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Head & Neck: Care of Radiation Therapy Side Effects

Information for people having radiation therapy to their head and neck. 
Side Effects

This does not include radiation to the brain.

Some organs in the head and neck include cervical esophagus, larynx, nasal sinuses, nasopharynx, oral cavity, oropharynx, parotid gland, salivary gland, tongue, and tonsils.

Radiation treatment damages cancer cells but can also affect normal tissues in the treatment area. Damage to normal tissues may cause side effects.

These side effects will vary depending on:

  • The amount of radiation prescribed.
  • The area of your body being treated.
  • The size of the treatment area.
  • Whether or not you are having chemotherapy.

Your BC Cancer health care team will explain which side effects you may have during or after your treatment. You will see a nurse or a doctor regularly during your treatment to talk about your radiation side effects. The doctor you see may not be your radiation oncologist.

If you have a problem or concern between visits with the nurse or doctor, please talk to your radiation therapists who can help you right away.

Fatigue

Fatigue is a feeling of extreme tiredness. If you are fatigued, you may want to rest and sleep more than is normal for you.

There are many causes of fatigue:

  • Radiation therapy
  • Previous treatments
  • Emotional stress
  • Changes in lifestyle

You may be able to continue your normal lifestyle or you may need to adjust your routine according to your energy level. For more information, go to our Managing Fatigue page.

Skin Care

If you are having external radiation therapy, a skin reaction in the treated area is possible. Talk to your BC Cancer health care team about whether this might happen to you.

The skin in the treated area may become warm, dry or itchy. It may change colour (become pink, red, darker or tanned looking) and you may have hair loss in the treated area.

Most skin reactions begin within the first week or so of starting treatment, but timing can be different for each person.  Some people do not have a skin reaction until after their radiation treatment is finished.

Skin reactions usually go away a few weeks after your last treatment. Some skin changes, like skin darkening or scarring, can be permanent (they will never go away).

Here are some tips to protect your skin and help it feel better:

Lifestyle and well-being

  • Be very gentle with the skin in the treated area.
  • Wear loose, comfortable clothing.
  • Protect the treated skin from wind and direct sunlight. If you cannot cover the area, use sunscreen with an SPF of 30 or higher.
  • It is okay to swim as long as your skin is not broken or irritated. It is best to shower right away after swimming: gently wash off the chlorine, pat dry and apply moisturizer

Hygiene and moisturizing

  • Keep your skin moisturized to prevent dryness. There is no evidence that any cream or product is better for this. If you like a certain product or brand, please continue to use it.
  • If you do not have a moisturizer, use one that is water-based (water or aqua is the first ingredient on the list).
  • Once you start your radiation treatment, use the moisturizer many times each day.
  • You can use deodorants and anti-perspirants.
  • When you bathe or shower, use warm water (not hot) and pat dry with a soft towel.
  • Use an electric razor if you want to shave.
  • If you have a skin reaction, your BC Cancer health care team may ask you to use a steroid-based cream or antibiotic on the treated area.

'Do Nots' for the treatment area

  • Do not use perfume, alcohol, astringents, and adhesives on the treated skin.
  • Avoid extremes of hot or cold (heating pads, ice packs, saunas, etc).
  • Do not use hot tubs or Jacuzzis®.
  • Do not rub, scratch, or massage the treated skin.

Mouth and Throat Care

Radiation treatments to the head and neck area may cause side effects including:

  • Dry mouth
  • Sore throat
  • Difficult or painful swallowing
  • Change in sense of taste
  • Hoarse voice
  • Thick saliva

It is very important that you take care of your mouth, teeth and gums. This will help decrease the reactions you may have and prevent infection.

If you have any of the side effects above, follow these instructions for as long as you have them:

  • Rinse your mouth several times a day with bland mouth rinse as follows:
    • Put 500 mL (about 2 cups) of water into a water bottle.
    • Add 5 mL (1 teaspoon) of baking soda. Shake to dissolve.
    • If you do not like the taste of the mouth rinse, add 2.5 mL (1/2 teaspoon) of salt.
    • Use the mouth rinse 3-4 times each day.  You may need to rinse up to 8 times each day.
    • Talk to your health care team about the mouth rinse and what is right for you.
  • Each time you rinse:
    • Put 15mL (1 tablespoon) of rinse in your mouth.
    • Swish in your mouth for 1 minute.
    • Spit it out. Do not swallow.
  • Use the mouth rinse until your mouth returns to normal. This may take many weeks or months.
  • Rinse with bland mouth rinse or water after eating and drinking. Rinse after drinking meal replacement drinks or sports drinks as these have a lot of sugar.
  • Use a soft toothbrush and gently brush your teeth or dentures after every meal. Use the toothbrush to clean your tongue after you brush. Remove dentures at night.

