More people are living longer after cancer than ever before. For example, in the United States, millions of people with a history of cancer are alive today. Many of them were diagnosed many years ago. As more and more people live longer after cancer, there are now new problems caused by cancer, its treatment, or both. These problems are called late effects. They can happen months or years after treatment ends.

Researchers and health care providers are trying to figure out why people have late effects, who might be more at risk for getting them, and what can be done to prevent or manage them. Late effects may include physical problems, psychological effects, a second cancer, and other problems. Late effects can depend on:

• The type of cancer you had.
• The age you were when you were diagnosed and treated.
• The type of treatments you had.

Having cancer does not mean that you'll have late effects. Ask your care team about your risk for late effects, what they might be, what you can do to help prevent them, and how to manage them if you do have them.

Physical problems can affect any part or function of the body. Some people develop problems with their bones, muscles, hearing, breathing, stomach, kidneys, bladder, blood, or bone marrow. Other people may have hormone problems. For example, children may have growth and puberty problems. Or adults may have premature menopause, infertility, or sexual problems. Some people have only one problem, while others may have more than one. It's not known why this happens to some people and not to others.

Here are a few treatments and common late effects linked to them. Please remember that this list is not complete. Talk with your doctor so you know what to watch for.

• Radiation. The late effects of radiation depend on what part of the body was treated and how much radiation was given. For example, if your head was treated with radiation, possible late effects can include cataracts and dental problems. If your belly (abdomen) or pelvic area was treated, bowel or bladder problems could develop. Radiation to the chest area can increase the risk of cardiovascular disease as well as breast cancer, especially if radiation is used at a younger age.
• Surgery. The late effects of surgery also depend on what part of the body was operated on and what was done. If you had lymph node surgery, you may develop swelling of the arm or leg (lymphedema). If you had abdominal surgery, scar tissue can sometimes cause bowel problems.
• Chemotherapy (chemo). Chemo late effects depend on the type and amount of medicines given. Some medicines can cause heart and lung damage. Others can affect nerves or cause memory problems. Very rarely, chemo can damage the bone marrow and lead to leukemia.

• Learning disabilities. Some cancers and their treatments can cause learning problems. These problems can affect how someone learns and remembers things. For example, many people who are treated for brain tumors need cognitive rehabilitation to train them how to remember and learn things. Researchers are also studying a phenomenon called chemo brain. This happens when attention, memory, and other thinking functions are affected by chemotherapy.
• Emotional problems. Worrying about having tests or about the cancer coming back is normal. But when the worry or fear takes over your life, you may need help. Depression and post-traumatic stress disorder (PTSD) are possible effects of cancer and its treatment. You may also be depressed because of problems caused by late effects. For example, if your cancer or treatment caused you to be infertile or sterile, you may be depressed about not being able to have children.

Depression is a serious illness. If you are depressed, you may:

• Focus on the bad things.
• Not enjoy life.
• Feel that life isn't worth living.
• Feel like you're a burden to others.
• Feel like you don't deserve any help.
• Not have energy.
• Stay away from friends and family.

Some people who live through cancer develop PTSD. This means that they have a hard time adjusting to having cancer or to life after cancer. If you have PTSD, you may:

• Have dreams or flashbacks about your cancer or treatment.
• Feel very scared, angry, or upset by certain sights, sounds, or smells.
• Have sleep problems.
• Have trouble thinking clearly.

If you think you have depression or PTSD, it's important to get help. Your care team can suggest a counselor for you to talk to or prescribe medicines that can help.

Developing a second cancer is not common. But it can happen. You could get a second cancer from the treatment you received to cure your first cancer. Chemotherapy and radiation are two treatments that may cause a second cancer. Also, cancer runs in some families who may be more likely to get more than one cancer. If you do things that increase your cancer risk, like using tobacco, you could also get a second cancer.

Ask your doctor what cancers you might be at higher risk for and what you can do to either reduce your risk for them or find them early. In some cases, the doctor may suggest having more frequent cancer screenings.

It's important to talk to your doctor about late effects. Your doctor can tell you which problems you could be at risk for, what you can do to help prevent them, and how to manage them if they occur. Remember that many people who've had cancer don't develop any late effects.

See your doctor for regular checkups. Ask if there are programs and support groups for people who've had cancer and their families. And remember that if you feel worried or depressed or are having a hard time coping, talk with a mental health provider. This might be a licensed clinical social worker, a clinical psychologist, or a psychiatrist.

Living with cancer is hard. Sometimes life after cancer can be hard too. There is help.