Radiation Treatment for Head and Neck Cancers
Radiation therapy uses high energy x-rays to damage the DNA of cells. This kills the cancer cells, or stops them from reproducing. It is used to treat many types of cancer.
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 treated area. The damage to these normal cells is the cause of the common side effects of radiation treatment. The possible side effects of radiation therapy are directly related to the area of the body being treated. If you are getting radiation for head and neck cancer, possible side effects will happen in the area of your head and neck.
What should I expect during treatment?
The side effects of radiation are cumulative, meaning the more treatments you have over time, the higher risk of side effects. Most patients do not have any side effects until a few weeks into their radiation treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary, going away over time once therapy is complete.
You will most often have a visit with your radiation treatment team at least once a week. This visit gives you the chance to ask questions, discuss any side effects, and learn about any necessary interventions to help relieve the side effects. However, you can report any new or worsening symptoms at any time to your treatment team.
Short-Term Side Effects
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 have these particular side effects. Talk with your radiation treatment 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 start 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: Also called esophagitis or mucositis, this tends to begin 2-3 weeks into treatment. It 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: Tends to develop a few weeks into treatment. This can be a temporary side effect, getting better during the year after treatment, or it can be a permanent loss of saliva production.
- Changes in taste: Can include metallic taste and not wanting to eat certain foods. Although the problem of taste changes typically get better over time after therapy ends, it can last for a year or longer.
- Earaches: Can be a result of earwax becoming hard. These tend to get better in the weeks following treatment. Sometimes eardrops to soften the ear wax can be helpful.
- Hair loss: You may lose hair in the area where you received radiation. Hair often 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: Very common with radiation treatment and tends to begin a few weeks into therapy. Fatigue often gets better 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 listed above tend to happen during treatment up until a few months after treatment.
Long-term effects can happen months to many years after cancer treatment and the risks depend on which area of the body had radiation. They also depend on the radiation techniques that were used, as these continue to develop and improve. Some of the possible long-term side effects of radiation to the head & neck are listed below:
- There is a low risk of developing a second cancer in or near the area treated with radiation therapy. These are called secondary cancers, and they develop because healthy tissue is often exposed to radiation. Many of the current 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 a lot of effect 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. This can lead to swallowing problems starting 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 help with swallowing and speech. A speech language pathologist (SLP) can help correct swallowing problems and help 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. Providers 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.
Radiological Society of North America, Inc. (RSNA). (2020). Head and neck cancer treatment. Retrieved from https://www.radiologyinfo.org/en/info.cfm?pg=hdneck
US Department of Health and Human Services: National Institutes of Health. (2013). Head and neck radiation treatment and your mouth. Retrieved from https://www.nidcr.nih.gov/sites/default/files/2017-09/head-neck-radation-treatment.pdf