(Bone Problems / Hot flushes or Sweats / Thyroid problems or Ovarian, Pituitary & Testicular Insufficiency)

Endocrine consequences of cancer treatment are very common after a wide range of treatments. They can be extremely debilitating and can include loss of fertility, impact on sexual function, fatigue, hot flushes, cardiovascular metabolic disorders, bone disease and hypothyroidism.

Bone Problems

Most people who have treatment for cancer as a young adult will not get bone problems. Bone problems can develop during or shortly after treatment finishes. They can also happen a long time after treatment.

Hormonal therapy to treat breast cancer can increase the risk of bone thinning – this is called osteoporosis. This may mean you are more likely to get a break (fracture) in a bone.

Radiotherapy to the pelvic area may increase the risk of small insufficiency fractures (stress fractures) in the pelvis, but this is not common.

Steroid treatments can also weaken the bones and increase the risk of osteoporosis.

Corticosteroids, radiotherapy and certain other drugs can lead to a loss of blood supply to the bone, causing bone tissue to die, leading to pain, reduced range of movement and a potential collapse of the bone, this is known as Avascular Necrosis (AVN)

If you have pain or aching in the bones, tell your cancer team. It can be caused by many different conditions, but it is important to get it checked.

Not smoking, eating a healthy, balanced diet and doing weight-bearing exercises such as walking can help you look after your bones. 

For more information on the effects on the bones, please follow the below links:

Bone changes | CCLG - The Children & Young People's Cancer Association

Late effects - Bone health: Osteoporosis | CCLG - The Children & Young People's Cancer Association

Late effects - Bone issues: Osteonecrosis and osteoradionecrosis | CCLG - The Children & Young People's Cancer Association

Understanding the late effects of cancer treatment | Macmillan Cancer Support

Hot Flushes and Sweats

Hot flushes and sweats can be caused by some cancer treatments. Find out more about ways to reduce their severity and how often they happen.

Hot flushes and sweating from cancer treatment | Macmillan Cancer Support

Menopause and cancer - coping with symptoms | Macmillan Cancer Support

Hot Flushes And Sweats In Women | Coping With Cancer | Cancer Research UK

If you develop hot flushes as a new symptom, please see your GP

Hot flushes for patients who can’t have HRT

For some patients, treatment can cause hot flushes where treatment with HRT or testosterone replacement is not appropriate.

Patients might have had:

• Breast Cancer
• Ovarian / Endometrial Cancer

You may already have non hormonal medication to help manage your hot sweats, if not , speak to your treating team or GP.

Top tips for managing hot sweats:

• Mind & Body Practices: Regular exercise, yoga and meditation can lower stress induced hot flushes
• Triggor Avoidance: Limit spicy foods, caffeine, alcohol
• Keep cool: use fans, cotton bedding and wear layers, wear natural fibres like cotton
• Use a Chiilow or cold packs
• Stress can cause flushing for some patients, managing stress through identifying stressors, adopting healthy habits like exercise, social interaction and relaxation techniques. Acupuncture has also been recognise to help with this.

Please speak to your treating team or GP if you are having difficulty managing your hot flushes

Please see below for more information:

Hot Flushes And Sweats In Women | Coping With Cancer | Cancer Research UK

Treatments That Cause Sex Hormone Symptoms | Coping With Cancer | Cancer Research UK

Menopause Post-Cancer: Tips for Night Sweats and Hot Flushes

Managing Your Hot Flashes Without Hormones | Memorial Sloan Kettering Cancer Center

Ovarian Insufficiency

Some cancer treatments can affect the way the ovaries work.

Before the menopause, the ovaries produce the hormones oestrogen and progesterone. These control your monthly cycle (periods). During the menopause, the ovaries stop producing these hormones and periods gradually stop. This usually happens naturally between the ages of 45 and 55.

Ovarian insufficiency or premature ovarian insufficiency (POI) occurs when ovaries stop functioning normally before age 40 due to cancer treatment. It causes infertility, early menopause, hot flashes, and long-term risks like osteoporosis and cardiovascular disease. Management includes hormonal replacement therapy (HRT) and fertility preservation. 

Patients at risk of this are:

• Patients who have received chemotherapy that can cause temporary or permanent infertility
• Surgery to remove both of the ovaries
• Radiotherapy to the pelvis
• Diagnosis that might have treatment that can affect fertility include:
• Cancers of the brain and nasopharynx
• Ovarian  / gynaecological cancer
• Blood cancers
• Colorectal cancer
• Breast cancer
• Bladder cancer
• Pancreatic cancer

This change in hormone levels can cause menopausal symptoms.

