On late complications For cancer treatments
Direct result of the enormous developments in the means and patterns of processors tumors of different, should enable more than 80% of children treated by passing the phase of the five-year recovery standard, an increase of 45% for years of the sixties, and increasing numbers of children of survivors and extension periods of their lives for longer than the generations the former, it has become possible to conduct research and extensive studies on issues related to their development of health in the long run, in what became known research on the effects and late complications of cancer and Maagath, and has researchers found that it can be for cancer treatments that affect a large and varying degrees on the health of children of survivors for a few years later, both during the periods and phases of their development and passage stages of puberty and adolescence and adulthood, or even further during the late years of age.
And are associated with these complications overall effects on physical growth and intellectual development of children, in addition to the effects appear in the long run some of the vital organs, but more importantly may have increased risk factors, that is prone to the development of secondary tumors is the tumor processor, where the proportion of the risk of a secondary tumor, ranging from 3% to 12% during the twenty years following the diagnosis and treatment of any kind of tumors of children, especially the risk of developing certain types of leukemia no leukemia.
And resulting complications and delayed effects on damaged tissue and the body's healthy cells as a result of various cancer treatments, from surgery and radiotherapy and the effects of certain categories of chemical drugs, in addition to marrow transplant bone marrow, and include the immediate factors leading to the injury of cells destitution, food and permanent damage to the cells of the different and the structure of tissues and organs, as well as the death of healthy cells, and despite the appearance of most of these complications as a result of receiving two treatments chemotherapy and radiation in particular, but the surgeries in turn may lead to the emergence of some of them later, especially in cases where conducted complicated surgeries and dilated included a swathe of the body.
As is known, responds to the body of every child with the processors in a manner and style special and unique, and also different patterns of response and reaction towards the tumor and therapies from child to child, as well as the command with the complications of treatment late, which is highly dependent on the type and style processors Received and dosage and periods of time, and of course increases risk in very young children, where they are most vulnerable to these complications as a result of exposure to disease and treatments strong during the early period of life, where the physical constitution is weak and still under the phases of different growth.
And as required to address tumors of children intensive care and specialized, so is the case with the late complications that may arise after the long years of the end of the treatments, with requiring follow-up alert and precise control in anticipation of the emergence of any of the symptoms, which will enable the distinguished early and then processed and management complexity.
In the following paragraphs we review the About the different aspects of the late complications of treatments of tumors.
Effects on the brain and central nervous system
Studies have shown a relationship between injection vaginalis (intrathecal) drug chemicals in the cerebrospinal fluid surrounding the spinal cord and brain, and the lack of educational capacity and vulnerability among children, and shows that are more common in children who received therapeutic doses age below the fifth age, and often become self-evident during periods ranging from two to five years after receiving treatment, and is particularly concentrated in children who were subjected to a common combination of chemotherapy and radiation therapy NA of the brain.
It appears this pattern of deficit which is known weakness of knowledge (cognitive impairment) is a traditional rates such as low IQ of about 10 to 20 points when testing the capacity of learning, in addition to the problems and other difficulties, including visual motor skills, poor memory, and dispersion or lack of attention and mental focus, and the weakness of non-linguistic skills such as mathematics, appears in particular when the NA received chemotherapy and radiation therapy in common, and although the doctors always try to minimize such effects to avoid giving the two treatments together, but it has been shown that injections NA alone can cause the occurrence in some cases.
As can radiation therapy, either alone or jointly with chemotherapy to affect the level of intelligence and cognition in children, especially those who are enacting the school and at the same pace, they could face the difficulties of the capabilities of learning and often language skills and memory, which can worsen over time, in addition to lethargy and reduced information processing speed and slow reactions, and it should be noted that this is inversely proportional to the age of the child, the more older when you receive treatment, the less damage can be done.
And the effects of radiation therapy task on the central nervous system in the long run a deficit in the growth hormones, which may lead to the small strength and short stature than normal, and children are treated with radiation therapy to the skull and spine before age five are more vulnerable to the risk of stunting , and is attributed to radiation damage effect on the hypothalamus hypothalamus any brain (hypothalamus) and is responsible for regulating growth, and may sometimes need to use hormonal Alaaadh give compensatory growth hormones to treat the case.
Effects on growth
The low frequency of natural growth through the processors tumors childhood from the usual problems, and may show a certain amount of delay for this rate is varies from child to child, and may be some effects, such as short stature, standing in some cases as a result of delayed natural growth, and in most cases, the effect of chemotherapy Babtaúh the pace of growth temporarily when given alone without radiation therapy, and then return most of the natural frequency of the patients in the end, but the effects of high doses of some drugs remain for a longer time.
Can radiation treatment to cause serious effects directly on the natural growth of bones and muscles that fall within the field of radiation, including radiation of the head, of course, which may slow the pace of this growth and development at any age, bones and soft tissues , muscles, blood vessels, is a tissue sensitive to radiation during the sessions of rapid growth, and so is the child at the age of less than five years or of passing phase of puberty, which is accelerating in some of the patterns of growth, more vulnerable to these effects, and add to the slow growth may shows something of the asymmetry growth of members, joints and problems with subsequent pain, and the emergence of what is known as the fragility and osteoporosis (osteoporosis), in addition to effects on the teeth and delayed growth, which in turn require special attention.
It should be noted that how the radiation affects the growth is still not understood precisely, and Perhaps the answer lies in how it would impact on the system, endocrine glands and body imbalance and functions secrete hormones, which is a system multi-faceted and complex the human body and easily influenced by treatments of tumors, as is well known, the endocrine glands, from which the thyroid gland and the adrenal gland and the ovaries, secrete hormones in the blood circulation, which in turn the search and stimulation of many of the physical functioning, such as motivating factors, puberty and fertility, and set the pace physical growth, and disruption and hamper the hormone system, (whether as a result of direct damage to the members of different, such as the testes or ovaries, or for part of the brain that controls the activities of the endocrine glands, which may be affected by radiation therapy to the head and neck), can develop complications of different , such as delayed puberty or the appearance of the signs early on at the time, and impaired fertility, and problems with growth retardation and delayed rates, combined with the effect on the structure of the bones and the height, and delay in achieving full attainment, and the usual appearance of such a low rate of growth clearly During the first five years after receiving treatment in most cases.
And may help Balaaadh hormonal replacement therapy, giving doses of growth hormones in the revocation, and deal with such harmful complications of radiation therapy, but it should of course consider this option very carefully into account when rehabilitated, and the need to investigate the extent and consequences of use.
And in this regard it is useful to note the thyroid gland and its potential complications, as they are more at risk of vulnerability as a result of radiation therapy for head and neck, the occurring bug hyposecretion thyroid (Hypothyroidism), where you can thyroid secretion of quantum enough thyroid hormone, and that symptoms of fatigue and extreme tiredness and dry skin, weak hair, and can show bug hyperactivity thyroid (Hyperthyroidism), and that was rare, which arise as a result of increased secretion of the thyroid gland, which calls for the need for annual inspection of the functions of the thyroid during the ten subsequent years of the end of treatments of tumors, to investigate such complications and the use of hormonal alternatives if needed.
Complications of vision and hearing
May be affected by the capacity optical in several ways as a result of treatments, especially when there is tumor position comes into contact with the eyes or close to it, as some drugs, toxic effects on the eyes and may lead to the emergence of the complexities of different, and if temporary, such as blurred vision and duplication and the emergence of bug water blue (glaucoma), and that radiation therapy directed to the eye area may cause illness cataracts or bung eye (cataracts), in addition to the radiation, when projected on the bones near the eyes, may cause weakness and shortcomings their growth, leading to distortions growth of the face may does not seem clear in some cases.
Some can also cause cancer of the processors in the emergence of problems and has audio capabilities of the hearing during the later periods after the treatments, for example, drugs can chemical compounds of the platinum group, such as real estate cisplatin (cisplatin) and carboplatin
(Carboplatin) to cause damage Balsairat sensory inner ear, leading to a loss of sensory hearing, while it can occur the same complications when receiving radiation therapy to the head, especially if directed at the brain stem or the ears, in addition to the emergence of deafness, conductive (conductive hearing loss) resulting the accumulation of wax or fluid or the emergence of infections or an ear sclerosis, Central State, and the surgical work, in turn, may lead to complications arise when a hearing of the brain or ears or auditory nerves associated with placements.
It should be noted that the support of some medicines may affect the audio capabilities and can increase the complications of chemical drugs on the hearing, and examples of some antibiotics such as Jintamaysan (Gentamicin) and Topramaysan (Tobramycin) and some types of diuretics such as Allaseks (Lasix) or Ydikeraan (Edecrin).
And so it is very important to conduct periodic tests of the capabilities of visual and audio while receiving treatment and for years after its completion, to investigate such effects, which will make it possible to change or modify treatment plans early to avoid disadvantages, and it may become necessary, of course, recommend some processors have some cases, such as removing bung eye or the use of glasses or the use of audio devices.
Effects of reproductive organs and sexual development
Males:
Of Alajan chemotherapy and radiation the ability to reduce sperm production, and of radiation doses low, and some types of drugs, chemicals, when given a single temporary impact on production rates, while the radiation doses high and many of the plans of chemotherapy-intensive to a lack of a permanent and final, and deficiency affects rates of sperm production negatively, of course, on fertility and the ability to have children, and this is important is taken into account before the direct processors of cancer in adolescents, can be thought of in terms of keeping sperm banks so that the members of the patient from having children later artificial means.
