Testicles

Testicular late effects are more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause testicular late effects:

• Acute lymphoblastic leukemia (ALL).
• Hodgkin lymphoma.
• Osteosarcoma.
• Sarcoma.
• Testicular cancer.
• Wilms tumor.
• Cancers treated with total-body irradiation (TBI) before a stem cell transplant.

Surgery, radiation and certain chemotherapy drugs increase the risk of late effects that affect the testicles.

The risk of health problems that affect the testicles increases after treatment with one or more of the following:

• Surgery, such as the removal of a testicle, part of the prostate, or lymph nodes in the abdomen.
• Chemotherapy with alkylating agents, such as cyclophosphamide, procarbazine, and ifosfamide.
• Radiation therapy to the abdomen or pelvis.
• Total-body irradiation (TBI) before a stem cell transplant.

Late effects that affect the testicles may cause certain health problems.

Late effects of the testicles include the following:

• Low sperm count: A zero sperm count or a low sperm count may be temporary or permanent. This depends on the radiation dose and schedule, the area of the body treated, and the age when treated.
• Infertility: The inability to father a child.
• Retrograde ejaculation: Very little or no semen comes out of the penis during orgasm.

Ovaries

Ovarian late effects are more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause ovarian late effects:

• Hodgkin lymphoma.
• Cancers treated with total-body irradiation (TBI) before a stem cell transplant.

Radiation to the abdomen and certain chemotherapy drugs increase the risk of ovarian late effects.

The risk of ovarian late effects may be increased after treatment with any of the following:

• Chemotherapy with alkylating agents, such as cyclophosphamide, mechlorethamine, cisplatin, ifosfamide, lomustine, and especially procarbazine.
• Radiation therapy to the abdomen or pelvis. In survivors who had radiation to the abdomen, the damage to the ovaries depends on the radiation dose, age at the time of treatment, and whether all or part of the abdomen received radiation.
• Radiation therapy to the abdomen or pelvis together with alkylating agents.
• Radiation therapy to the brain and spinal cord.
• Total-body irradiation (TBI) before a stem cell transplant. In survivors who had TBI, the damage to the ovaries is greatest in survivors who had not reached puberty at the time of treatment.

The risk may also be greater in survivors who were age 13 to 20 years at the time of treatment.

Late effects that affect the ovaries may cause certain health problems.

Ovarian late effects include the following:

• Early menopause, especially in women who were treated with both an alkylating agent and radiation therapy to the abdomen.
• Changes in menstrual periods.
• Infertility (inability to conceive a child).
• Puberty does not begin.

Possible signs of ovarian late effects include irregular or absent menstrual periods.

These symptoms may be caused by ovarian late effects:

• Irregular or no menstrual periods.
• Hot flashes.
• Night sweats.
• Trouble sleeping.
• Mood changes.
• Lowered sex drive.
• Vaginal dryness.
• Inability to conceive a child.
• Sex traits, such as developing arm, pubic, and leg hair or having the breasts enlarge, do not occur at puberty.
• Heart disease.
• Osteoporosis (weak or thin bones that can break easily).

Other conditions may cause the same symptoms. Talk to your child's doctor if your child has any of these problems.

Fertility and reproduction

Treatment for cancer may cause infertility in childhood cancer survivors.

The risk of infertility increases after treatment with the following:

• In boys, treatment with radiation therapy to the testicles.
• In girls, treatment with radiation therapy to the pelvis, including the ovaries and uterus.
• Radiation therapy to brain and spinal cord or lower back.
• Total-body irradiation (TBI) before a stem cell transplant.
• Chemotherapy with alkylating agents, such as cyclophosphamide and procarbazine.
• Surgery, such as the removal of a testicle or an ovary or lymph nodes in the abdomen.

Childhood cancer survivors may have late effects that affect pregnancy.

Late effects on pregnancy include increased risk of the following:

• High blood pressure.
• Miscarriage or stillbirth.
• Low birth-weight babies.
• Early labor and/or delivery.
• Delivery by Cesarean section.
• The fetus is not in the right position for birth (for example, the foot or buttock is in position to come out before the head).

There are methods that may be used to help childhood cancer survivors have children.

The following methods may be used so that childhood cancer survivors can have children:

• Freezing the eggs or sperm before cancer treatment in patients who have reached puberty.
• Testicular sperm extraction (the removal of a small amount of tissue containing sperm from the testicle).
• Intracytoplasmic sperm injection (an egg is fertilized with one sperm that is injected into the egg outside the body).
• In vitro fertilization (IVF) (eggs and sperm are placed together in a container, giving the sperm the chance to enter an egg).

Children of childhood cancer survivors are not affected by the parent’s previous treatment for cancer.