Respiratory
Introduction
Treatment of childhood cancer is associated with an increased risk of acute or chronic damage to the lungs, pulmonary vasculature and thoracic structures.
The childhood cancer survivor study is a multi institutional study of survivors of childhood cancer diagnosed between 1970-1986. Data was collected from the subjects by questionnaire and their treatment was abstracted from their medical records. Information from patients was compared with their siblings. Mertens et al reported on pulmonary complications from this cohort in 2002.
Overall the risk of pulmonary problems in the survivors was more than 3 times that of their siblings. There was a statistically significant increased incidence of lung fibrosis, recurrent pneumonia, chronic cough, pleurisy, use of supplemental oxygen, abnormal chest wall, exercise induced shortness of breath, bronchitis, recurrent sinus infections and tonsillitis.
Damage to many different structures contribute to respiratory problems:
Lungs (Pulmonary):
- Underlying disease
- Chemotherapy
- Radiation therapy (RT)
- Surgery
- Chronic graft versus host disease (GVHD)
- Infection
Chest wall:
Deformity and restrictive defect secondary to
- Underlying disease
- Surgery
- RT leading to under-development and abnormal growth (hypoplasia)
Airways:
Deformity and narrowing secondary to:
- Underlying disease
- RT leading to under-development
