Central Nervous System
Assessment and Monitoring
It is recommended that survivors of childhood cancer have yearly re-evaluations with their HCP for chronic health problems.
Screening for late CNS problems should include a history to ascertain if there are any symptoms of:
- Headaches (migraine/ new onset)
- Short term memory problems
- Seizure type episodes
- Transient neurological dysfunction (TIAs)
- Visual changes
- Diplopia
- Visual loss
- Hearing loss
- Depression
- Lethargy and lack of energy
Physical examination should assess:
- Neurological function
- Mental status
- Visual function
- Cranial nerve function
- Fundoscopy
- Gross motor/sensory function
- Other organs potentially affected by therapy:
- Palpation of thyroid
- Examination of spine (craniospinal RT associated with scoliosis)
Investigations should include:
- Routine blood work
- Including:
- CBC reticulocytes and platelets
- Lytes, creatinine and BUN
- Tests for endocrine dysfunction
Endocrine dysfunction:
- Cranial radiation therapy (RT) is associated with an increased risk of endocrinopathy.
- Any patient who has had high dose cranial RT previously for a brain tumor should have periodic evaluation by an endocrinologist for pituitary dysfunction and hypothyroidism.
- Low dose cranial RT for leukemia is less likely to be associated with pituitary dysfunction, but there is still a significant risk of hypothyroidism and thyroid nodules
- Every year blood work should be drawn to check the levels of different hormones
- Thyroid function (T4, T3 and TSH)
- Pituitary function
Second Neoplasm
- Patients who have had cranial RT are at significantly increased risk for the development of a meningioma. It is prudent to perform MR brain scans on asymptomatic patients every 3 years to exclude this complication.
- Any cranial RT is also associated with an increased risk of thyroid nodules and cancer. Recommendations are to examine the thyroid every year and to perform an ultrasound scan of the thyroid every 3 years.
- A malignant second neoplasm would be difficult to detect using routine screening. Patients should be aware that if they have any new symptoms (such as headache) they should contact their health care practitioner immediately.
Neurocognitive Problems:
- If there are serious problems with short term memory and executive function, the patient should be seen in consultation by a psychologist for neurocognitive testing
- Links:
Example:
Here is a PDF (which can be printed) giving an example of the type of follow up necessary for a long-term survivor of medulloblastoma:
