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Lung and Breathing Problems

Certain treatments for childhood cancers can cause lung and breathing problems. You can take steps to protect and promote your lung health.

You can help prevent lung conditions and ensure problems are found and treated early.

How do the lungs work? A graphic of the respiratory system showing labels for the nose, ethmoid sinuses, tongue, phaynx, trachea, lungs, bronchus, and bronchioles. A zoomed in graphic shows a closeup of the alveoli and bronchioles, which are labeled.

How the Lungs Work

The lungs transfer oxygen from the air to the blood, where it is circulated to the body tissues. The lungs also remove carbon dioxide, a waste product made by the body’s cells.

To reach the blood, oxygen must move through tiny air sacs (alveoli) in the lungs and into tiny blood vessels (capillaries) that surround each air sac.

Cancer Treatments That Can Cause Lung and Breathing Problems

Treatments that can lead to lung damage include some chemotherapy drugs, radiation, surgery, and complications of hematopoietic cell transplant (also known as bone marrow transplant or stem cell transplant). They can damage tiny air sacs and blood vessels in the lung. Therapies can also cause swelling of air passages and increased mucus production because of irritation or infection.

Chemotherapy

Radiation

  • Radiation to the chest or underarm area
  • Total body radiation

Surgery

Surgical procedures involving the chest or lungs. These do not include surgery for placement of a central venous access device.

Bone Marrow Transplant

Transplant patients with graft versus host disease are at risk.

Drugs called anthracyclines can damage the heart and may contribute to lung problems. This risk increases if patients received anthracyclines along with chemotherapy and radiation that causes lung problems.

Risk Factors for Lung and Breathing Problems

  • Younger age at the time of treatment
  • A history of lung conditions
  • Tobacco use
  • Exposure to secondhand smoke
  • Inhaled drugs, such as smoking marijuana
  • Vaping or JUULing

Lung Problems that May Occur After Cancer Treatment

  • Lung scarring (pulmonary fibrosis)
  • Repeated lung infections (chronic bronchitis, bronchiectasis, or recurrent pneumonia)
  • Inflammation of lung tissue and airway passages (bronchiolitis obliterans)
  • Rupture of tiny air sacs in the lungs or thickening and blocking of air passages (restrictive/ obstructive lung disease)

Symptoms of Lung and Breathing Problems

  • Shortness of breath
  • Frequent coughing
  • Wheezing
  • Chest pain
  • Frequent bronchitis, pneumonia
  • Tiring or shortness of breath during mild exertion
Pulmonary function tests may show lung problems that are not apparent during a regular exam.

Pulmonary function tests may show lung problems that are not apparent during a regular exam.

Tell your primary health care provider about your risk. Share your Survivorship Care Plan which will include a treatment summary.

Tell your primary health care provider about your risk. Share your Survivorship Care Plan which will include a treatment summary.

Ask your oncologist about your risk of late effects.

Ask your oncologist about your risk of late effects.

What Cancer Survivors Can Do for Lung Health

Know Your Risk and Monitor Your Health

  • Know your risk of developing lung and breathing problems. Ask your doctor if you have received treatments that increase your risk for lung disease.
  • Share a copy of your Survivorship Care Plan with health care providers. This plan includes details about your cancer treatment and information about health problems that may occur because of your treatment.
  • A yearly check-up with a health care provider is recommended.

Recommended Screenings for Lung Problems

Pulmonary function tests including DLCO and spirometry may show lung problems that may not be apparent during a regular examination.

It is helpful to have these tests done at least once at least 2 years after completing cancer treatment to find out if there are any problems. Based on the results, your provider can decide if further testing is needed.

Lung Disease Prevention for Cancer Survivors

  • Get the pneumococcal vaccine.
  • Get yearly flu vaccines.
  • Avoid scuba diving unless a pulmonologist (lung specialist) has advised that diving is safe for you.
  • Do not smoke cigarettes.
  • Do not vape or JUUL.
  • Avoid secondhand smoke.
  • Exercise regularly.
  • Don’t smoke marijuana or inhale drugs.
  • Don’t breathe toxic fumes from chemicals, solvents, and paints.
  • Follow all safety rules at work. Use protective ventilators when needed. Report any unsafe working conditions to the Occupational Safety and Health Administration (OSHA).
  • Get regular check-ups
  • Have recommended screenings
  • Lead a healthy lifestyle

For more information, visit Children’s Oncology Group’s Pulmonary Health after Cancer Treatment.


Reviewed: May 2020