The lungs are the organs responsible for supplying oxygen to the body and ridding it of carbon dioxide. Sometimes, treatments given for children's cancer can cause lung damage. If a patient received bleomycin during treatment for childhood cancer, it is important that they learn about certain lung problems that can occur from this treatment, which may include:

Interstitial Pneumonitis (Lung Inflammation)
Interstitial pneumonitis is inflammation of the thin layer of tissue between the air sacs (alveoli) in the lungs. This inflammation can worsen if a person develops lung infections, such as pneumonia. Interstitial pneumonitis sometimes develops after exposure to toxic fumes, tobacco, or high levels of oxygen given over several hours.

Pulmonry Fibrosis (Lung Scarring)
Pulmonary fibrosis is the formation of scar tissue in the small air sacs (alveoli) of the lungs. Scarring makes the lungs stiffer and affects the exchange of oxygen and carbon dioxide in the alveoli. Pulmonary fibrosis may worsen over time and can sometimes lead to early heart failure.

Acute Respiratory Distress Syndrome (ARDS)
Breathing problems associated with high levels of oxygen and/or intravenous fluids
ARDS is a serious condition that occurs when alveoli in the lungs are damaged and can no longer provide oxygen to the body. People who have received bleomycin; may be at risk for developing ARDS, usually as a result of a combination of high levels of oxygen and large amounts of intravenous fluid given during surgery. However, the risk of developing ARDS is very low. When undergoing a medical procedure requiring oxygen or general anesthesia, patients must tell their surgeon, anesthesiologist, and other healthcare providers that they have received bleomycin for treatment of childhood cancer.

Factors that Increase the Risk of Developing Lung Problems

  • High total doses of bleomycin (400 units/m2 or more in all doses combined)
  • Radiation to the chest or lungs, or total body irradiation (TBI)
  • Treatment with other chemotherapy drugs that can also damage the lungs
  • Exposure to high oxygen levels (such as during general anesthesia or SCUBA diving)
  • Smoking

Recommended Monitoring

  • Yearly medical check-up
  • A chest X-ray and pulmonary function tests may show lung problems that are not apparent during a check-up. For this reason, it is helpful to have these tests done at least once (at least 2 years after completing cancer treatment) to find out if there are any problems. Your healthcare provider can decide if further testing is needed based on these results.
  • Chest X-ray and pulmonary function tests should be repeated before any scheduled surgery that requires general anesthesia to check for changes in the lungs that could increase the risk of breathing problems during or after anesthesia.

Special Precautions
If a patient received therapy with bleomycin, he or she should:

  • Avoid SCUBA diving. During SCUBA diving, increased underwater pressures and high oxygen levels can damage the lungs.
  • Tell the surgeon, anesthesiologist, and other healthcare providers about their medical history before any scheduled procedures that may require oxygen.
  • Avoid breathing high concentrations of oxygen whenever possible, especially for long periods of time (such as over several hours). If the patient requires oxygen, monitoring of the oxygen levels can usually be done so that he or she can receive the lowest oxygen concentration necessary.
  • Get the pneumococcal (pneumonia) vaccine.
  • Get yearly influenza (flu) vaccines.

Don't smoke. If the patient currently smokes, he or she should talk to his or her healthcare provider about starting a program to quit.

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