Radiation Treatment for Head and Neck Cancers
Radiation therapy is often used to treat head & neck cancers, either before or after surgery. The doses of radiation used to destroy cancer cells can also hurt normal cells in the surrounding area. The damage to these normal cells is the cause of the common side effects of radiation treatment. Thus the possible side effects of radiation therapy are directly related to the area of the body being treated. Side effects are caused by the cumulative effect of radiation on the cells; therefore most patients do not experience any side effects until a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary, disappearing gradually after therapy is complete.
Most radiation oncologists see their patients at least once a week while the patient is receiving treatment. This visit with the healthcare team serves as an opportunity to ask questions, discuss any side effects, and implement any necessary interventions to help relieve the side effects. However, you can report concerning symptoms any time to your treatment team.
The following list includes some of the most common side effects of radiation therapy for head & neck cancers. Remember that the treatment can affect each patient differently, and you may not experience these particular side effects. Talk with your radiation oncologist and health care team about what you can expect from your specific treatment.
- Skin irritation: The skin in the treatment area may become red, irritated, dry, or sensitive. This may progress to look like a sunburn. Treat the skin gently to avoid further irritation, and bathe carefully, using only warm water and mild soap. Avoid perfumed or scented lotions or soaps, as these may cause further irritation. Avoid sun exposure, which can worsen the irritation.
- Sore throat and mouth, which may also be called esophagitis or mucositis. This tends to begin 2-3 weeks into treatment and begins to improve about 2 weeks after treatment is complete.
- Pain when swallowing, caused by the sore throat and mouth. Your oncology team can prescribe pain medications and help with nutritional concerns. If the pain prevents you from eating and drinking properly, a feeding tube may be used during treatment to maintain your nutrition and prevent weight loss.
- Dry mouth and/or thickened saliva, which tends to develop a few weeks into treatment. This can be a temporary side effect, resolving completely or partially over the year after treatment, or result in a permanent loss of saliva production.
- Changes in taste, which can include metallic taste and food aversions. Although the problem of taste changes typically resolves over time after therapy ends, it can persist for a year or longer.
- Earaches, which can be a result of hardening of earwax. These tend to resolve in the weeks following treatment. Sometimes eardrops to soften the ear wax can be helpful.
- Hair loss may occur where you received radiation. Hair typically starts to regrow a month or so after treatment. However, your hair might not grow back exactly as it was before treatment and for some, the hair loss becomes permanent.
- Fatigue is very common with radiation treatment and tends to begin a few weeks into therapy. Fatigue typically resolves slowly over the weeks and months following treatment.
- Swelling or changes in the texture of the skin in the treatment area.
Long-Term Side Effects
The side effects discussed thus far tend to occur during treatment up until a few months after treatment. Long-term effects can occur months to many years after cancer treatment and the risks vary depending on the areas included in the field of radiation and the radiation techniques that were used, as these continue to develop and improve. Some of the potential long-term side effects of radiation to the head & neck includes:
- There is a low risk of developing a second cancer in or near the radiation field. These are called secondary cancers, and they develop as a result of the exposure of healthy tissue to radiation. Modern radiation techniques are designed to limit this exposure, but it is not always possible to prevent all exposure and still achieve the desired outcomes.
- Dry mouth can become a long-term issue for some patients, which can have significant effects on your quality of life and dental health. Your oncology team will give you instructions for dental care and suggest products to help with the lack of saliva.
- Some survivors experience long-term swallowing problems. In addition, radiation can result in the development of scar tissue months to years after treatment, which can lead to swallowing problems developing many years after treatment. Report any changes in swallowing to your oncology team.
- Radiation fibrosis is a scarring of muscles that can occur in the area of treatment, making the muscles feel stiff or tough. These muscles can have spasms, stiffness, pain and/or become weak. Scarring of muscles in the neck can cause the head to be rotated and tilted to the side. Physical therapy, certain medications, and cancer rehabilitation can be very helpful.
- Nerves in the area that is radiated can be damaged or impinged by scar tissue, resulting in weakness or pain in the area.
- Lymphedema of the face, chin and neck area can occur in rare cases. Notify your healthcare provider if you notice swelling. Physical therapy is used to treat lymphedema. Learn more about reducing the risk of lymphedema.
- Trismus is a chronic contraction of the muscle that controls opening and closing of the mouth (TMJ), which results in an inability to open the mouth normally. This can make it difficult to eat, speak or perform dental care. Your oncology team can recommend jaw exercises to help with trismus. For some patients, jaw manipulation by a dentist can be helpful.
- In some cases, a prosthesis (an artificial dental and/or facial part) can be used to restore satisfactory swallowing and speech. A speech language pathologist (SLP) can help manage swallowing difficulties and help with devices and techniques to assist with your speech. SLPs can be accessed at any time in a survivor's life for new concerns, or to explore newer technologies for speech.
There are treatments available for many of these complications. Doctors who specialize in Cancer Rehabilitation Medicine can be very helpful in treating these concerns. After treatment, talk with your oncology team about receiving a survivorship care plan, which can help you manage the transition to survivorship and learn about life after cancer. You can create your own survivorship care plan using the OncoLife Survivorship Care Plan.