Survivorship: Health Concerns After TBI
Total body irradiation (TBI) may be used to treat leukemias and lymphomas or may be given to patients who are undergoing bone marrow transplant. Although radiation is given to every part of the body during TBI, doses are much lower than those used to treat some other cancers. As a result, some side effects are different.
Mouth & Eye Health
Total body irradiation can affect your organs and glands within your head and neck. It may damage the salivary glands and cause dry mouth and increased risk of cavities. You should have regular dental visits. Artificial saliva may also be helpful. You may also have dry eyes and may use artificial tears for comfort. TBI also puts you at increased risk for the development of cataracts, so you should see an ophthalmologist yearly.
Total body irradiation can result in thyroid problems, including hypothyroidism, hyperthyroidism, and thyroid nodules/tumors. Symptoms of hypothyroidism (the most common issue) include fatigue, weight gain, constipation, dry skin, brittle hair or cold intolerance. You should have your thyroid checked each year and have thyroid function testing (TSH level) done.
Total body irradiation can also cause long-term damage to the liver. Signs of liver damage are abdominal pain, swelling of the abdomen (ascites), weight gain, and/ or yellowing of the skin (jaundice). You should call your provider right away if you have these symptoms. You should have yearly blood tests done to evaluate liver function and should be seen by a specialist for any issues. You should avoid alcohol use, as this may increase the risk of liver disease.
Total body irradiation may cause long-term damage to the kidneys. This can result in renal insufficiency (decreased kidney function) and hypertension (high blood pressure). This risk is increased if you have diabetes or if you have received cisplatin or carboplatin chemotherapies. At your annual physical you should have your blood pressure checked. Kidney function should be checked using blood tests. Hypertension should be treated with medication. If you have diabetes, you should have strict control of blood sugar levels.
TBI can cause scarring of the lungs. You are strongly encouraged not to smoke, as this increases the risk of lung issues. Yearly history and physical by a healthcare provider should include a pulmonary exam and review of possible symptoms (cough, shortness of breath, wheezing). You should receive an annual flu vaccine and the pneumococcal vaccine. You may need chest x-rays or pulmonary function tests if you are at high risk or have a change in how your lungs are working.
Fertility and Sexual Health
Total body irradiation almost always causes damage to the reproductive organs. For men, the primary concerns are the risk of infertility caused by damage to germ cells (which become sperm) and damage to the Leydig cells, which produce testosterone. Without testosterone, a young boy may not achieve puberty or an adult male may have a loss of secondary sex characteristics (facial hair, mature genitals, and a deep voice) or loss of sexual function. If you are experiencing any of these changes, you should be seen by an endocrinologist (hormonal specialist). For women, damage to the ovaries may cause infertility and premature ovarian failure. Failure of the ovaries to produce enough hormones may cause a survivor to experience symptoms of menopause, such as loss of periods, hot flashes, vaginal dryness, and loss of bone density (osteoporosis). Female survivors who experience these symptoms should be counseled about their risk of developing osteoporosis.
After radiation, the skin is more sensitive to sunlight, and you should be especially cautious to use sunscreen, wear hats and protect yourself from sun exposure when outdoors. Follow sun safety tips all year long.
Cancer Screening after TBI
TBI and chemotherapy can increase your risk of developing a second cancer. You should undergo all recommended cancer screening tests. These include breast and cervical cancer screening for women, and colorectal cancer screening for men and women.
For people treated with abdominal radiation before age 18, it is recommended to begin colon cancer screening with colonoscopy or DNA stool testing 5 years after radiation or at age 30, whichever occurs later. The American Cancer Society recommends that the general public begin screening at age 45. You and your provider should discuss these recommendations and the risks and benefits of these tests and decide when you should begin screening. Report any new, unusual or persistent symptoms to your provider.
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