Oral Complications Of Head And Neck Radiotherapy
Oral Mucositis: TABLE 2
Fungal/Bacterial/Viral Infections:Due to changes in the saliva, which has antibacterial properties, there are alterations in oral microflora resulting in bacterial and fungal infections. Oral candidiasis is common due to an overgrowth of fungi. It is usually found at the corners of the mouth, oropharynx, lateral and posterior boarders of the tongue, and under dentures. It may be more important to prevent rather than treat oral candidiasis.
Viral infections are often seen in irradiated, immunocompromised patients as oral ulcerations caused by reactivation of latent herpes simplex virus.
Taste Changes:Teeth:Trismus:Alveolar Bone:osteoradionecrosis
How Long Do Side Effects Last
Remember that the type of radiation side effects you might have depends on the prescribed dose and schedule. Most side effects go away within a few months of ending treatment. Some side effects may continue after treatment ends because it takes time for the healthy cells to recover from radiation.
Side effects might limit your ability to do some things. What you can do will depend on how you feel. Some patients are able to go to work or enjoy leisure activities while they get radiation therapy. Others find they need more rest than usual and cant do as much. If you have side effects that are bothersome and affecting your daily activities or health, the doctor may stop your treatments for a while, change the schedule, or change the type of treatment youre getting. Tell your cancer care team about any side affects you notice so they can help you with them.
Your Role On Your Radiation Therapy Team
Youre part of your radiation therapy team, and your role includes:
- Arriving on time for all of your radiation therapy appointments.
- Asking questions and talking about your concerns. We have included a list of possible questions at the end of this resource.
- Telling someone on your radiation therapy team when you have side effects.
- Telling your doctor or nurse if youre in pain.
- Caring for yourself at home, including:
- Quitting smoking, if you smoke. If you want to quit, call our Tobacco Treatment Program at .
- Following your healthcare teams instructions to care for your skin.
- Drinking liquids as instructed by your healthcare team.
- Eating the foods suggested by your healthcare team.
- Maintaining your weight.
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If Youre Having Radiation Therapy To The Pelvis
Radiation therapy to the pelvis can cause side effects such as:
- Bladder problems
- Fertility problems
- Changes in your sex life
You might also have some of the same problems people get from radiation to the abdomen, such as nausea, vomiting, diarrhea, or constipation.
Radiation to the pelvis can cause problems with urination, including:
- Pain or burning sensations
- Blood in the urine
- An urge to urinate often
Most of these problems get better over time, but radiation therapy can cause longer-term side effects as well:
- Radiation cystitis. If the radiation damages the lining of the bladder, radiation cystitis can be a long-term problem that causes blood in the urine or pain when passing urine.
- Urinary incontinence. Radiation treatments for certain cancers, such as prostate and bladder cancer, may make you unable to control your urine or have leakage or dribbling. There are different types and degrees of incontinence, but it can be treated. Even if incontinence cant be corrected completely, it can still be helped. See Bladder and Bowel Incontinence to learn more. This side effect is most often a problem for men being treated for prostate cancer, but some of the information might also be helpful for women dealing with treatment-related incontinence.
If Youre Getting Radiation Therapy To The Chest
Radiation treatment to the chest may cause side effects such as:
Radiation can also cause other problems in the heart or lungs.
Getting radiation to the middle portion of the chest can raise your risk of heart disease. This risk increases with higher radiation doses and larger treatment areas in this part of your body. Radiation can also cause hardening of the arteries , heart valve damage, or irregular heartbeats.
Radiation pneumonitis is inflammation of the lungs that can be caused by radiation treatment to the chest . It may occur about 3 to 6 months after getting radiation therapy. Its more likely if you have other lung diseases, like emphysema . Common symptoms of radiation pneumonitis include:
- Shortness of breath that usually gets worse with exercise
- Chest pain, which is often worse when taking in a deep breath
Sometimes there are no symptoms, and radiation pneumonitis is found on a chest x-ray.
Symptoms often go away on their own, but if treatment is needed, it is based on trying to decrease the inflammation. Steroids, like prednisone, are usually used. With treatment, most people recover without any lasting effects. But if it persists, it can lead to pulmonary fibrosis . When this happens, the lungs can no longer fully inflate and take in air.
Be sure you understand what to look for, and tell your cancer care team if you notice any of these side effects.
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Changes To Your Concentration And Memory
After treatment for a head and neck cancer, some people have difficulty concentrating and remembering things. Doctors call these cognitive changes .
Changes in memory or concentration are usually mild. They often get better within a year of finishing treatment. Sometimes they can go on for longer, or have more of an impact on your day-to-day life.
We have more information about cognitive changes.
Treatment Areas And Possible Side Effects
|Part of the body being treated
|Possible side effects
Healthy cells that are damaged during radiation treatment usually recover within a few months after treatment is over. But sometimes people may have side effects that do not improve. Other side effects may show up months or years after radiation therapy is over. These are called late effects. Whether you might have late effects, and what they might be, depends on the part of your body that was treated, other cancer treatments you’ve had, genetics, and other factors, such as smoking.Ask your doctor or nurse which late effects you should watch for. See the section on Late Effects to learn more.
