema: Secondary lymphoedema affects around 2 in 10 women with breast cancer, and 5 in 10 women with vulval cancer. About 3 in every 10 men with penile cancer get lymphoedema.

People who have treatment for melanoma in the lymph nodes in the groin can also get lymphoedema. Research has shown around 20-50% of people are affected.

Your treatment team will let you know if you're at risk of getting lymphoedema from your cancer or cancer treatment. Any planned treatment you have will try to avoid causing damage to your lymph nodes.

The Cancer Research UK website has more information about lymphoedema and cancer.

Source: NHS Choices UK20

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References

  1. Source: NCI (NIH): cancer.gov/ about-cancer/ treatment/ side-effects
  2. Source: CDC Features: cdc.gov/ cancer/ dcpc/ resources/ features/ CancerSurvivorship/ index.htm
  3. Source: CDC Features: cdc.gov/ cancer/ dcpc/ resources/ features/ cancerflu/ index.htm
  4. Source: NCI (NIH): cancer.gov/ about-cancer/ treatment/ drugs/ related-conditions
  5. Source: NIAMS (NIH): niams.nih.gov/ Health_Info/ Bone_Health/ default.asp
  6. Source: NCI (NIH): cancer.gov/ types/ childhood-cancers/ late-effects-pdq
  7. ibid.
  8. Source: NIMH (NIH): nimh.nih.gov/ health/ publications/ chronic-illness-mental-health-2015/ index.shtml
  9. Source: NICHD (NIH): nichd.nih.gov/ health/ topics/ infertility/ conditioninfo/ Pages/ faqs.aspx
  10. Source: NCI (NIH): cancer.gov/ about-cancer/ coping/ feelings/ depression-pdq
  11. ibid.
  12. Source: NCI (NIH): cancer.gov/ about-cancer/ treatment/ side-effects/ cardiopulmonary-pdq
  13. Source: NCI (NIH): cancer.gov/ types/ childhood-cancers/ late-effects-pdq
  14. ibid.
  15. ibid.
  16. ibid.
  17. Source: CDC Features: cdc.gov/ cancer/ dcpc/ resources/ features/ CancerSurvivorship/ index.htm
  18. Source: CDC Features: cdc.gov/ cancer/ dcpc/ resources/ features/ preventinfections/ index.htm
  19. Source: CDC: cdc.gov/ fungal/ diseases/ Candidiasis/ thrush/ 
  20. Source: NHS Choices UK: nhs.uk/ conditions/ Lymphoedema/ 

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Note: This site is for informational purposes only and is not medical advice. See your doctor or other qualified medical professional for all your medical needs.