It was observed that young children who have received treatments of tumors in ages far from the age of puberty are less likely to have a deficit in the production of sperm, and in general, and for many can not predict definitively the extent of affected processors tumors and are on their way to the stages of puberty, and has been proven in some cases, lower production rates Almnuyat happen temporarily, rising rates of the census to normal levels after the lapse of 15 years from the end of the processors.
On the other hand can show other complications as a result of receiving radiation therapy to the brain, including a change in the levels of male hormone the main testosterone (Testosterone), which leads to delays or the inability to complete the stage of puberty, or the appearance of signs of precocious puberty, in addition to the possibility of a sexual dysfunction and depression desires and bug impotence, and can achieve positive results and monitor these changes carefully monitored and treatment effects early.
In females,
Disrupted the functions of the ovaries as a result of the effects of radiation therapy to the cavity, the abdominal and chemotherapy, and may vary the extent of this dysfunction largely on age and stage of puberty at diagnosis and during treatment, and noted that girls who did not arrive at adulthood when you receive treatment are less vulnerable to the emergence such disorders, and obviously that is the protection of the ovaries when the radiation to the abdominal cavity is necessary, as it's in addition to its effect on the properties of eggs and its sound, weakens the ability of the uterus to carry the eggs as normal through the stages of pregnancy and until it ends.
As can radiation therapy to the brain that affects the hormones necessary for the functions of the ovaries, and these effects in turn lead to irregular menstruation, and changes in the stages of the production of eggs, in addition to early puberty.
And with some types of chemical drugs to allow normal growth, progress and stages of puberty, and perform the functions normally after the treatments, but the risk of complications of chemotherapy remain, and are included delayed menopause and early menopause and impaired fertility.
Reproduction:
It is natural to feel sick children with cancer treatments after the end of many concerns regarding the extent of their ability to reproduce in the future, and how the ability to keep the baby and the continuation of pregnancy until birth, and then to have offspring together and in good health, and although most of them are able to have children healthy and without complications but the risks remain, which can be of poor fertility and early menopause and complications therapeutic effect on the stages of pregnancy and childbirth, and may have conditions more favorable for pregnancy during the early years of young people to enhance opportunities for successful pregnancy, and are advised to always seek independent advice medical specialist on the reproductive and genetic characteristics at the initiation of a family.
On the other hand are still studies underway to monitor the development of embryos and the risk of congenital anomalies of potential at the atomic survivors of cancer, and so far did not prove the results of recent studies and a strong relationship between the two, ie, treatments and risks, although many of the plans treatment may include the use of several drugs, doses and has not been proven to be safe on the children's future atomic therapists.
Effects on the heart and cardiovascular system (Cardiovascular System)
Linking research between drugs chemical known category Alantraschaelin (anthracyclines) and a reduction in the functionality of the heart and cardiovascular following the end of treatments of tumors, and with that of some other types of risks to cardiovascular (cardiovascular) but they are not the same level of impact, and radiation therapy to the chest area is also considered a risk to the heart, and of course contribute to many factors in determining the proportion of risk, such as doses total received, and the channels of the injection and the type of property and the child's age when you receive treatments, and longer care for careful monitoring the effectiveness of the heart in the performance of the functions of the matters very important, given the lack of symptoms diagnostic benchmark, and can not investigate the complexities and problems can exist only conducted tests of the heart, such as echocardiography (echocardiogram) using ultrasound, and conduct periodic examinations, in order to detect any potential complications early and then treated if needed.
It should be noted that clinical studies are still ongoing to investigate the extent of benefit of medications that have been shown to protect the heart and prescribed for adults who receive a similar course of chemotherapy, which may be useful to the children equally.
Effects on the respiratory system
Are disorders of respiratory problems typical in children who received radiation therapy to the chest wall, which include decreasing the size of the lungs, and fibrosis of lung tissue (fibrosis), (and used this treatment in particular when dealing with tumors, Hodgkin's, and the cases that have evolved have secondary tumors of the lung moved elsewhere), and complications are also expected emergence of inflammatory lung tissue or lung illness with (pneumonitis), and that the initial symptoms of dry cough and difficulty breathing, and complications can become more severe when combined radiation therapy and some types of chemical drugs, which can cause such complications, such as real estate Bleomaesen (bleomycin), and is worth mentioning that the complexity of the respiratory system can occur many years after the end of the treatments, and is usually used to appear during the initial period of the year to biennium.