If you have pain or infection, your doctor will prescribe medication for you.

Also, go to our Dry Mouth and Mouth Pain page.

Difficulty Eating, Loss of Appetite, and Weight Loss

You may have difficulty eating and/or have a loss of appetite during your radiation treatment. This may lead to weight loss. It is very important to maintain your weight so that your body shape is the same as when your treatment was planned. Eating well also gives you energy and helps you manage side effects.

Here are some tips:

  • Eat small meals and snacks frequently.
  • Eat high calorie, high protein foods.
  • Eat when your appetite is best.
  • Try to drink at least 8 - 10 cups (2 - 2.5 litres) of fluid each day (unless you are on a fluid- restricted diet).

For more information, go to our Nutrition Information page.

 These handouts may help you:

If you are unsure what to eat or drink, or you are having trouble with weight loss, please ask to speak with a BC Cancer dietitian.

Difficulties with Swallowing or Communication

You may develop difficulty swallowing (dysphagia). Swallowing problems can be related to the cancer or a side effect of the radiation treatment. Radiation treatment can cause scarring and stiffening of your mouth and throat muscles. This means your mouth and throat muscles may not work as well.

These are some signs of swallowing problems:

  • Swallowing extra times to clear food from your mouth and throat
  • Taking longer to finish a meal
  • Having the feeling of food or fluid stuck in your throat
  • Avoiding or adapting certain foods to make swallowing easier
  • Having a gurgly, wet-sounding voice after swallowing
  • Coughing or choking during or after meals
  • Clearing your throat while eating

Speech Language Pathologists (SLP) can help you with:

  • Swallowing
  • Reduced jaw movement (trismus)
  • Communication (speech and voice changes)
  • Lymphedema management (swelling)

To help minimize side effects and open your mouth wide:

  • Continue to eat and drink whenever possible
  • Complete a swallowing exercise plan (your SLP will give you one)

Please go to our Speech-Language Pathology page for more details, including contact information for SLP services at each cancer centre.

Nausea and Vomiting

If your stomach is included in the treatment area, you may have nausea (feeling sick to your stomach) or vomiting. We suggest a non-prescription medication, Dimenhydrinate (Gravol ®). If nausea and vomiting is more frequent or severe, talk to your BC Cancer health care team about a stronger medication.

Weight loss and dehydration (loss of water from the body) can happen with vomiting. It is important to try to drink 6-8 cups (1.5 – 2 litres) of fluids daily and maintain a healthy diet

Here are some food and drink suggestions when you have nausea and vomiting:

  • Write down all of the things that give you nausea or make you vomit.
  • Eat and drink what works for you. Try foods that have made you feel better in the past.
  • These might be bland foods, sour candy, dry crackers, toast, flat ginger ale, or flat soda.
  • Try not to eat your favorite foods when you have nausea or vomiting. This may cause you to dislike them when you are feeling well.
  • Try eating small meals more often instead of three large meals a day.
  • Sip fluids often during the day including water, juice, soups, broths, sports drinks, herbal tea, or nutritional drinks such as Ensure®.
  • Try chewing food slowly and well.
  • Eat foods that are lukewarm or cold. The smell of hot foods may make your nausea worse.
  • Do not eat fatty, fried, very spicy, or very sweet foods.

If you are not sure what fluids to drink or foods to eat, talk to your BC Cancer health care team.

You can also speak with a BC Cancer dietitian or call 8-1-1 and ask to speak with an oncology dietitian. For more information, go to our Nausea & Vomiting page.

Pain

If you have pain from your cancer or radiation treatment, please tell your BC Cancer health care team. Also, go to our Pain from Cancer page.


Support Services

BC Cancer helps those living with or affected by cancer to cope with the physical, practical, emotional, and psychological aspects of their care.

If you have any questions or concerns, please talk to your BC Cancer health care team.

Alcohol and Smoking

Alcohol and Smoking

Please try not to smoke during your treatment. Smoking may cause more irritation and increase the side effects you experience.

Stopping smoking has major and immediate benefits for people of all ages. It:

  • Helps improve your body's ability to heal.
  • Improves your body's response to cancer treatment.
  • Lowers the risk of your cancer returning or another cancer developing.
  • Lowers your risk of pneumonia and respiratory failure (when your lungs cannot work properly).

If you use tobacco or have recently quit, ask your BC Cancer health care team for more information. You can also go to our Smoking Cessation Program page.

Depending on the area of your body being treated, alcohol may worsen your side effects. Small amounts of alcohol may be fine for some people. Please check with your BC Cancer health care team.

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