- Reviewed:January 11, 2022
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Problems Eating And Drinking
- reduced sense of taste
Tell your care team if you have any of these problems. They may recommend painkillers or a special mouthwash that can help. Avoiding spicy, salty or sharp foods can also help.
Mucositis usually gets better a few weeks after treatment finishes, although sometimes a dry mouth can be a long-term problem.
A Dry Mouth And Changes To Your Saliva
Radiotherapy or chemoradiation to the head or neck can affect your salivary glands. This means that you may not make as much spit as before and so your mouth may become dry.
Your salivary glands may gradually recover after treatment finishes, but your saliva may be thicker and sticky. Some people have a dry mouth permanently.
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Benefits Of Proton Therapy
In treatment of head and neck cancers, proton therapy can reduce or avoid radiation to surrounding healthy tissue and organs.
Depending on the tumor location and type, proton therapy may achieve the following benefits:
- Reduced risk of painful sores in the mouth during treatment.
- Reduced risk of dental decay after radiation.
- Reduced risk of problems swallowing during or after therapy.
- Reduced risk of hoarseness during treatment.
- Reduced risk of dry mouth after radiation.
- Reduced risk of hearing loss after radiation. This is relevant for tumors near the cochlea, such as those in the nasopharynx, paranasal sinuses, or skull base.
- Reduced risk of hormone imbalances which can particularly affect growth and development in children and young adults. This is relevant for tumors near the pituitary and hypothalamus, such as those in the nasopharynx, paranasal sinuses, or skull base.
- Reduced radiation to the bone marrow and circulating lymphocytes, which may help support the function of the immune system in fighting cancer.
- Reduced risk of developing a future second tumor or cancer, which is most relevant in younger patients, those with a good prognosis and a long life expectancy, and those patients who may have genetic conditions putting them at higher risk for developing other cancers.
Preventing And Controlling Oral Complications Can Help You Continue Cancer Treatment And Have A Better Quality Of Life
Sometimes treatment doses need to be decreased or treatment stopped because of oral complications. Preventive care before cancer treatment begins and treating problems as soon as they appear may make oral complications less severe. When there are fewer complications, cancer treatment may work better and you may have a better quality of life.
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What Is A Late Effect
A late effect is a side effect that is caused by cancer treatment but happens months to years after cancer treatment has finished. Some side effects that you develop during treatment can last for months to years after treatment is completed . These are called long-term side effects.
Late effects can be health issues or psychological, emotional, and practical challenges.
Effects On Your Sex Life
The physical and emotional effects of cancer and its treatment may affect your sexual confidence or ability to have sex. You may lose interest in sex, feel unattractive or worry that you will never be able to be sexually active. For some people, these problems continue after treatment is over.
After treatment, some people have problems with their body image and self-esteem. Others may be left with a low sex drive or have sexual difficulties as a result of the physical effects of treatment. Changes to your face, mouth and neck can change how you feel about kissing and having sex. Most difficulties will improve over time.
You may feel too exhausted to have sex during treatment and for a while afterwards. Most people find that this gradually improves, but occasionally it can last for months or even longer.
If you have problems with pain, this may affect your sex drive. Controlling the pain may improve your desire to have sex.
Some treatments can temporarily affect periods. Often periods return to normal after treatment ends but sometimes they stop permanently. This can lead to an early menopause.
We have more information about cancer and your sex life.
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Late Effects After Radiation For Head And Neck Cancer
Side effects from radiation treatment are directly related to the area of the body being treated. Any area in the treatment field has a risk of being damaged by radiation, causing side effects. The way radiation is given has changed over the years, leading to a lower risk of late effects.
Some of the possible long-term side effects of radiation to the head & neck include:
There are treatments available for many of these issues. Doctors who specialize in Cancer Rehabilitation Medicine can be very helpful in treating these concerns. You should see a dentist regularly and perform good oral hygiene . You should avoid smoking, secondhand smoke, vaping, hookah, and using oral tobacco products, which can make oral problems from radiation worse.
Because the head & neck treatment field can encompass several other structures and organs, the risks to these areas are discussed below. Talk with your radiation oncologist to find out which areas were in your treatment field.
Hearing and Ear Changes
Radiation to the head can damage the cochlea , and/or the ear canal. This can cause hearing loss, dryness of the ear canal, and fluid collection in the inner ear. These problems could result in:
- A full or clogged ear feeling.
- Ringing in the ears .
If you are having any of these issues, you should call your provider. An audiogram or seeing an audiologist can determine how to treat these side effects.
Damage to the Salivary Glands
Damage to the Bones
Signs of sinusitis include:
Forgotten Patients: New Guidelines Help Those With Head
Like many cancer patients, Jennifer Giesel has side effects from treatment.
