Puberty and fertility effects of brain tumour treatmentPPuberty and fertility effects of brain tumour treatmentPuberty and fertility effects of brain tumour treatmentEnglishNeurology;Genital and reproductiveChild (0-12 years);Teen (13-18 years)Brain;Uterus;Fallopian tubes;Ovaries;TesticleNervous system;Reproductive systemConditions and diseasesAdult (19+)NA2009-08-14T04:00:00ZEric Bouffet, MD, FRCPC10.000000000000048.00000000000001382.00000000000Flat ContentHealth A-Z<p>Detailed information on the effect that brain tumour treatment may have on your child's fertility and puberty development.</p><p>In rare cases, puberty is affected by treatment. Similarly, a child’s ability to become a parent after reaching adulthood may also be affected. This is because some treatments may have an effect on sex hormones, the chemicals that signal the body to mature. As a result, some children may have early puberty, while others have late puberty. Treatment may also damage the cells and organs that are involved in producing babies. These effects depend on the age at which a child is treated, and on the type and dose of treatment. The situation is different for girls and boys.</p><h2>Key points</h2> <ul><li>Certain types of tumours, radiation and chemotherapy may have an affect on puberty causing it to be early or delayed.</li> <li>Chemotherapy or radiation treatment may have an affect on your child's fertility in the future.</li> <li>Hormone suppression or hormone replacement may be given if your child has early or delayed puberty.</li> <li>Treatment and outcomes will be different for girls and boys.</li></ul>
Effets liés à la puberté et à la fertilité du le traitement des tumeurs cérébralesEEffets liés à la puberté et à la fertilité du le traitement des tumeurs cérébralesPuberty and fertility effects of brain tumour treatmentFrenchNeurology;Genital and reproductiveChild (0-12 years);Teen (13-18 years)Brain;Uterus;Fallopian tubes;Ovaries;TesticleNervous system;Reproductive systemConditions and diseasesAdult (19+)NA2009-08-14T04:00:00ZEric Bouffet, MD, FRCPC10.000000000000048.00000000000001382.00000000000Flat ContentHealth A-Z<p>Renseignements détaillés sur l’effet que le traitement contre les tumeurs cérébrales peut avoir sur la fertilité et le développement de la puberté chez votre enfant.</p><p>Dans de rares cas, le traitement affecte la puberté. De même, la capacité d’un enfant de devenir parent après avoir atteint l’âge adulte pourrait aussi être affectée, car certains traitements pourraient avoir un effet sur les hormones sexuelles, c’est-à-dire les produits chimiques qui indiquent au corps de devenir mature. En conséquence, certains enfants pourraient avoir une puberté précoce ou tardive. Le traitement peut aussi endommager les cellules et les organes qui participent à la reproduction. Ces effets dépendent de l’âge auquel l’enfant est traité, du type de traitement et de la dose administrée. La situation est différente pour les filles et les garçons. </p><h2>À retenir</h2> <ul><li>Certains types de tumeurs, la radiothérapie et la chimiothérapie peuvent avoir un effet sur la puberté, la devançant ou la retardant.</li> <li>Les traitements de chimiothérapie ou de radiothérapie peuvent avoir un effet sur la fertilité future de votre enfant.</li> <li>Des suppresseurs hormonaux ou des hormones de remplacement peuvent être administrés si la puberté de votre enfant est précoce ou retardée.</li> <li>Le traitement et les répercussions seront différents pour les filles et les garçons.</li></ul>

 

 

Puberty and fertility effects of brain tumour treatment1428.00000000000Puberty and fertility effects of brain tumour treatmentPuberty and fertility effects of brain tumour treatmentPEnglishNeurology;Genital and reproductiveChild (0-12 years);Teen (13-18 years)Brain;Uterus;Fallopian tubes;Ovaries;TesticleNervous system;Reproductive systemConditions and diseasesAdult (19+)NA2009-08-14T04:00:00ZEric Bouffet, MD, FRCPC10.000000000000048.00000000000001382.00000000000Flat ContentHealth A-Z<p>Detailed information on the effect that brain tumour treatment may have on your child's fertility and puberty development.</p><p>In rare cases, puberty is affected by treatment. Similarly, a child’s ability to become a parent after reaching adulthood may also be affected. This is because some treatments may have an effect on sex hormones, the chemicals that signal the body to mature. As a result, some children may have early puberty, while others have late puberty. Treatment may also damage the cells and organs that are involved in producing babies. These effects depend on the age at which a child is treated, and on the type and dose of treatment. The situation is different for girls and boys.</p><h2>Key points</h2> <ul><li>Certain types of tumours, radiation and chemotherapy may have an affect on puberty causing it to be early or delayed.</li> <li>Chemotherapy or radiation treatment may have an affect on your child's fertility in the future.</li> <li>Hormone suppression or hormone replacement may be given if your child has early or delayed puberty.</li> <li>Treatment and outcomes will be different for girls and boys.