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Lung and Breathing Problems

Most childhood cancer survivors don’t experience lung and breathing problems as a result of their therapy.

But certain treatments for childhood cancers can cause lung and breathing problems. 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.

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.

Treatments That Can Cause Lung and Breathing Problems

Treatments that can lead to lung damage include some chemotherapy drugs, radiation treatment, surgery, and complications of hematopoietic cell transplant (also known as bone marrow transplant or stem cell transplant).

Chemotherapy

  • Bleomycin
  • Carmustine (BCNU)
  • Lomustine (CCNU)
  • Busulfan

Radiation

  • Chest radiation
  • Total body radiation

Surgery

Surgical procedures to the chest. These procedures do not include central line placement.

Transplant

Transplant patients with graft versus host disease are at risk.

Drugs such as anthracyclines that cause heart problems can also impact lung health. The risk of late effects increases if patients received these medicines along with treatments that heighten the risk of lung damage.  

Other risk factors

Risk factors include:

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

Lung Problems as a Result of Treatment

Problems can include:

  • 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)

Signs and Symptoms

  • Shortness of breath
  • Frequent coughing, wheezing
  • Chest pain
  • Frequent bronchitis, pneumonia

Easy tiring or shortness of breath during mild exercise is also a possible symptom.

What Survivors Can Do

Know Your Risks and Monitor Health

  • Ask your oncologist about your risk of late effects.
  • Tell your primary health care provider about your risk. Share a copy of your Survivorship Care Plan, which includes a treatment summary.
  • Have a yearly physical examination. It should include a blood pressure check and urine testing.
  • Have a physical examination every year.
  • Pulmonary function tests (including DLCO and spirometry) may show lung problems that are not apparent during a regular examination.

Prevention

  • Get the pneumococcal vaccine.
  • Get yearly flu vaccines.
  • Avoid scuba diving unless a pulmonologist (lung specialist) has approved it after conducting a complete check-up.
  • Do not smoke cigarettes.
  • Current smokers should stop smoking.
  • Exercise regularly.
  • Don’t smoke marijuana or inhale drugs.
  • Don’t “huff” chemicals.
  • Follow all safety rules at work. Use protective ventilators when needed.


Reviewed: June 2018

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