Bleomycin (Blenoxane ^® )

Busulfan (Myleran ^® )

Nitrosoureas (CCNU, BCNU)

• Chest x-ray, PFTs (breathing tests) baseline, then as needed.

Cisplatin (Platinol ^® )

Carboplatin (Paraplatin ^® )

• Complete pure tone audiogram (hearing test) or brainstem auditory evoked response baseline and then at least yearly if hearing loss is detected. For survivors who also had cranial or ear irradiation, test yearly for at least 5 years.

• Blood tests: BUN, Cr, Na, K, Cl, CO2, Ca, Mg, PO4 baseline and then periodically if indicated.

• Creatinine clearance baseline, then every year if abnormal.

• Fasting lipid profile baseline, then as needed.

Cyclophosphamide (Cytoxan ^® )

• Blood tests: LH, FSH, estradiol/testosterone baseline at age 13, then as needed.

Ifosfamide (Ifex ^® )

• Semen analysis.

• Menstrual history (females every year after puberty).

• Yearly discussion of any urinary problems.

• Blood tests: LH, FSH, estrogen/testosterone baseline at age 13, then as needed.

• Urinalysis every year.

• Creatinine clearance baseline, then as needed.

• Blood tests: BUN, Cr, Cl, CO2, Ca, Mg, PO4 baseline and periodically if indicated.

Nitrogen mustard (mechlorethamine or Mustargen ^® )

Lomustine (CCNU)

Carmustine (BCNU)

• Complete blood count every year.

• Semen analysis (upon request).

• Chest x-ray, PFTs (breathing tests) every 3 to 5 years (only if you received BCNU).

Daunorubicin (Cerubidine ^® )

Doxorubicin (Adriamycin ^® )

Epirubicin

Idarubicin

Mitoxantrone

• Electrocardiogram (EKG) and echocardiogram baseline, then every 1 to 5 years depending on risk (higher risk from higher cumulative dose, young age, being female, radiation to chest).

• Holter monitor (24-hour EKG test) every 2 to 5 years depending on total dose.

• Exercise testing.

• If pregnant, see an obstetrician who specializes in high-risk care.

High-dose cytarabine (ARA-C)

• Neurologic examination.

• Neuropsychological evaluation baseline, then as needed if educational or vocational problems emerge.

Asparaginase

• None, unless associated with acute problems.

Methotrexate (systemic)

Intrathecal medications:

• Methotrexate

• ARA-C

• Hydrocortisone

• Neuropsychological testing baseline, then every 2 years if any learning problems noted.

• Educational assessment every year.

• Bone density evaluation baseline, then as needed.

Mercaptopurine (6-MP or Purinethol ^® )

Thioguanine (6-TG)

• Liver function tests baseline, then as needed.

Prednisone

Dexamethasone (Decadron ^® )

• Evaluation for joint pain.

• Bone density evaluation baseline, then as needed.

• Growth evaluation.

• Examination for cataracts every year.

Vincristine (Oncovin ^® )

• Neurologic exam yearly for 3 years, then as needed.

• Examination for peripheral neuropathy yearly for 3 years, then as needed.

Etoposide (VP-16 or Vepesid ^® )

Teniposide (VM-26)

• Neurologic examination.

• Skin exam every year for 10 years.

• Complete blood count every year for 10 years.

• Counseling about second cancers.

Bone

• X-rays every 5 years.

• Evaluation of bone growth and overlying soft tissue in area irradiated every year.

Cranial

Nasopharyngeal

• Educational assessment every year.

• Neuropsychological testing baseline, then every 2 to 3 years.

• Neurologic evaluation every year.

• X-ray of full set of teeth (Panorex) at age 5.

• Monitor for early or delayed puberty.

• Growth curve every year (every 6 months between ages 10 to 12).

• Bone age (x-ray of hand) at 9 years of age for a baseline, then every year until puberty (based on risk factors).

• Blood tests: growth hormone, somatomedin C, IGFBP3, and others as indicated.

• Complete eye examination by ophthalmologist every year that includes check for cataracts.

• Blood tests: Free T4, TSH, fasting glucose, fasting lipid profile every year.

Flank

• Observe for scoliosis (curvature of the spine) every year (every 6 months during puberty).

Chest or mantle

• Blood tests: Free T4, TSH every year.

• Chest x-ray, PFTs (breathing tests) baseline, then as needed.

• Fasting glucose and lipid profile every 3 to 5 years.

• Breast self-exam every month.

• Breast examination by healthcare provider every year.

• Mammogram 8 years after radiation or by age 25 (whichever comes last), then every 2 years until age 40, then every year (females only).

• Growth curve (sitting and standing heights) every year until fully grown.

• Dental exam every year.

• EKG and echocardiogram baseline, then every 1 to 5 years depending on risk (higher risk from higher cumulative dose, young age, being female, radiation to chest).

• Exercise testing.

• If pregnant, see an obstetrician who specializes in high-risk care.

• Counseling about not smoking.

Whole lung

• Chest x-ray.

• PFTs (breathing tests) every 3 to 5 years.

• Breast self-examination every month.

