Radiation Therapy for Head and Neck Cancers

Radiation therapy is often used to treat head and neck cancers. Head and neck cancers can also be treated with surgery, chemotherapy, targeted therapy, and immunotherapy. Radiation can be used on its own or with another treatment, such as surgery (before or after) or chemotherapy. Proton therapy, photon therapy, or brachytherapy (internal radiation therapy) may be used for treatment.

What should I expect during treatment?

Before starting radiation therapy, you will have an initial consultation (meeting) with your radiation oncologist to decide if radiation is right for you and to review the treatment consent. If you plan to have radiation, you will have a CT simulation. During the simulation, you will be placed in the position you will be in for your treatments and pictures will be taken of the inside of your body. Immobilization devices (things that help you stay still during treatment) and tattoos are often used to make sure you are in the same position each time you have treatment.

After the CT simulation, a treatment plan will be made for you. During the treatment planning process, your radiation oncologist will decide how many treatments you will have and how often. There are many people on your radiation care team, some you will meet, and others stay behind the scenes.

What side effects should I expect during treatment?

Radiation is used to kill cancer cells but can also hurt normal cells in the treatment area. Some side effects of radiation treatment are caused by your normal cells being harmed. Side effects from radiation are caused by the cumulative effect (the build-up of radiation over time) on the cells. These effects happen over time, and you may not have any side effects until a few weeks into treatment. The possible side effects of radiation therapy are based on the area of the body that is being treated.

You will visit with your radiation care team once a week while you are getting treatment. This visit gives you the chance to ask questions and talk about side effects and how to best manage them. If you start having a new or worsening side effect, you should call your care team. Each patient is different so you may not have all the possible side effects. Talk to your care team about what you can expect from your treatment.

Short-Term Side Effects

Short-term side effects start during or shortly after your radiation treatment. Some of the most common short-term side effects of radiation therapy for head and neck cancer are:

• 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 more irritation, and bathe carefully, using only warm water and mild soap. Do not use perfumed or scented lotions or soaps, and avoid sun exposure, as they may cause more irritation.
• Mucositis (Mouth sores): Tends to start 2 to 3 weeks into treatment and begins to improve about 2 weeks after treatment is done.
• Esophagitis (Swelling of the esophagus): Swelling of the esophagus (the tube that connects your throat to your stomach) that causes pain and discomfort with swallowing. It is described as having a “lump” in your throat. It starts 2 to 3 weeks into treatment and starts to improve 7 to 10 days after treatment is done.
• Xerostomia (Dry mouth): This can include thick or stringy saliva. It starts a few weeks into treatment. This can be a side effect that gets better during the year after treatment, or it can be a permanent loss of saliva production.
• Taste changes: Changes can include a metallic taste and not wanting to eat certain foods. These often get better over time after therapy ends but they can last for a year or longer.
• Fatigue: Fatigue is feeling very tired or exhausted. This is very common and tends to start a few weeks into treatment. Fatigue often gets better slowly over the weeks and months after treatment.
• Nausea: Nausea is when you feel sick to your stomach or may be vomiting. This is common and may start during or right after treatment and last for weeks after treatment ends. If you feel sick or are vomiting, let your care team know so they can help you manage this side effect.
• Alopecia (Hair loss): You may lose hair in the area where you received radiation. Hair often starts to regrow a month or so after treatment. Your hair might not grow back exactly as it was before treatment, and for some people, the hair loss is permanent.
• Ear pain: Can be caused by swelling, infection, or earwax becoming hard. It tends to get better in the weeks following treatment. Sometimes eardrops to soften the wax can be helpful.

Long-Term Side Effects

Long-term effects can happen months to many years after treatment and the risks depend on the area of the body being treated. They can also depend on the radiation techniques that are used. Some of the long-term side effects of radiation to the head and neck are:

• Xerostomia (Dry mouth): This can become a long-term (permanent) issue, which can affect your quality of life and dental health. Your care team can give you instructions for dental care and suggest products to help with the lack of saliva.
• Swallowing problems: Radiation can cause scar tissue to form months to years after treatment. This can lead to swallowing problems starting many years after treatment. Let your care team know if you have any changes in your swallowing.
• Radiation fibrosis: Scarring of muscles that can happen in the treatment area, 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 help.
• Lymphedema: This is chronic (long-term) swelling. Lymphedema of the face, chin, and neck area can happen in rare cases. Tell your care provider if you notice swelling. Physical therapy is used to treat lymphedema. Learn more about reducing the risk of lymphedema.
• Trismus: Also called lockjaw, trismus is not being able to open the mouth normally. This can make it hard to eat, speak, or have dental care. Your care team can recommend jaw exercises to help with trismus.
• Osteoradionecrosis: Radiation harms the healthy gums that cover your jaw bone. The bone becomes exposed. Since the bone isn’t covered, it is more likely to become infected or not be able to heal.
• Secondary Cancer: There is a low risk of developing a second cancer in or near the treatment area. These are called secondary cancers, and they develop from healthy tissue being exposed to radiation. Many of the current types of radiation help limit this exposure, but it is not always possible to prevent all exposure and still have the desired outcomes.

Side effects may be unpleasant, but some treatments can help you deal with them. 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.