And of course there are treatments available to help alleviate the symptoms of pneumonia (pneumonitis) in addition to the problems of cirrhosis of the tissue (fibrosis), and helps to follow closely and carefully identify patients most vulnerable to the emergence of these effects, and thus make some special tests have periodically In addition to consulting a specialist doctor for periodic lung disease.
About the emergence of secondary tumors
The survivors of cancer in general more vulnerable to the risk of secondary tumors in their future life, and the extent of which varies from child to child, and they are more likely to develop tumors that appear in adults is usually the more progress they age, and adopt the proportion of risk, of course, on many factors, the most important type of tumor the original processor, and the type of treatments received, (for example, show a higher proportion of the development of secondary tumors placements radiation in the use of radiation therapy), in addition to genetic factors, the effects of aging and living conditions of different, and environmental conditions, and personal factors of each child.
As noted above, the proportion of risk and vulnerability of the development of secondary tumor is the original tumor wizard after periods varying between 3% to 12% during the twenty years following the diagnosis and treatment of any of the types of tumors of childhood, according to some medical reports about the possibility of the emergence of leukemia, acute myeloid in children who received doses of intensive chemotherapy for the treatment of various tumors, especially the treatment of leukemia lymphoma, acute and noted in this regard that they usually arise in three years on average after the diagnosis of leukemia, lymphoma, and some studies suggest a strong link between the emergence of leukemia, acute myeloid and between the use of high doses and for long periods of Aitoboseid drugs (Etoposide) and Saakulovosvamaid (Cyclophosphamide), which also believes there is a connection between him and the development of secondary cancer of the bladder during the later years in some cases.
On the other hand according to some medical reports about the danger of the emergence of secondary brain tumors when you receive radiation therapy to the skull (cranial radiation) especially if used in children less than age five years, and are gliomas
(Gliomas) of the most common types of brain tumors can be detected, as reported on the risk of developing thyroid cancer (thyroid cancer) radiation at the neck, especially when dealing with Hodgkin's tumors.
Has reported the results of one of the medical studies that included 9100 children, survivors, and which aimed at exploring the evolution of the types of bone tumors in the survivors, that the risk of developing tumors of bone Algarnih (Osteosarcoma) reached 2.8% when the cases surveyed, and focused the ratio of the therapists tumors Jveat retinal inherited (hereditary retinoblastoma), reaching 14.1%, and the therapists from the Group of tumors Ewing's where the percentage of 22.1%, and the study indicates that the proportion of risk concentrated among patients treated with high doses of radiation therapy and intensive use of drugs, chemical class elements alkylation (alkylating agents) but not others (1).
And concludes another study, common to several specialized medical centers that the proportion of risk for the emergence of secondary tumors in children treated successfully reached 9.2% during the next twenty years after the diagnosis of the original tumor and treatment, and the percentage of tumors Algarnih (Sarcomas) high around 6.5% and did not develop any of the therapists doses of radiation therapy reduced (2).
And linking many of the medical studies dilated between receiving radiation therapy to the entire body (Total-body irradiation), and used especially when the configurations of the marrow transplant bone marrow, and between the development of tumors of a solid secondary, and found one that the rate of approximately 8.3% in 13 years from the end of treatment (3).
Medical care
Continue to follow-up medical minute, and continued for several years after the end of the processors tumors of children from aspects of the very important and necessary in the treatment of cancer, and should be regular check-ups on a permanent basis in case of any complications, and of course will doctors monitoring cautious for signs of tumor recurrence during these tests, in addition to investigate the effects of treatments, both in the short term or long term, and these complications vary, no doubt from child to child, and vary according to treatments and treatment plans.
And it's important to take comprehensive treatments received by the child, and their impact on the final outcome on the various aspects of his life and grow up and is moving towards maturity, which may delay the emergence of many of the effects of physical, psychological, and emotional child, and of course it is very important to consult with medical team about what to expect from the effects of long-term based on the treatment plan for children.
The topics related to emotions and feelings may appear later in order to impact on all stages and levels of maturity and adulthood, and although most of the children of survivors coping well with the conditions of daily life and activities, and integrate into society as normal, but the real impact because they are living Knagan of cancer remains a need for more understanding, it is not easy to adapt to the lifestyle of a strict hand, taking into account the health controls imposed on them, and fear of the return of cancer, and meet the requirements of life, and building social relationships and marriage and a family, in addition to facing discrimination among their peers or discrimination in working conditions and quality, or feeling, and the disagreements and lack of symmetry and so on.
In spite of the late complications of processors tumors may cause a problem in turn later in the stages of life, but statements that try as a result of treatments successful saved many lives from the clutches of disease was considered incurable, and inextricably, and still studies going on all over the world, to find ways and ways to minimize these effects and complications and treatment, if not avoided entirely.
