Puberty and fertility
Certain treatments may affect puberty and fertility. These are:

1. Radiotherapy to the brain
2. Radiotherapy to the lower abdomen or pelvis, including the ovaries and testicles
3. Total Body Irradiation (TBI) usually done with a bone marrow transplant
4. Certain chemotherapy drugs
5. Surgery to the ovaries, womb or testicles.

Your child will be watched carefully at the follow up clinic for signs of puberty. If this appears to be delayed hormone replacement therapy may be needed so that puberty can occur.

It is difficult to know whether these treatments have affected fertility until your child is old enough for tests to be carried out. This will be discussed at follow up clinics.

Growth and development
Radiotherapy can have important effects on growth and development. It may affect growing bones: for example, if radiotherapy is given to the spine, the child may not grow quite as tall as expected. If it is directed at a leg, then that leg may be shorter than the other.

Radiotherapy to the brain may affect production of growth hormone in the pituitary gland. The pituitary gland helps regulate growth and development from childhood to adulthood. It does this by producing hormones. If your child does not produce enough growth hormone from the pituitary gland he will not grow normally and may need treatment with synthetic growth hormone to help growth.

At the follow up clinic your child will be regularly weighed and measured. If growth is not satisfactory tests will be done to see if growth hormone replacement is required.

Heart and lungs
Certain treatments can have effects on the heart and lungs some time after treatment is completed. These treatments include some chemotherapy drugs and radiotherapy. If your child is at risk of these problems they will be regularly followed up with echocardiograms (heart ultrasound) and sometimes it is necessary to perform special tests on the lungs (lung function tests).

Kidney problems
These can occur after some types of treatment for childhood cancer but fortunately they are not usually severe. Removal of one kidney as part of treatment does not usually cause any problems because the remaining kidney can make up for the one removed.

Certain anti-cancer drugs can cause problems for the kidneys. If your child has had these drugs your doctor will organise checks on their kidneys from time to time. Patients whose kidneys are working satisfactorily at the end of treatment should not develop problems in the future.

Intellectual development and education
Following treatment most children are able to continue in normal education and their intellectual development is not affected. However, some children, especially children treated for brain tumours, may develop learning difficulties and may require special help at school. The extent of these difficulties will depend on the age of your child, when they were treated, and the treatment they received.

Some children will need a statement of special educational needs to provide the necessary help in the school environment. You can discuss this at the follow up with the doctor who can provide details of treatment and, if necessary, talk to the school or Education Authority.