Some children with brain tumours may experience long-term effects to their lungs, heart, kidneys and bladder after chemotherapy treatment. With regular monitoring, most of these problems can be managed and treated before more serious symptoms develop.
Lungs
Lung problems can occur as a result of brain tumour treatment. Some chemotherapy agents, particularly the group of drugs called nitrosoureas (this includes the drugs CCNU or lomustine and BCNU or carmustine), may negatively affect the lungs. Radiation to the spine may also injure the lungs by causing inflammation or reduced lung capacity. A child with a spinal cord tumour can develop scoliosis (sideways curving of the spine), either from the tumour itself, from surgery for the tumour, or from radiation treatment to the spine. Severe scoliosis can affect lung development and cause chronic breathing problems.
Doctors are aware of these risks and will follow-up with regular pulmonary function tests during treatment if indicated. If your child received any of these medications or radiation, pulmonary function testing may be repeated at the end of treatment. After that, this testing is typically only repeated if new problems develop. If any lung problems develop, your child may need to see a respirologist, a doctor who treats lung diseases.
Heart
Although rare, heart problems can occur after treatment for brain tumours. Radiation to the spine or chest may damage the heart. Some chemotherapy, such as cyclophosphamide, can also directly damage the heart. Children with brain tumours are at increased risk for being overweight and having high blood pressure, which may also contribute to heart problems.
Children who are at risk for heart problems will have regular echocardiograms (heart ultrasounds) during follow-up. If any heart problems develop, your child may need to see a cardiologist, a doctor who treats heart conditions.
Kidneys and bladder
The kidneys and bladder may be affected by chemotherapy drugs–including cisplatin, carboplatin, ifosfamide, and cyclophosphamide—or radiation (to the spine). Some children with decreased kidney function may experience changes in urination (peeing) or swelling of the hands, feet or around the eyes. However, most children with decreased kidney function do not have any symptoms.
These treatments can also irritate the lining of the bladder and cause blood or blood clots to appear in the urine. Less commonly, children may have difficulty urinating due to the irritation. Other medications and intravenous (IV) fluids can help prevent this irritation.
During clinic visits, urine and blood tests will show whether the kidneys and bladder are working properly. These tests can identify problems early, sometimes before any symptoms have developed. High blood pressure may also be a sign that the kidneys are not working properly, so blood pressures are checked in clinic too. Early detection of kidney or bladder problems is important because medications may slow the rate of damage.
Losing too much of certain salts and minerals in the urine is a common problem during treatment, so these levels are checked in the blood. If levels are low, they may need to be corrected with oral or intravenous (IV) supplements. It is unusual for this problem to continue after treatment is complete.
With regular monitoring, most kidney or bladder problems can be managed and treated before more serious symptoms develop. If problems with the kidneys occur, your child may need to see a nephrologist, a doctor who treats kidney diseases.
How will this affect your child’s future?
Because of the small risk of having long-term lung, heart, kidney, or bladder problems, it is important that you and your child make healthy lifestyle choices to improve your child’s general health. They should:
- Get regular check-ups, at least once per year.
- Eat a healthy diet, including daily fruits and vegetables.
- Exercise several times a week.
- Maintain a healthy body weight.
- Avoid smoking tobacco or cannabis products and avoid exposure to second-hand smoke. Do not chew tobacco. Long-term risks of vaping are not currently known, but vaping should be avoided as well.
- Alcohol should be consumed in moderation.