Thereâs the neuropathy in her hands, a holdover from chemo. Thereâs jaw stiffness from her multiple surgeries: an emergency intubation when she couldnât breathe due to the golf ball-sized tumor on her larynx and two follow-up surgeries to remove the cancer. And then thereâs hypothyroidism and xerostomia, or dry mouth, a result of the 35 radiation treatments that beat back the cancer but destroyed her salivary glands and thyroid.
âI went to my primary care doctor a couple of times and mentioned the side effects,â said the 41-year-old laryngeal cancer patient from Cleveland, who was diagnosed two years ago. âShe was great but she didnât seem too knowledgeable about what I was telling her. She was like, âOh really?â It was more like she was learning from me.â
âHead-and-neck cancer survivors can have enormous aftereffects from the disease and treatment by virtue of the location of the primary tumor,â said Dr. Gary Lyman, a public health researcher with Fred Hutchinson Cancer Research Center who helped create the guidelines. âThere are functional interruptions, like losing the ability to talk, eat or taste. And some of the surgeries can be disfiguring.
Currently, there are more than 430,000 head-and-neck cancer, or HNC, survivors in the U.S., accounting for around 3 percent of the cancer patient population.
An isolating group of diseases
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Reducing The Risk Of Radiation
While neck radiation can cause serious side effects, there are steps you can take in advance to lessen these adverse reactions.
The goal when prescribing and delivering radiation therapy as part of a patients treatment plan is to reduce the risks as much as possible, says Kamal M. Patel, MD, doctor of radiation oncology at Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, IL. However, when radiation therapy is indicated as a treatment option, patients may experience some acute side effects, including fatigue, sunburn and blistering of the skin, as well as a severe sore mouth and throat. Patients can also experience some long-term side effects, such as skin fibrosis or ulceration, hypothyroidism, permanent problems with swallowing, permanent dry mouth, risk of permanent damage to the jaw/TMJ, life-threatening vessel perforation, brachial plexopathy, spinal cord paralysis and risk of secondary malignancies.
Fatigue down to the bones exhaustion is another radiation side effect. We knew there would be fatigue, says Peggy. What we didnt learn until months later is that Toms lack of energy is essentially chronic, and that a man who used to live very efficiently on less than 6 hours of sleep a night now needs well over 8 and even that is not sufficient to sustain the level of activity he needs to do his job and normal daily activities.
Damage To The Ear And Hearing Loss
Patients who undergo RT for HNC can develop hearing especially when receiving 60 Gy. Complaints include ear heaviness, earache, decreased hearing, tinnitus, and dizziness. Dose of radiation is directly proportional to ototoxicity .
Radiation to the ears may result in serous otitis . It is associated with fluid collection in the middle ear and temporary reduced hearing. Serous otitis and conductive deafness are reversible over time. High doses of radiation can cause sensorineural hearing loss due to damage to the inner ear, the auditory nerve, or the vestibular apparatus. This condition is not reversible. Damage to the vestibular apparatus can cause dizziness and vertigo.
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Combined Radiation And Chemotherapy
Combined modality therapy plays a central role in the management of head and neck cancers. Clinical studies have suggested that combining chemotherapy with radiation is better than using either treatment alone for the treatment of head and neck cancers. For example, three large studies involving patients with throat cancer have shown that treatment with radiation plus chemotherapy lead to longer survival rates and a lower rate of recurrence than treatment with radiation alone. Currently, clinical trials are ongoing to determine the optimal chemotherapy combinations and sequencing of radiation.
Effects of treatment with radiation and chemotherapy vs radiation alone in three studies of patients with throat cancer
If Youre Getting Radiation Therapy To The Head Or Neck
People who get radiation to the head and neck might have side effects such as:
- Soreness in the mouth or throat
How to care for your mouth during treatment
If you get radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth, and throat. Here are some tips that may help you manage mouth problems:
- Avoid spicy and rough foods, such as raw vegetables, dry crackers, and nuts.
- Dont eat or drink very hot or very cold foods or beverages.
- Dont smoke, chew tobacco, or drink alcohol these can make mouth sores worse.
- Stay away from sugary snacks.
- Ask your cancer care team to recommend a good mouthwash. The alcohol in some mouthwashes can dry and irritate mouth tissues.
- Rinse your mouth with warm salt and soda water every 1 to 2 hours as needed.
- Sip cool drinks often throughout the day.
- Eat sugar-free candy or chew gum to help keep your mouth moist.
- Moisten food with gravies and sauces to make it easier to eat.
- Ask your cancer care team about medicines to help treat mouth sores and control pain while eating.
If these measures are not enough, ask your cancer care team for advice. Mouth dryness may be a problem even after treatment is over. If so, talk to your team about what you can do.
How to care for your teeth during treatment
Radiation treatment to your head and neck can increase your chances of getting cavities. This is especially true if you have dry mouth as a result of treatment.
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