Childhood cancer survivors can be at risk for developing the following renal and genitourinary late effects:
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Bladder Dysfunction
-
Bladder Fibrosis
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Hemorrhagic Cystitis
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Urinary Tract Toxicity
-
Vesicoureteral Reflux (VUR)
-
Dysfunctional Voiding
-
Chronic Urinary Tract Infections
-
Renal Toxicity
-
Glomerular Injury
-
Tubular Injury
-
Renal Insufficiency
-
Proteinuria
-
Hyperfiltration
-
Hypertension (HTN)
-
Hydronephrosis
-
Hydrocele
-
Incontinence/Neurogenic Bladder
-
Genitourinary Dysfunction
For Gonadal late effects visit the Ovary/Testis Quick Fact:
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Gonadal Dysfunction
-
Uterine Vascular Insufficiency
-
Sexual Dysfunction
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If your patient does not have a Survivor Health Plan (SHP), please refer
him/her to the appropriate survivor clinic.
Important factors in determining risk for pulmonary late effects:
·
Age at treatment
·
Time since treatment
·
Total dose of radiation
·
Total dose of chemotherapy
·
Retroperitoneal node dissection
·
Single kidney
·
Bilateral Wilms tumor
·
WAGR syndrome
·
Denys-Drash syndrome
·
Chronic graft-vs-host disease
·
Hypospadias
·
Cryptochidism
·
Diabetes mellitus
·
Alcohol use
·
Hypertension
·
Smoking
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Chemotherapy
Table 1
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Bladder Dysfunction
|
Urinary Tract Toxicity
|
Renal Toxicity
|
Hypertension
|
Hydronephrosis
|
Hydrocele
|
Incontinence
|
GU Dysfunction
|
Alkylating Agents
Carmustine
BCNU
Busulfan
Lomustine
CCNU
Chlorambucil Cyclophosphamide
Cytoxan
Ifosphamide
Mechlorethamine
Melphalan
Procarbazine
Thiotepa
Dacarbazine
DTIC
Temozolomide
|
X
Cyclophosphamide and Ifosphamide only
|
X
Cyclophosphamide and Ifosphamide only
|
X
Ifosphamide only
|
|
X
Cyclophosphamide and Ifosphamide only
|
|
|
|
Heavy Metals
Carboplatin
Cisplatin
|
|
|
X
|
|
|
|
|
|
Antimetabolites
Cytarabine
Ara-C
Mercaptopurine
6MP
Thioguanine
6TG
Methotrexate
|
|
|
X
Methotrexate only
|
|
|
|
|
|
Anthracycline antibiotics
Daunorubicin
Doxorubicin
Adriamycin
Epirubicin
Idarubicin
Mitoxantrone
|
|
|
|
|
|
|
|
|
Chemotherapy
Table 2
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Bladder Dysfunction
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Urinary Tract
Toxicity
|
Renal Toxicity
|
Hypertension
|
Hydronephrosis
|
Hydrocele
|
Incontinence
|
GU Dysfunction
|
Anti-tumor antibiotics
Bleomycin
Dactinomycin
|
|
|
|
|
|
|
|
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Corticosteroids
Dexamethasone
Decadron
Prednisone
|
|
|
|
|
|
|
|
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Enzymes
Asparaginase
|
|
|
|
|
|
|
|
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Plant alkaloids
Vincristine
Vinblastine
|
|
|
|
|
|
|
|
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Epipodophyllotoxins
Etoposide
VP16
Teniposide
VM26
|
|
|
|
|
|
|
|
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Radiation
|
Bladder Dysfunction
|
Urinary Tract Toxicity
|
Renal Toxicity
|
Hypertension
|
Hydronephrosis
|
Hydrocele
|
Incontinence
|
GU Dysfunction
|
All Radiation
|
|
|
|
|
|
|
|
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TBI
|
|
|
X
|
X
|
|
|
|
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Head/Brain
|
|
|
|
|
|
|
|
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Neck
|
|
|
|
|
|
|
|
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Thorax
|
|
|
|
|
|
|
|
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Abdomen
|
> 30 Gy
Include TBI in total dose calculation
|
> 30 Gy
Include TBI in total dose calculation
|
X
|
X
|
> 30 Gy
Include TBI in total dose calculation
|
|
|
Vaginal Fibrosis/
Stenosis
|
Pelvis
|
> 30 Gy
Include TBI in total dose calculation
|
> 30 Gy
Include TBI in total dose calculation
|
|
|
> 30 Gy
Include TBI in total dose calculation
|
|
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Vaginal Fibrosis/
Stenosis
|
Extremity
|
|
|
|
|
|
|
|
|
Hematopoeitic Stem Cell Transplant
|
Bladder Dysfunction
|
Urinary Tract Toxicity
|
Renal Toxicity
|
Hypertension
|
Hydronephrosis
|
Hydrocele
|
Incontinence
|
GU Dysfunction
|
Hematopoeitic Stem
Cell
Transplant
with any
history
of chronic
GVHD
|
|
|
|
|
|
|
|
Vaginal Stenosis/
Fibrosis
|
Surgery
|
Bladder Dysfunction
|
Urinary Tract Toxicity
|
Renal Toxicity
|
Hypertension
|
Hydronephrosis
|
Hydrocele
|
Incontinence
|
GU Dysfunction
|
Cystectomy
|
|
X
|
X
|
|
X
|
|
X
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Cysectomy Related Problems
|
Hysterectomy
|
|
|
|
|
|
|
X
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Pelvic Floor Dysfunction
|
Neurosurgery – Spinal Cord
|
|
|
|
|
|
|
X
|
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Pelvic Surgery
|
|
X
|
|
|
|
|
X
|
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Nephrectomy
|
|
|
X
|
|
|
X
|
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Oopherexy
|
|
|
|
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Pelvic Adhesions and Ovarian Cysts
|
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