As long-term cancer survival increases, patients are more likely to develop endocrine disorders later in life. These problems have become more common as patients survive longer past their cancer diagnosis. In the past, cancer sufferers may not have had a long enough lifespan to experience the effects of treatment on their endocrine systems.
Disorders like adrenal insufficiency, hyper- and hypothyroidism, polycystic ovary syndrome, diabetes mellitus and Cushing’s Disease are common consequences of endocrine imbalance.
Dr. Christopher Sonnier, an endocrinologist from Blacksburg, Virginia, explains the mechanisms of damage to the endocrine system and offers suggestions for doctors and patients who are dealing with these issues.
Literature Review Leads to New Findings
In 2019, Judith Gebauer conducted a review of cases and studies involving long-term cancer survivors who have experienced endocrine problems as a result of their treatment. In the review, Gebauer discovered that children have a 50 percent chance of developing an endocrine disorder under these conditions.
Certain cancer regimens are more likely to cause endocrine problems than others. Gebauer found that all cancer patients, not just children, need to be followed for longer than five years post-remission to discover whether they have become susceptible to endocrine disease.
Types of Cancer Treatment and Their Endocrine Risks
All types of cancer treatment carry some risk to the patient’s endocrine system. However, these risks are generally outweighed by the benefit of possibly life-saving cancer treatment. Chemotherapy and radiotherapy carry the highest risks, but surgery can also cause unwanted consequences.
Radiotherapy involves treating the cancerous area with concentrated doses of radiation. This treatment can damage existing organs and DNA, though the risk-benefit analysis shows that it outweighs the risk of going untreated.
Chemotherapy is a means of using targeted medications to kill cancer cells. This treatment also has the possibility of creating havoc within the endocrine system. Surgery can damage bodily systems as well. Hormone therapy helps the body to fight off cancer but can also have unwanted consequences.
Immune Checkpoint Inhibitors
A particular type of cancer treatment which carries risks for endocrine systems is the immune checkpoint inhibitor. Immune checkpoint inhibitors work by disrupting the link between the cancer cells and the immune cells in the body. These targeted drugs are able to keep cancer cells from attacking immune cells by binding to specific receptors. These drugs include nivolumab, ipilimumab, and pembroluzimab.
Unfortunately, the blocking capabilities of these drugs are not limited to cancerous cells. This treatment causes normal cells to be destroyed as well.
The potential side effects of immune checkpoint inhibitors include skin rashes or dermatitis, liver irritation or hepatitis, inflammation of the intestines or colitis, and lung inflammation or pneumonitis. These are more common side effects than endocrine problems, but they may point to a problem that will be experienced in the future.
Long-Term Monitoring is Needed
Frequently, adults who have recovered from cancer are closely monitored for only five years past their remission date. Gebauer’s review recommends that all cancer survivors, not only children, should be monitored for endocrine system disorders for the rest of their lives.
If these problems are discovered early on, it is more likely that they can be treated without serious consequences to the patient’s long-term health.
Side Effects of Cancer Treatment
While cancer treatment can have many unexpected side effects, it is necessary to ensure the survival of the patient. With careful monitoring post-treatment, cancer patients can live longer and healthier lives.
Dr. Christopher Sonnier encourages all cancer patients to educate themselves about the possible side effects of cancer treatment and to make sure that they receive long-term monitoring after their treatment is complete.