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 sec- tions below explains problems that may arise from different cancer treatments.
RADIATION EFFECTS Children who receive radiation to the brain, abdomen, pelvis, lower spine, or those who receive total body irradiation (TBI) are at the highest risk for fertility problems. The dose of radiation that causes infertility is different for all children because it depends on the child’s age and other treatments the child receives. HEAD AND TBI Radiation given directly to the brain can cause damage to the pituitary gland that makes hormones that tell the testes to make sperm and are necessary for fertility. TBI damages the pituary gland, as well as the testes. Therefore, TBI affects hormone production in both the brain and the testes. Boys who are treated for a brain tumor may have radiation directly to the brain and will be at the highest risk for both infertility (no sperm) and damage to the cells responsible for making testosterone. Brain tumors are typically treated with very high doses of radiation to the tumor itself or the brain after the tumor is removed to prevent the tumor from returning. Doses over 40 Gy used to treat brain tumors will prevent the brain from sending signals to the testes to produce testosterone. Radiation to the eye, brain, or ears in high doses (> 18 Gy) may affect pubertal devel- opment, and boys who receive radiation to the head may start puberty early. PELVIC RADIATION Males who receive radiation directly to the pelvic region or lower abdomen, including the testes, may also have delayed puberty, precocious or early puberty (puberty that occurs before age 9 in boys), and arrested or stopped puberty. TESTICULAR RADIATION Testicular radiation will almost always affect sperm production but the extent of the impact will depend on the total dose of radiation to the testes and the age of the patient when radiation is given.
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