Potential side effects of chemotherapy for childhood brain and spinal cord cancer
Side effects can occur with any type of treatment for childhood brain and spinal cord cancer, but not every child has them or experiences them in the same way. Side effects of chemotherapy will depend mainly on the:
- type of drugs
- length of treatment
Chemotherapy kills cancer cells, but it can also damage healthy cells. Different cells and tissues in the body tolerate chemotherapy differently.
Side effects can happen anytime during chemotherapy. Some may happen during, immediately after, or a few days or weeks later. Most side effects go away after chemotherapy is finished. Late side effects can occur months or years later. Some side effects may last a long time or become permanent.
Children may react differently to chemotherapy. It is difficult to say exactly which side effects a child will experience, how long they will last and when the child will recover.
It is important to report side effects to the healthcare team. Doctors may also grade (measure) how severe certain side effects are. Sometimes chemotherapy treatments may need to be adjusted if side effects are severe.
Not all chemotherapy drugs cause nausea and vomiting. Individual drugs vary in their effects, but nausea and vomiting are more likely when combinations of chemotherapy drugs are given.
Nausea and vomiting can occur within the first few hours after chemotherapy drugs are given and usually last about 24 hours. However, delayed nausea and vomiting may continue for a few days after treatment. Some children may have anticipatory nausea after having a few treatments, where they feel nauseous even before treatment is given because they expect to be sick.
Hair loss (alopecia) is a common side effect of many, but not all, chemotherapy drugs. Hair follicles are vulnerable to chemotherapy drugs because they grow fast. The extent and duration of hair loss is unpredictable because it depends on the type and dose of drugs used as well as personal factors. Hair loss can occur on all parts of the body, including the face and scalp. Hair loss can begin with a few days or 2–3 weeks after chemotherapy starts. The child’s hair usually grows back once chemotherapy treatments are over.
Bone marrow suppression is a condition in which one or more of the main types of blood cells are decreased.
- A low white blood cell count (neutropenia or leukopenia) increases the risk for infection.
- A low platelet count (thrombocytopenia) increases the risk for bruising and bleeding.
- A low red blood cell count (anemia) causes fatigue, paleness and malaisemalaiseA general feeling of discomfort or illness..
Low blood cell counts occur because of chemotherapy's effect on the bone marrow, where blood cells are made. Blood cell counts often reach their lowest level about 7–14 days after chemotherapy. Bone marrow suppression is the most common and most serious side effect. When it happens, the dose of chemotherapy is adjusted right away or chemotherapy may have to be stopped temporarily.
A sore mouth (also called stomatitis or oral mucositis) occurs because of chemotherapy's effect on cells inside the mouth. Many drugs can cause a sore mouth and it occurs more often when higher doses of drugs are used. A sore mouth occurs within 1–2 weeks after the child’s chemotherapy is started. It often improves on its own a few weeks after treatment is finished.
Painful mouth sores, ulcers in the mouth and mouth infections can also develop. Thorough, regular mouth care can help prevent a sore mouth and reduce infection. The healthcare team will give instruction about how often to clean and rinse the mouth and what to use. Pain medications or special oral solutions may be needed to relieve pain.
Nausea and vomiting, fatigue or a buildup of waste products as cancer cells die can cause loss of appetite. Some chemotherapy drugs can cause temporary changes in taste and smell, which can make foods seem less appetizing. Some children lose interest in food completely and don't eat, even though they know they need to. This can lead to weight loss and malnutrition. Maintaining good nutrition during and after chemotherapy is important to help a person recover from treatment.
Diarrhea is an increase in the number and looseness of stools. It occurs because chemotherapy drugs often affect the cells that line the gastrointestinalgastrointestinalReferring to or having to do with the digestive organs, particularly the stomach, small intestine and large intestine. tract. Many factors increase the risk of diarrhea, including the type and dose of chemotherapy drug used. Diarrhea is often worse when combinations of drugs are given. Diarrhea occurs soon after chemotherapy starts and can continue for up to 2 weeks after treatment has ended.
Constipation is when stools become hard, dry and difficult to pass. Many factors increase the risk of constipation, including the type of chemotherapy drug used (particularly vinca alkaloids, such as vincristine or vinblastine), medications given with chemotherapy to relieve nausea and vomiting, and decreased fluid intake. Constipation usually occurs 3–7 days after the chemotherapy drug is given.
Fatigue makes a child feel more tired than usual and can interfere with daily activities and sleep. It occurs for a variety of reasons. Fatigue may be caused by anemia, specific drugs, poor appetite or depression. It may also be related to toxic substances that are produced when cancer cells break down and die. Fatigue can occur within days after a chemotherapy treatment cycle and can continue long after the child has finished their cancer treatment. It will get better as time goes by.
Nerve damage, particularly the peripheral nerves, may occur with certain chemotherapy drugs. Numbness, tingling or a burning sensation in the hands or feet, muscle weakness and altered reflexes are signs of peripheral nerve damage.
Nerve damage is often related to the dose and type of the chemotherapy drug given (especially vinca alkaloids, platinum drugs and taxane drugs). Many children experience some degree of nerve damage after chemotherapy. Nervous system damage can develop months or years after treatment and may take months to go away. In a few children, it can become a long-term problem.
Hearing loss (also called ototoxicity) may occur if the child receives certain chemotherapy drugs, such as cisplatin, carboplatin or ifosfamide. Hearing loss may be more pronounced if chemotherapy is combined with radiation to the brain. It occurs because these treatments damage the tiny hair cells within the ear. These hair cells are responsible for processing sound waves in the inner ear (cochlea). The blood supply to the inner ear may also be damaged, which can affect hearing. Hearing loss usually occurs in the high-frequency range and will depend on the dose of chemotherapy drugs given. Hearing loss is irreversible and will become a long-term problem.
Some chemotherapy drugs can damage the kidneys. Kidneys break down and remove some chemotherapy drugs from the body. When chemotherapy drugs break down, they make products that can damage cells in the kidneys, ureters and bladder.
Kidney damage is often related to the amount and type of chemotherapy drugs used. Symptoms include headache, weakness, increased blood pressure, decreased urination and edema (swelling or puffiness) in the hands, feet or other areas of the body. These symptoms can occur during chemotherapy treatment and may be temporary or become permanent. Kidney damage may be mild to severe. If severe, it could lead to kidney failure.
Allergic reactions are not a common side effect of chemotherapy, but they can happen. Allergic reactions are most likely to occur when drugs are given intravenously. They usually happen shortly after the drug is given. Although any drug can cause an allergic reaction, some chemotherapy drugs are more likely than others to cause allergic or hypersensitivity reactions.
Some chemotherapy drugs or combinations of drugs can damage the ovaries or testicles and affect a person's ability to have a child. The type of drug, the dose and whether one drug or a combination of drugs is used will influence chemotherapy's effect on fertility.
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