LUNG PROBLEMS
This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.
PLAIN version 3: 03/03/2025
This PLAIN summary is based on the PanCare Follow-Up guideline about “Pulmonary problems” [1], which is itself based on the corresponding IGHG* guideline[2].
Lung problems
Our lungs are essential for breathing and located in our chest on each side of the heart. When we breathe in, tiny air sacs in the lungs take up oxygen, which is then transported through the bloodstream to all parts of the body. When we breathe out, carbon dioxide is removed from the blood and released into the air.
Sometimes problems can occur with the lungs. Cancer treatment may cause problems with the lungs including the air sacs becoming damaged or lungs becoming stiff and not expanding as well when breathing. Lung problems that may occur in the general population and in survivors include:
- Obstructive lung abnormalities, where the airways are narrowed or blocked (for example Chronic obstructive pulmonary disease (COPD)).
- Restrictive lung abnormalities, where the lung cannot hold as much air anymore and does not fully expand while breathing in (for example pulmonary fibrosis).
- Diffusion capacity impairment, where oxygen cannot sufficiently transfer from the lungs to the bloodstream.
There are a number of things anyone can do that may lower the risk of lung problems, such as avoiding smoking.
The lungs
Created with BioRender.com
Hover over the letters/numbers in the figure for more information.
Survivors
Am I at higher risk of lung problems?
Anyone, including people who have never had cancer treatment, may develop lung problems. However, there are some cancer treatments that may increase the risk of having lung problems later in life. The problems that can occur depend on the type of cancer treatment received.
The following treatments can increase the risk of lung problems:
- Radiotherapy to the lungs or an area that includes the lungs
- Stem cell transplantation with stem cells from a donor (allogeneic)
- Surgery of the chest
You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.
If you experience lung problems, it does not always mean that this is caused by your cancer treatment. Lung problems may have other causes, such as smoking, being overweight and older age. For more information on being overweight and obese, please read: Overweight and obesity.
Stem cell transplantation
Stem cell transplantation means that blood stem cells are taken out of the body of a person and transplanted back into the same person (autologous) or to another person (allogeneic).
This procedure is often used to treat diseases such as leukaemia and lymphoma, and some solid tumours (such as neuroblastoma) as well as certain immune system and genetic disorders.
There are different types of stem cell transplants, including:
- Autologous Transplant: Uses the patient’s own stem cells, which are harvested before treatments like chemotherapy or radiation and then returned to the body to help recover.
- Allogeneic Transplant: Uses stem cells from a donor. The donor can be a relative (often a sibling) or someone unrelated with a matching tissue type.
The blood stem cells can be harvested in different ways. They can either be taken out of the blood stream (peripheral blood stem cell transplantation) or out of the bone marrow (bone marrow transplantation).
During the transplantation process, the patient often undergoes a treatment to kill the diseased bone marrow cells before receiving the new stem cells through an intravenous line, similar to a blood transfusion. After the transplant, it takes time for the new stem cells to grow and start producing healthy blood cells, during which the patient needs close medical care to prevent and manage potential complications, such as infections or graft-versus-host disease (in case of allogeneic transplants).
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
What are the symptoms and signs of lung problems?
There are symptoms and signs that can tell you if you might have lung problems. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.
These symptoms and signs may suggest that you have lung problems:
- Shortness of breath or difficulty in breathing
- A cough that does not get better
- A decrease in ability to exercise
- Pain or discomfort when breathing in or out
- Coughing up mucus or blood
- Frequent chest infections, for example pneumonia
If you recognise any of these symptoms or signs in yourself, please contact your general practitioner or follow-up care specialist.
Symptoms and signs
Pain
From a physical point of view, pain is a life-sustaining biological reaction to damaging influences – even if tissue damage has not yet occurred. Due to its function as a damage indicator or warning, pain is usually associated with negative feelings so that we pay sufficient attention to it and learn as quickly as possible when it is dangerous for us. How intensely we feel a pain stimulus, whether it causes us to feel fear and panic, depends not only on the pure nerve signal, but is an interplay of biological, psychological and social factors.
All pain whose duration exceeds the extent of an acute (recent) cause and lasts for an incomprehensibly long time is called chronic pain. Strong and prolonged pain stimuli can make the transmitting nerve cells of the spinal cord and brain more sensitive to subsequent pain stimuli. This means that even mild stimuli can be perceived as severe pain. Under certain circumstances, these nerve cells, which have become hypersensitive
I am at higher risk of lung problems. What tests should I have and when?
If you are at higher risk of lung problems, it is advised to:
- Discuss your medical history and whether you experience(d) any symptoms and signs of lung problems with your general practitioner or follow-up care specialist. This should be done at least every 5 years.
Long-term follow-up (LTFU)
In LTFU, you will be monitored and tested for potential late effects according to your Survivorship Care Plan. If you don’t have one, contact your LTFU specialist or GP. For more information about the survivorship care plan click here.
What happens if I have lung problems?
If you have lung problems, your general practitioner or follow-up care specialist may perform a lung function test to test how well your lungs are working.
They will probably also refer you to a:
- Respiratory physician (physician specialised in the lungs)
The respiratory physician may discuss different treatment options with you.
What else can I do?
Knowing that you may be at increased risk of lung problems can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.
To lower your risk of lung problems, adopting or maintaining a healthy lifestyle is extremely important. In particular, it is important to avoid smoking (cigarettes, vapes, cigars, pipes and breathing in second-hand smoke) and being exposed to polluted air or working with harmful substances. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.
To reduce your risk of pneumonia, you may want to consider vaccination against pneumococci. Pneumococci are bacteria that can cause pneumonia. Sometimes pneumonia can also occur when you have the flu. Therefore, yearly vaccination against the influenza virus may help in preventing the development of lung problems. You can discuss with your general practitioner or follow-up care specialist whether it is necessary for you to get vaccinated and the benefits of vaccination.
If you are at higher risk of lung problems or if you were treated with the chemotherapy drug bleomycin and wish to go scuba diving, it is advised to first be assessed by an experienced diving physician.
It is important that you are aware of the possibility of developing lung problems and that you know the symptoms and signs. If you have any further questions or if the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
Second-hand smoke
Like smoking yourself, second-hand smoke also is harmful and can cause health problems later in life. Especially, if you are at higher risk of certain late effects (subsequent lung cancer or lung problems) it is extremely important to avoid second-hand smoke.
Where can I find more information?
You may find more information about lung problems online. However, it is important to be aware that this information is not always up to date or accurate.
Some sources of further information are:
- Together: Here you can find more information about lung and breathing problems
On this website, you can also find more information related to this topic:
Please note
This PLAIN summary is based on the PanCare Follow-Up guideline about “Pulmonary problems” [1], which is itself based on the corresponding IGHG* guideline[2].
While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.
Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.
No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.
The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.
*International Guideline Harmonization Group for Late Effects of Childhood Cancer
[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext
[2] Otth, M. et al. (2024) Recommendations for surveillance of pulmonary dysfunction among childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Available at: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00066-X/fulltext