• ovarian dysfunction • premature ovarian failure or menopause • infertility • inability to carry a pregnancy to full term. Each child is different and each may respond to cancer treatment differently. Not all survivors will develop these problems. The types of problems that can develop after cancer treatment
depend on the types and doses of chemotherapy, radiation, and surgery a child receives. The sections below will explain which types of treatments may cause these problems. RADIATION EFFECTS Children who receive radiation to the brain, abdomen, pelvis, lower spine, as well as those who receive total body irradiation (TBI), are at the highest risk for fertility prob- lems. The dose of radiation that causes infertility is different for all children because it depends on the age of the child, and other treatments they receive. HEAD AND TBI Radiation given directly to the brain can cause damage to the pituitary gland. The pituitary gland makes hormones that signal the ovaries to make the hormones estro- gen and progesterone. If the pituitary gland is damaged, the signals to the ovaries will be affected and the ovaries will not make the right amounts of hormones. This will impact puberty and fertility. Females who receive TBI will also have damage to their pituitary gland. Radiation to the brain can cause delayed, precocious, or arrested puberty in females. Doses greater than 30 Gy are likely to make it difficult for a woman to become preg- nant. RADIATION TO FEMALE REPRODUCTIVE TRACT Radiation to the pelvis, abdomen, or spine may damage the uterus or ovaries. Radiation to the uterus can make it more difficult for a woman to carry a pregnancy and increase the risk for miscarriage, premature birth, or having a baby with a low birth weight. Women may also have irregular periods or no periods after receiving radiation to the uterus. Radiation to the uterus may decrease blood flow. The uterus becomes less elastic and may not be able to grow during pregnancy, preventing a woman from being able to carry a child to full term (9 months). Women receiving
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