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TABLE 2

Childhood Cancer Therapy Affecting Reproductive Tissues

Reproductive EffectPredisposing TherapyModifying Factors
Sex    
 Both Altered pubertal timing (precocious, early, rapid tempo), delayed puberty, gonadotropin insufficiency or deficiency Hypothalamic-pituitary radiation Altered pubertal timing more common after low-dose radiation at 18–24 Gy, gonadotropin insufficiency more common after radiation at more than 30 Gy 
 Female Acute ovarian failure (ovarian failure within 5 y of diagnosis), premature menopause (cessation of menses before age 40 y) Alkylating-agent chemotherapy, radiation affecting the female reproductive system (whole abdomen, pelvis, lumbosacral spine, total body), oophorectomy Older age at treatment due at higher risk 
 Uterine vascular insufficiency, uterine growth impairment Radiation affecting the uterus (whole abdomen, pelvis, lumbosacral spine, total body) History of Wilms tumor and associated Müllerian anomalies 
 Vaginal fibrosis or stenosis Radiation affecting the vagina History of hypogonadism (estrogen insufficiency), history of chronic graft-versus-host disease 
 Sexual dysfunction, dyspareunia Pelvic surgery, hysterectomy, radiation affecting the uterus or vagina History of hypogonadism (estrogen insufficiency) 
 Spontaneous abortion, neonatal death, premature labor, neonate with low birth wt, fetal malposition Radiation affecting the uterus (whole abdomen, pelvis, lumbosacral spine, total body) History of Wilms tumor and associated Müllerian anomalies 
 Male Azoospermia oligospermia Alkylating-agent chemotherapy, radiation affecting the male reproductive system (pelvic, testicular, total body), orchiectomy (bilateral) Prepubertal status at treatment does not reduce risk 
 Retrograde ejaculation, anejaculation erectile dysfunction Pelvic surgery (retroperitoneal node or tumor dissection, cystectomy, radical prostatectomy), radiation to pelvis, bladder, or spine History of hypogonadism (androgen insufficiency) 
Reproductive EffectPredisposing TherapyModifying Factors
Sex    
 Both Altered pubertal timing (precocious, early, rapid tempo), delayed puberty, gonadotropin insufficiency or deficiency Hypothalamic-pituitary radiation Altered pubertal timing more common after low-dose radiation at 18–24 Gy, gonadotropin insufficiency more common after radiation at more than 30 Gy 
 Female Acute ovarian failure (ovarian failure within 5 y of diagnosis), premature menopause (cessation of menses before age 40 y) Alkylating-agent chemotherapy, radiation affecting the female reproductive system (whole abdomen, pelvis, lumbosacral spine, total body), oophorectomy Older age at treatment due at higher risk 
 Uterine vascular insufficiency, uterine growth impairment Radiation affecting the uterus (whole abdomen, pelvis, lumbosacral spine, total body) History of Wilms tumor and associated Müllerian anomalies 
 Vaginal fibrosis or stenosis Radiation affecting the vagina History of hypogonadism (estrogen insufficiency), history of chronic graft-versus-host disease 
 Sexual dysfunction, dyspareunia Pelvic surgery, hysterectomy, radiation affecting the uterus or vagina History of hypogonadism (estrogen insufficiency) 
 Spontaneous abortion, neonatal death, premature labor, neonate with low birth wt, fetal malposition Radiation affecting the uterus (whole abdomen, pelvis, lumbosacral spine, total body) History of Wilms tumor and associated Müllerian anomalies 
 Male Azoospermia oligospermia Alkylating-agent chemotherapy, radiation affecting the male reproductive system (pelvic, testicular, total body), orchiectomy (bilateral) Prepubertal status at treatment does not reduce risk 
 Retrograde ejaculation, anejaculation erectile dysfunction Pelvic surgery (retroperitoneal node or tumor dissection, cystectomy, radical prostatectomy), radiation to pelvis, bladder, or spine History of hypogonadism (androgen insufficiency) 

See www.survivorshipguidelines.org for health risks to other organs and tissues resulting from treatment of childhood cancer. Adapted, with permission from Elsevier, from Hudson MM. Survivors of childhood cancer: coming of age. Hematol Oncol Clin North Am. 2008;22(2):218.

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