These include:

• Hot flushes and sweats
• Vaginal dryness
• Loss of interest in sex
• Difficulty sleeping
• Dry skin
• Aches and pains
• Needing to pass urine (pee) more often
• Weight gain
• Mood swings
• Loss of confidence
• Poor concentration.

If you are experiencing these symptoms, please see your GP, as you may need a referral to an endocrinologist

For more information please see the links below

Menopause and cancer - coping with symptoms | Macmillan Cancer Support

cclg-lefs-female-repro-2022.pdf

Questions about cancer and fertility | CCLG - The Children & Young People's Cancer Association

Menopausal symptoms and cancer treatment | Cancer Research UK

Pituitary Insufficiency

Pituitary Insufficiency is where the pituitary gland fails to produce enough ACTH (adrenocorticotropic hormone) which is the signal for the adrenal glands to release cortisol. This can also cause deficiencies in other hormones such as the thyroid stimulating hormone. Pituitary insufficiency is a cause of cortisol insufficiency

Patients at risk of this may have had:

• Treatment for brain tumours or brain metastasis
• Treatment for cancers of nasopharynx, orbit or surrounding tissue
• Treatment for Blood cancers
• Symptoms of Pituitary Insufficiencies are:
• Fatigue, weakness
• Depression
• Weight loss, loss of appetite
• Sexual dysfunction, loss of libido, erectile dysfunction
• Irregular / no periods
• Vaginal dryness
• Hot flushes
• Fertility problems
• Symptoms of hypothyroidism

If you are experiencing these symptoms, please see your GP, as you may need a referral to an endocrinologist

For further information, see the links below

cclg-late-efcts-pituitary-gland-2022.pdf

Endocrine problems | CCLG - The Children & Young People's Cancer Association

Adrenal  / Cortisol Insufficiency

Adrenal insufficiency is when your body does not make enough cortisol hormone. Cortisol allows the body to cope with stress when there is illness or injury. Cortisol is made by your adrenal glands, located above the kidneys. Cortisol is controlled by hormones produced by the pituitary gland in your brain. Adrenal  / Cortisol insufficiency is when your adrenal gland can’t produce enough cortisol.

Patients at risk of this may have had:

• Long term, high dose steroids
• Immunotherapy treatments
• Cancer of the adrenal gland
• Chemotherapy has affected the adrenal gland
• Surgery to remove the adrenal gland
• Cancer of the brain

Symptoms of Adrenal insufficiency:

• Debilitating fatigue and muscle weakness.
• Loss of appetite and weight loss, abdominal pain
• Dizziness, fainting, or low blood pressure.
• Nausea and stomach pain.

If you are experiencing these symptoms, please see your GP.

Please see the links below for more information

cclg-late-efcts-adrenal-insufficiency-2022.pdf

Both Cortisol insufficiency and pituitary insufficiency lead to low cortisol levels

Testicular Insufficiency

Primary testicular insufficiency is when the testes are damaged

Secondary testicular insufficiency is when damage occurs to the pituitary/hypothalamus

Patients at risk of this may have had:

• Treatment for cancers of the brain
• Treatment for cancers of nasopharynx, orbit or surrounding tissue
• Treatment for Testicular cancer
• Treatment for Colorectal  / anal cancer
• Treatment for Bladder Cancer
• Treatment for Blood cancer

Symptoms of testosterone insufficiency are:

Reduced libido

• Erectile dysfunction
• Fertility problems
• Reduced frequency of shaving
• Reduced muscle bulk
• Osteoporosis/fragility fracture
• Hot flushes, night sweats, palpitations
• Problems with memory and Concentration

If you are experiencing these symptoms, please see your GP, as you may need a referral to an endocrinologist

Thyroid Problems

Thyroid problems such as hypothyroidism, hyperthyroidism and thyroid nodules (growths)  are potential late effects of cancer treatment.

Patients at risk may have had:

Brain/head and neck cancers

• Pituitary tumours
• Thyroid cancer
• Breast cancer
• Blood Cancer

Symptoms of thyroid problems include:

• Fatigue
• Weight loss or weight gain
• Heat or cold intolerance
• Diarrhoea or constipation
• Anxiety, tremors, sweating
• Dry hair or skin
• Hair loss
• Menstrual disturbance
• Neck lump

If you are experiencing these symptoms, please see your GP, as you may need a referral to an endocrinologist