</li></ul><h2>What may happen with girls</h2> <ul> <li> Early puberty occurs more often in girls than in boys. Symptoms of early puberty are the development of breasts or underarm hair before the age of eight. </li> <li> Symptoms of late puberty are the lack of breast development by age 13, and lack of sexual development and menstrual periods (amenorrhea). </li></ul> <h2>What may happen with boys</h2> <ul> <li> Symptoms of early puberty in boys are the development of the penis and testicles, and underarm or facial hair, before the age of nine. </li> <li> Symptoms of late puberty in boys are the lack of enlargement of testicles by age 14, and lack of sexual development.</li></ul> <h2>What causes the problem?</h2> <p>Several factors affect puberty or fertility by causing damage to the organs and cells involved:</p> <ul> <li> Children who have a hypothalamic glioma may experience early puberty. This is more common in children with neurofibromatosis (NF). </li> <li> Certain tumours such as germ cell tumours can trigger early puberty. </li> <li> Radiation therapy to parts of the brain called the hypothalamus and pituitary gland may affect their ability to produce hormones that are needed for puberty. The radiation may cause early or delayed puberty. </li> <li> Craniospinal radiation may have an impact when the radiation beam exits the body through the upper pelvis. In girls, the radiation beam may directly hit the uterus or ovaries. In boys, the radiation beam may hit the testes. </li> <li> Chemotherapy drugs, in particular, alkylating agents, may delay puberty. This category of drugs includes cyclophosphamide, ifosfamide, lomustine (CCNU), carmustine (BCNU), and thiopeta. </li></ul> <h2>What happens in the body during puberty</h2> <p>Puberty begins through a chain of events that start in the centre of the brain, in areas called the hypothalamus and pituitary gland. The hypothalamus produces gonadotropin-releasing hormones (GnRH). These hormones then trigger the pituitary gland to produce two hormones called follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Next, FSH and LH trigger the female ovaries or male testes to produce: </p> <ul> <li> the sex hormones needed for puberty: testosterone, progesterone, and estradiol</li> <li> eggs (in girls) or sperm (in boys)</li></ul> <p>Radiation therapy can affect the hypothalamus or pituitary gland. The hypothalamus is more sensitive to radiation than the pituitary gland. </p> <h2>How fertility is affected in girls</h2> <figure> <span class="">Fertility in Girls</span> <img /> <figcaption class="“asset-image-caption”">The hypothalamus and pituitary gland trigger the female ovaries to produce sex hormones, and mature and release eggs.</figcaption> </figure> <p>In girls, the ovaries and the uterus may be damaged by chemotherapy or radiation. These are two organs located in the lower abdomen that are involved in menstruation and reproduction. The ovaries are two almond-shaped organs that produce eggs (ova). Each month an eggs travels to the uterus, a pear-shaped organ, where it is either released in menstruation, or fertilized by a sperm to produce a baby. </p> <p>When a girl receives treatment for a brain tumour, for example with chemotherapy or radiation, this can cause some damage to hormone production. Because of damage or too little hormone production, girls may not start menstruating, or if they have started it may stop (amenorrhea). In most cases, this problem will go away with time and menstruation will return spontaneously. </p> <p>Teenaged girls receiving treatment are at a greater risk of having early menopause. One study showed that girls treated between the ages of 13 and 19 were twice as likely to reach menopause in their 20s, compared with girls who were healthy. Girls who were treated between the ages of 0 and 13 had no greater risk of early menopause. The ovaries can tolerate chemotherapy better than male sexual reproduction organs. </p> <p>During follow-up clinic visits, the development of secondary sexual characteristics such as breast development and underarm hair in girls will be monitored. Growth and height will be recorded on a growth chart. Sex hormone levels will be checked by blood tests if early or late puberty is suspected. </p> <h2>How fertility is affected in boys</h2> <figure> <span class="">Fertility in Boys</span> <img /> <figcaption class="“asset-image-caption”">The hypothalamus and pituitary gland trigger the male testes to produce sex hormones and sperm.</figcaption> </figure> <p>In boys, the testes may be affected. The testes are 2 oval-shaped organs that produce sperm. They are found in the scrotum, which is located behind the penis. The testes contain Leydig cells that produce testosterone, a hormone needed for sexual development. They also contain Sertoli cells that make sperm. </p> <p>As a result of treatment, boys who have reached puberty may not be able to produce sperm because the Sertoli or Leydig cells are damaged. Sometimes this problem will go away with time. It is believed that boys who receive treatment before puberty are less likely to have permanent damage to the testes, compared with boys who have reached puberty. </p> <p>During follow-up clinic visits, the development of secondary sexual characteristics such as testicle development and underarm and facial hair will be monitored. Growth and height will be recorded on a growth chart. Sex hormone levels will be checked with blood tests if early or late puberty is suspected. </p> <h2>What can be done?