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Lung problems

Anyone, even people who have never had cancer, can develop lung problems. However, some cancer treatments can increase the risk. It is important that you recognize and understand symptoms and signs that may indicate lung problems.

What are lung problems?

The lungs, located in the chest, extract oxygen from the air you breathe. Oxygen passes from the alveoli into the blood and reaches all parts of the body. The blood returns waste products (carbon dioxide = CO2) to the alveoli, which you then exhale. Proper breathing requires functioning alveoli, sufficiently large lungs, and space in the chest.

Sometimes lung problems occur, making it harder to breathe:

  • Lung fibrosis: scar tissue in the lungs

  • Frequent infections, such as pneumonia

  • Chronic obstructive pulmonary disease (COPD): the bronchi are chronically inflamed (chronic bronchitis) or the alveoli are damaged (emphysema), making breathing difficult

Not smoking helps reduce the risk of lung problems.

Do I have an increased risk of lung problems?

Anyone, including people who have never had cancer, can develop lung problems. However, certain cancer treatments can increase the risk.

The following treatments may increase the risk of lung problems:

  • Chemotherapy: carmustine (BCNU), lomustine (CCNU), busulfan, and bleomycin. Bleomycin can cause lung fibrosis; lung fibrosis can worsen with high oxygen concentrations, for example during surgery.

  • Radiotherapy to the lungs or an area including the lungs

  • Allogeneic stem cell transplantation (from a donor)

  • Chest surgery

You can check your treatment summary to see whether you have had any of these treatments. If you do not have a summary, you can contact the LATER clinic or the hospital where you were treated. Lung problems do not always result from treatment; other causes include smoking, overweight, and aging.

What are the symptoms and signs of lung problems?

Certain symptoms and signs may indicate lung problems. Even if you do not currently have these symptoms, it is important to recognize them in case they occur in the future.

The following symptoms and signs may indicate lung problems:

  • Shortness of breath or difficulty breathing

  • A cough that does not go away

  • Reduced ability to move or exercise

  • Pain or discomfort when inhaling or exhaling

  • Coughing up mucus or blood

If you recognize any of these symptoms or signs, contact your general practitioner or LATER doctor.

I have an increased risk of lung problems. What tests are needed and when?

If you have an increased risk of lung problems, it is recommended to:

  • Schedule an appointment with your LATER doctor every 5 years

  • Have your lungs and chest examined at least every 5 years

  • Have a lung function test at your first LATER appointment to check how your lungs work; this test may be repeated if necessary

What happens if I have lung problems?

If you have lung problems, your general practitioner or LATER doctor may refer you to:

  • Pulmonologist

  • Physiotherapist, who will discuss treatment options with you

What else can I do?

It can be difficult to know that you have (an increased risk of) lung problems. Talking with friends and family can help. Contact with others in a similar situation can also be helpful, for example through a patient organization such as VOX, part of the Dutch Childhood Cancer Organization.

Take good care of yourself. You can reduce the risk of lung problems by living a healthy lifestyle. The most important thing is not to smoke (cigarettes, vapes, cigars, pipes) and avoid second-hand smoke. Avoid polluted air and work with harmful substances. Take care of your mental health as well. Small changes can already have a positive impact on your physical and mental well-being. Read more about choosing a healthy lifestyle and paying attention to your mental health.

To reduce the risk of pneumonia, you can ask your general practitioner or LATER doctor whether it is advisable to receive the annual flu vaccine and pneumococcal vaccination. If you were treated with bleomycin, you must not receive high oxygen concentrations. Therefore, always inform the anesthesiologist before planned anesthesia that you received bleomycin as a child. It is important to recognize that you may develop lung problems and to know the symptoms and signs.

Wear an S.O.S. bracelet so that in an emergency, first responders know that you cannot receive high concentrations of oxygen.

If you have questions or concerns after reading this information, contact your general practitioner or LATER doctor.

Where can I find more information?

This LATER website also provides information on topics related to lung problems:

  • Healthy lifestyle

  • Mental health

  • Overweight and obesity

  • Secondary cancer: lung cancer

The PanCare Plain Language Summaries provide links to reliable information in English. You can search online for information about lung problems, but be aware that it may not always be up-to-date or accurate.

Disclaimer

This information is based on the PLAIN language summary of the guideline, prepared by the PanCare PLAIN Information Group, and has been adapted where necessary to the Dutch LATER guideline. Do not rely solely on this information if you have symptoms or concerns, but consult your general practitioner, LATER doctor, or specialist.