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Posttherapy management
Source: Late Effects of Treatment for Childhood Cancer (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: April 14, 2025 · Captured 2026-09-09.
Selected source text with whitespace normalised. This Triangle page is not an NCI PDQ summary.
Survivors with liver dysfunction should be counseled regarding risk-reduction methods to prevent hepatic injury.
Standard recommendations include maintenance of a healthy body weight, abstinence from alcohol use, and immunization against hepatitis A and B viruses.[42]
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In patients with chronic hepatitis, precautions to reduce viral transmission to household and sexual contacts should also be reviewed.
Table 7 summarizes hepatobiliary late effects and the related health screenings.
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| Predisposing Therapy | Hepatic Effects | Health Screening/Interventions |
|---|---|---|
| ALT = alanine aminotransferase; AST = aspartate aminotransferase; HSCT = hematopoietic stem cell transplant. | ||
| aAdapted from the Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. | ||
| Methotrexate; mercaptopurine/thioguanine; HSCT | Hepatic dysfunction | Laboratory tests: ALT, AST, bilirubin levels |
| Ferritin in those treated with HSCT | ||
| Mercaptopurine/thioguanine; HSCT | Veno-occlusive disease/sinusoidal obstructive syndrome | Examination: scleral icterus, jaundice, ascites, hepatomegaly, splenomegaly |
| Laboratory tests: ALT, AST, bilirubin, platelet levels | ||
| Ferritin in those treated with HSCT | ||
| Radiation exposing liver/biliary tract; HSCT | Hepatic fibrosis/cirrhosis; focal nodular hyperplasia | Examination: jaundice, spider angiomas, palmar erythema, xanthomata, hepatomegaly, splenomegaly |
| Laboratory tests: ALT, AST, bilirubin levels | ||
| Ferritin in those treated with HSCT | ||
| Prothrombin time for evaluation of hepatic synthetic function in patients with abnormal liver screening tests | ||
| Screen for viral hepatitis in patients with persistently abnormal liver function or any patient transfused before 1993 | ||
| Gastroenterology/hepatology consultation in patients with persistent liver dysfunction | ||
| Hepatitis A and B immunizations in patients lacking immunity | ||
| Consider phlebotomy and chelation therapy for iron overload | ||
| Radiation exposing liver/biliary tract | Cholelithiasis | History: colicky abdominal pain related to fatty food intake, excessive flatulence |
| Examination: right upper quadrant or epigastric tenderness (acute episode) | ||
| Consider gallbladder ultrasonography in patients with chronic abdominal pain | ||
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