</h2> <p>For early puberty, there are medications that suppress sex hormones. This treatment keeps hormone levels low until the child is older. If puberty is late, hormone replacement may be given to start puberty. These decisions will be made with the treatment team and the endocrinologist, a doctor who specializes in treating hormone problems. </p> <p>Treatments are constantly being redesigned to try and reduce puberty and fertility problems. Specific treatments are different for girls and boys. </p> <h3>Treatment for girls</h3> <p>Girls may be treated with estrogen for puberty and estrogen/progesterone for menstrual cycles.</p> <p>For girls, certain measures can be taken before treatment to try and preserve fertility. One technique for girls receiving craniospinal radiation is to locate the ovaries by ultrasound to see where they are. If necessary, one ovary is moved out of the path of the radiation beam. This is done by surgery. </p> <p>Another option that is being studied for both sexes is to give patients medicines before therapy that “turn off” the hormones that produce eggs or sperm. The efficacy of this technique is not yet known. The thinking is that treatment seems to have less effect on fertility when it is given to children who have not reached puberty. The medicines try to create that “pre-puberty” state. </p> <h3>Treatment for boys</h3> <p>Boys may receive testosterone to make sure that puberty occurs and they will be able to have normal sexual relations.</p> <p>Teenage boys with cancer have a unique opportunity to father a child in later life, through a process called cryopreservation of sperm, also known as sperm banking. In this program, sperm is collected from the teen soon after he is diagnosed with cancer, and before he starts anti-cancer treatment. The sperm is stored in a special cryopreservation unit until the teen reaches adulthood and is ready to father a child. Studies have shown that teens who have not been offered this opportunity feel disappointed and regretful about it in later life. </p> <p>It is important to offer sperm banking to as many newly diagnosed teen boys as possible. However, there are a number of barriers to overcome. When introducing this idea to the teen and his family, doctors need to address a number of things, including: </p> <ul> <li> how to offer the program to teenage boys without embarrassing them</li> <li> when to introduce the idea, especially if the cancer is life-threatening and needs swift treatment</li> <li> how to address ethical issues related to sperm cryopreservation, such as what role the parents should play in the teen’s decision to join this program </li> <li> how to collect the sperm sample, taking into account the fact that some cultures and religions may oppose the use of masturbation to collect the sample </li> <li> whether to offer alternatives to masturbation, such as procedures called electrovibration or electrostimulation, which may require a waiting time that is not practical when the teen needs to urgently undergo cancer treatment </li> <li> what will happen with the sperm sample if the teen passes away before the sample is used</li></ul> <p>These are considerations that you, your teen, and his health care team will need to address if he wishes to preserve his sperm for future use. If your son is interested in participating in this program, please speak with his oncologist to obtain more details. </p> <h2>How will this affect your child’s future?</h2> <p>Children who are affected may need to remain on hormone therapy for life. In girls, if estradiol (estrogen) deficiency is not treated, there may be an increased risk of osteoporosis and early heart disease in the future. If early puberty is not treated, then the adult height will be shorter than with treatment. </p> <p>Teenaged girls have a greater risk of developing early menopause. As adults, they should not delay in having their babies. They have a greater chance of becoming pregnant in their 20s. </p> <p>However, there is reassuring news for girls from the U.S. Childhood Cancer Survivor Study. This study followed girls who survived childhood cancer into adulthood. It included 276 pregnancies in women who had survived brain tumours. The study showed that most chemotherapy drugs or radiation therapy did not affect the rate of birth when the women were compared to their sisters. However, their rate of miscarriage was higher than that of their sisters. </p> <p>Depending on the treatment, boys may lose their ability to father a child. It is not clear what proportion of boys will be affected. They will likely be able to have normal sexual relations as an adult. </p>Puberty and fertility effects of brain tumour treatment

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