| Investigation |
Important aspects: |
| History |
General:
- Current health, energy level, appetite, any new symptoms
- Social/employment situation
- Life style: smoking, alcohol and recreational drug history, exercise
- Current medications
- List of physicians/HCPs following patient
|
After cranial RT, ask about:
|
After spinal RT also check:
|
| Examination |
Always Check:
- Blood pressure
- Weight and height (Body Mass Index)
- Scalp for alopecia/thinning of hair within previous RT field
- Scalp skin for skin cancers (e.g. basal cell carcinoma and rarely melanoma)
- Examine neck to exclude thyroid nodules
- Visual acuity, visual fields, signs of Parinaud's syndrome and fundoscopy
- General examination of respiratory, cardiovascular and GI systems
|
After spinal RT also check:
|
| Neurocognitive testing |
- If there are problems like a poor short term memory, it may be important to document higher mental function formally to obtain vocational or recreational rehab & to be eligible for a disability pension
|
| Blood work |
|
After chemotherapy also check:
- Serum magnesium and phosphate (chemotherapy related renal damage)
|
| Radiology screening |
- MR of the head at least every 3 years or so in long term follow up to exclude RT induced meningiomas
- Ultrasound scan of the thyroid every 3 years after cranial and craniospinal RT to exclude thyroid carcinoma
- Also excludes late tumor recurrence
|
Specialist
follow-up |
Patient should be assessed by specialists in the following fields every 1 - 2 years:
- Endocrinology
- Ophthalmologist/Neuro-ophthalmology
|
| Hearing assessment |
- Referral to an audiologist every 1 - 2 years for audiology testing
|
| Supportive care |
- Family counselling
- Psychology
- Psychiatry
|
| Other screening |
After spinal RT there is an increased risk of secondary malignancy
- Patient should have early screening for colon cancer COG recommends that colonoscopy should be performed beginning at age 35 years or 10 years following
RT (whichever occurs last)
- Increased risk of skin cancer within previous RT field
|
Early screening for osteoporosis (bone density)
|
| Advice |
ACTH deficiency:
- Survivors of pineal tumors are at risk for hypopituitarism and ACTH deficiency. During infection, surgery and illness survivors of pineal tumors may need support with extra steroid medication.
- Medic Alert bracelets are advised to warn about ACTH deficiency
|
Lifestyle:
- Advise about diet, exercise and lifestyle choices (such as smoking) which may further increase the risk of vascular disease
- Avoid sunburn, use sun screen and wear a hat in bright sunlight to protect skin
|
Second malignant neoplasms (SMNs):
The patient should be advised to seek immediate medical help if:
- A new
swelling (painless or painful) appears within the previous RT field as this may
be due to a SMN
- Severe, persistent headaches develop associated with possible nausea and vomiting (may be associated with a new intracranial mass lesion)
|
Patient Information
Children's Oncology Group
long term follow up guidelines: |
|
