Childhood Cancer

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Childhood Cancer Survivors

Muscles

The human body comes equipped with more than 650 muscles. These muscles, together with other connective tissues (tendons and cartilage), form the support system for the skeleton. The muscular system enables body movement through a process of contraction and relaxation.

There are three types of muscle: skeletal, smooth, and cardiac.

  • Skeletal muscle.  Also called striated muscle, it manipulates the skeleton to cause movement. Skeletal muscles are voluntary muscles because their actions can be controlled.

  • Smooth muscle.  Involuntary muscle is found in many internal organs, such as the bladder, arteries, veins, and digestive tract.

  • Cardiac muscle.  A type of involuntary muscle found only in the heart.

All of these types of muscles can be affected by radiation and/or surgery.

Damage to the muscles

The most common late effect after radiation is muscle and soft tissue underdevelopment, called hypoplasia. Over time, the non-irradiated muscles became larger and stronger than treated muscles. For some survivors, hypoplasia is a problem more of appearance than function. For others, particularly those who had high-dose radiation many years ago, the weakening of bone and muscle increases with age and can severely impact quality of life.

I had 4320 cGy of mantle radiation and 3600 cGy para-aortic and perisplenic when I was 13. When I finished treatment I was so thin there was no fat on me anywhere. When I regained weight, the irradiated parts did not change. The muscles in my chest and neck look like leather with veins. There is no fat and the irradiated areas did not grow. I lift weights and have built up the surrounding muscles, but no amount of exercise changes the areas in the radiation field.

• • • • •

I had high-dose mantle radiation 27 years ago. I’m 45, but feel like I have the body of a million-year-old woman. My whole upper torso is weakened. This occurred gradually over time. In my 20s I could chop wood and stack it. Now I have trouble just walking around the grocery store. I have very little strength, and hunch over. All of the muscles of my back, chest, and neck are atrophied.

Survivors who didn’t have radiation or muscle-removing surgery in most cases quickly regain muscle strength and endurance.

I was diagnosed with leukemia at age 12. I was heavily into sports so it was pretty traumatic when I was diagnosed. I had played soccer since I was 6 and was on the basketball team. I was on the sports fast track, doing really well, but that was nipped in the bud immediately.

After the intensive part of treatment, I started playing tennis and volleyball. Then, after I finished treatment, I went back to playing soccer and basketball. In college I was on the national championship crew team. During treatment I thought my sports dreams were dashed, but I had no late effects in terms of my muscles or strength.

If you had radiation to one side of the body while you were growing (for example, to treat Wilms tumor), you may have less muscle and fat tissue in the areas that were irradiated. This difference between the two sides of your body is called asymmetry. The more weight you gain, the more noticeable this disparity may become.

I only weigh 105. I had right flank radiation in 1962 for Wilms tumor. Because I’m so thin you can hardly see any difference in my hips. My doctor told me if I was heavier, it would be more obvious.

I do have a slight scoliosis and that caused a problem when they tried to start an epidural during the birth of my second child. They went too far and entered the spinal canal. When I was in labor with the third, I told them the history and told them to be careful and everything was fine.

Some survivors who had radiation to muscle groups have persistent problems with muscle tone. Occasionally, lack of exercise during years of treatment can also cause loss of muscle tone.

I had neuroblastoma at age 9 months and was treated with radiation on my left side. The muscle tone is really different on that side. I look a bit lopsided, and I’m just not as strong on that side.

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I really should exercise more because I’ve never had as healthy a body as I’d like to have. It’s hard to discipline myself to exercise. I also don’t have a strong back or good posture. A physical therapist told me that I had lain in bed for so many years as a kid that the muscles just aren’t in as good as shape as they should be.

My back hurts much of the time. Especially lately, because my son weighs 27 pounds and likes to be picked up and carried.

The muscles across my chest have atrophied a bit, causing me to sort of lean forward. I’m really not comfortable sitting up straight. I have sort of a rounded back and a hunched appearance.

Signs and symptoms

Signs and symptoms of hypoplasia are as follows:

  • Decreased muscle mass

  • Asymmetry of muscle mass of treated and untreated areas

  • Decreased range of motion

  • Decreased strength of affected muscles

  • Stiffness and pain

Screening and detection

An evaluation of late effects to the muscles includes a visual inspection of all muscle groups, looking for asymmetry, swelling, atrophy, fibrosis, and strength. Your healthcare provider should also assess your gait and posture. Careful measurements and comparisons of irradiated and untreated areas are important. An evaluation of tone, size, and strength is done for all muscle groups. You should have range of motion evaluated for affected muscle groups in arms or legs.

You should discuss your ability to participate in daily activities such as going to work, school, and taking care of your home. Talk about any limitations such as problems walking up stairs. Tell your healthcare provider about what types of exercise you do and how often. If you have late effects to the muscles that alter your appearance, discuss whether this affects your life in any way. Comprehensive care includes helping you adapt to changes in your body’s appearance.

Medical management

Reversal of late effects to the muscles isn’t possible, but trying to prevent further deterioration is. The primary way to do this is through a reasonable exercise program that works on range of motion and muscle strengthening. A physical therapist can help you design an individualized program to suit your needs.

I was very athletic when I was diagnosed with Hodgkin’s in 1982. It was hard for me to accept the changes in my body—I stopped growing, the muscles in my chest, back, and neck were atrophied. I needed to feel healthy after going through all that so I started exercising. I wanted to be strong and I achieved that. Except for the irradiated muscle groups, I am in great shape.

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I went to a physical therapist and she helped me plan an exercise program. I have scoliosis and am slightly overweight. My back was hurting and the program has made a big difference. I do 6 days a week of aerobic exercise—usually swimming or walking. I also work out with weights three times a week.

Chapter 17. Muscles and BonesBody size and weight

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