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Late Effects of Pediatric Cancer Therapy
Jill P. Ginsberg, M.D., is an assistant professor of pediatrics at the University of Pennsylvania Medical School and an attending physician at the Children's Hospital of Philadelphia. Here, she discusses the types of pediatric cancer and their survival rates, therapies, and side effects. The author notes that three out of four children with cancer survive into adulthood so more attention is being paid to long-term effects of cancer therapy in children. These effects may include organ dysfunction, second malignancies, impaired fertility, and psychosocial problems in childhood cancer. She cites the Children's Oncology Group's guidelines for the continuing care of childhood and adolescent survivors. The lecture details the growth effects, mainly radiation-induced, including hypoplasia, decreased bone mass, and vascular necrosis, that can occur in pediatric cancer patients. In young males, chemotherapy-induced Leydic cell failure can lead to androgen insufficiency, and even low doses of radiation can suppress spermatogenic capacity. In young females, chemotherapy and radiation may produce ovarian failure. Other late effects include cardiac toxicity likely caused by doxorubicin, daunomycin, idarubicin, and epirubicin ... and pulmonary, thyroid, and gastrointestinal involvements. Secondary neoplasms, says the author, are now the leading cause of death in long-term survivors and include cancers of the breast, skin, thyroid, and bone. The lecture concludes with a discussion of such surgical effects as splenectomy, nephrectomy, amputation and enucleation as well as the psychosocial effects that include posttraumatic stress symptoms and suicide symptoms. |
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