• Breast examination by healthcare provider every year.

• Mammogram 8 years after radiation or by age 25 (whichever comes last), then every 2 years until age 40, then every year (females only).

• Growth curve (sitting and standing) every year until fully grown.

• EKG/echocardiogram/chest x-ray baseline, then every 1 to 5 years depending on risk (higher risk from higher cumulative dose, young age, being female, radiation to chest).

• Holter monitor (24-hour EKG test) every 2 to 5 years depending on total dose.

• Exercise testing.

• Counseling about not smoking.

Spinal

• Evaluation for scoliosis (curvature of the spine), kyphosis (curvature of spine in hunchback shape).

• Blood tests: Free T4, TSH every year.

• Growth curve (sitting and standing heights) every year.

• Blood tests: LH, FSH, estrogen (females baseline at age 12, then as needed).

• Evaluate stage of puberty.

• EKG/echocardiogram/chest x-ray baseline, then every 2 to 5 years depending on risk (higher risk from higher cumulative dose, young age, being female, radiation to chest).

• Exercise testing.

Testicular (males only)

• Testes exam every year by a healthcare provider.

• Testicular self-exam every month.

• Blood tests: LH, FSH, testosterone at age 14, then as needed.

• Evaluate stage of puberty.

• Sperm count (as requested)

Neck and jaw

• Dental exam every year.

• Complete eye examination by ophthalmologist every year that includes check for cataracts.

Leg

• Monitor for leg-length discrepancy.

Orbit (eye)

• Complete eye examination by ophthalmologist every year.

• X-ray of orbits every 3 to 5 years.

• Blood tests: LH, FSH, estrogen/testosterone (baseline at age 12, then as needed).

• Evaluate stage of puberty.

Whole body (TBI)

• Growth curve (sitting and standing heights) every year.

• Bone age (x-ray of hand) as needed.

• Urinalysis (check for blood, protein, sugar).

• Puberty evaluation every year from ages 8 to 18.

• Blood tests: LH, FSH (baseline at 12, then as needed).

• Menstrual history (females) every year after puberty.

• Blood tests: Free T4, TSH every year.

• Complete eye examination by ophthalmologist every year that includes check for cataracts.

• Skin checks and counseling on protecting skin from the sun.

Abdomen

Pelvis

Inverted Y

• Blood tests: LH, FSH, estrogen/testosterone (baseline at age 12, then as needed).

• Evaluation for scoliosis (curvature of the spine) and kyphosis (curvature of spine in hunchback shape).

• Blood culture if you have a fever.

• ALT, AST, bilirubin at baseline, then as needed.

• Colonoscopy every 5 years starting 10 years after the radiation or age 35, whichever occurs last.

• Creatinine, BUN, Na, K, Ca, Cl, CO ₂ , Mg, PO ₄ at baseline, then as needed.

• Evaluate stage of puberty and obtain menstrual history.

• Semen analysis (males).

• Nutritional history.

• Stool test for blood every year.

• Urinalysis every year.

• If pregnant, see an obstetrician who specializes in high-risk pregnancies.

All areas

• Skin check of irradiated areas every year.

Adrenal gland removal

• Information about symptoms of adrenal insufficiency.

Abdominal surgery

• Serum magnesium every year.

Amputation

• Examination with attention to range of motion and muscle contractures.

• Prosthesis check every 6 months until skeleton has stopped growing, then yearly.

• Antibiotics prior to dental work if an allograft.

Enucleation (removal of the eye)

• Socket examination each year.

• Evaluation by ophthalmologist every year.

Laparotomy

• Gastrointestinal and nutrition status evaluation.

Limb salvage

• Bone x-ray every year.

• Evaluation by an orthopedic surgeon every 6 months until skeleton has stopped growing, then yearly.

• Counseling about exercise restrictions.

Nephrectomy (removal of a kidney)

• Blood pressure every year.

• Urinalysis every year (check for blood, protein, sugar).

• Blood tests: BUN, Cr, Ca, Na, K, Cl, CO ₂ , Mg, PO ₄ baseline and then as needed.

• Counseling about kidney protection.

Neurosurgery

• Neuropsychological evaluation baseline, then as needed.

• Evaluation by neurologist and rehabilitation specialist every year.

Splenectomy

• Penicillin daily (erythromycin if allergic to penicillin).

• Antibiotics prior to dental work.

• Pneumovax (recommendations on frequency vary).

• Annual influenza vaccine.

• Fever above 101° F requires a blood culture and evaluation for infection by a doctor.

Transfusions

• Baseline HIV blood test.

• Blood tests: If transfused prior to July 1992, have HBV (hepatitis B virus) and HCV (hepatitis C virus) tests.

Primary disease

Counseling and surveillance for second cancers if the primary disease was:

• Hodgkin lymphoma.

• Hereditary retinoblastoma.

• Sarcoma.

• Neuroblastoma.

• ALL if treated with cranial radiation.

Health maintenance

• Low-fat diet.

• Exercise.

• Lifestyle counseling.

• No smoking.

• Moderate alcohol use.

Family history of cancer

• Counseling about risk of second cancers.

• Genetic evaluation.