Side effects from head and neck and cancer therapy include the following.
Appetite changes are common with cancer and cancer treatment, including chemotherapy. Individuals with a poor appetite or appetite loss may eat less than usual, not feel hungry at all, or feel full after eating only a small amount. Ongoing appetite loss can lead to weight loss, malnutrition and loss of muscle mass and strength. The combination of weight loss and loss of muscle mass, also called wasting, is referred to as cachexia.
Diarrhea is frequent, loose or watery bowel movements. It is a common side effect of certain chemotherapeutic drugs or of radiation therapy to the pelvis, such as in women with uterine, cervical or ovarian cancers. It can also be caused by certain tumors, such as pancreatic cancer.
Difficulty chewing can result from pain in the mouth, stiffness or pain in the jaw muscles, scarring or problems with the teeth. Difficulty chewing can be a result of physical changes to the mouth, jaw or tongue caused by cancer itself, especially oral and oropharyngeal cancers, or it can be a side effect of cancer treatment, especially from radiation therapy and surgery. For patients who wear dentures, pain or swelling in the mouth or gums may make it temporarily impossible to wear dentures for chewing. Difficulty chewing meats, fruits and vegetables can make it difficult to eat a nutritious diet.
Difficulty Swallowing (Dysphagia)
Dysphagia occurs when a patient has trouble getting food or liquid to pass down the throat. Some patients may gag, cough or choke when trying to swallow, while others experience pain or feel like food is stuck in their throat. Difficulty swallowing is a relatively common side effect of some cancer treatments. Potential side effects of cancer treatment that can cause swallowing difficulties include soreness, pain or inflammation in the throat, esophagus or mouth (mucositis); dry mouth from radiation treatment or chemotherapy; infections of the mouth or esophagus from radiation treatment or chemotherapy; swelling, scarring or constriction of the throat or esophagus from radiation treatment or surgery; and physical changes to the mouth, jaw, throat or esophagus as a result of surgery. Difficulty swallowing may be a long-term problem after treatment with radiation therapy.
Dry Mouth (Xerostomia)
Xerostomia occurs when the salivary glands do not make enough saliva to keep the mouth moist. Because saliva is needed for chewing, swallowing, tasting and talking, these activities may be more difficult with a dry mouth. Dry mouth can be caused by chemotherapy or radiation treatment, which can damage the salivary glands. Dry mouth caused by chemotherapy is usually temporary and normally clears up about two to eight weeks after treatment ends. Radiation treatment to the head, face or neck can cause dry mouth and is most common with radiation treatment to the oral cavity to treat head and neck cancer.
An extreme exhaustion or tiredness, and is the most common problem that people with cancer experience. More than half of patients experience fatigue during chemotherapy or radiation therapy, and up to 70% of patients with advanced cancer experience fatigue. Patients who feel fatigue often say that even a small effort, such as walking across a room, can seem like too much.
Hair Loss (Alopecia)
A potential side effect of radiation therapy and chemotherapy is hair loss. Radiation therapy and chemotherapy cause hair loss by damaging the hair follicles responsible for hair growth. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms and pubic areas. The hair may fall out entirely, gradually or in sections. In some cases, the hair will simply thin-sometimes unnoticeably and may become duller and dryer. Losing one’s hair can be a psychologically and emotionally challenging experience and can affect a patient’s self-image and quality of life. However, the hair loss is usually temporary, and the hair often grows back.
Hypercalcemia is an unusually high level of calcium in the blood. Hypercalcemia can be life threatening and is the most common metabolic disorder associated with cancer, occurring in 10% to 20% of patients with cancer. While most of the calcium in the body is stored in the bones, about 1% of the body’s calcium circulates in the bloodstream. Calcium is important for many bodily functions, including bone formation, muscle contraction and nerve and brain function. Patients with hypercalcemia may experience loss of appetite, nausea and/or vomiting; constipation and abdominal pain; increased thirst and frequent urination; fatigue, weakness, and muscle pain; changes in mental status, including confusion, disorientation, and difficulty thinking; and headaches. Sever hypercalcemia can be associated with kidney stones, irregular heartbeat or heart attack and eventually loss of consciousness and coma.
An infection occurs when harmful bacteria, viruses or fungi such as yeast invade the body and the immune system is not able to destroy them quickly enough. Patients with cancer are more likely to develop infections because both cancer and cancer treatments (particularly chemotherapy and radiation therapy to the bones or extensive areas of the body) can weaken the immune system. Symptoms of infection include fever (temperature of 100.5°F or higher); chills or sweating; sore throat or sores in the mouth; abdominal pain; pain or burning when urinating or frequent urination; diarrhea or sores around the anus; cough or breathlessness; redness, swelling, or pain, particularly around a cut or wound; and unusual vaginal discharge or itching.
Mouth Sores (Mucositis)
Mucositis is an inflammation of the inside of the mouth and throat, leading to painful ulcers and mouth sores. It occurs in up to 40% of patients receiving chemotherapy treatments. Mucositis can be caused by a chemotherapeutic drug directly, the reduced immunity brought on by chemotherapy or radiation treatment to the head and neck area.
Nausea and Vomiting
Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. It is a natural way for the body to rid itself of harmful substances. Nausea is the urge to vomit. Nausea and vomiting are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable but cause no serious problems. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression and avoidance of chemotherapy.
Depending on the stage of disease, 30% to 75% of all patients experience pain from cancer. About 85% to 95% of cancer pain can be treated successfully. Pain can make other aspects of cancer seem worse, such as fatigue, weakness, sleep disturbance and confusion. Pain can come from the tumor itself or may be a result of cancer treatment. Pain from a tumor can be a result of the tumor growing and spreading to the bones or other organs and putting pressure on and damaging nerves. Pain from surgery is normal and may persist for months or years. Common procedures that cause pain afterward include mastectomy (removal of the breast and, occasionally, the surrounding tissue), chest surgery, neck surgery and amputation of a limb (stump pain). Phantom pain is perceived pain in an organ or limb that has been removed. Pain may develop after radiation therapy and go away on its own. It can also develop months or years after treatment, especially after radiation therapy to the chest, breast or spinal cord. Certain chemotherapeutic drugs can cause pain along with numbness in the fingers and toes. Usually this pain goes away when treatment is finished, but sometimes the damage can be permanent.
The skin is an organ system that contains many nerves. Because of this, skin problems can be very painful. Because the skin is on the outside of the body and visible to others, many patients find coping with skin problems especially difficult. Because the skin protects the inside of the body from infection, skin problems can often lead to other serious problems. As with other side effects, prevention or early treatment is best. In other cases, treatment and wound care can often improve pain and quality of life. Skin problems can have many different causes, including chemotherapy leaking out of the intravenous (IV) tube, which can cause pain or burning; peeling or burned skin caused by radiation therapy; or pressure ulcers (bed sores) caused by constant pressure on one area of the body.
Surgery Side Effects
Surgery often causes swelling of the mouth and throat, making it difficult to breathe. After the operation, the lungs and windpipe produce a great deal of mucus. The mucus is removed with a small suction tube until the person learns to cough through the stoma. Similarly, saliva may need to be suctioned from the mouth because swelling in the throat prevents swallowing.
Surgery may also cause permanent loss of voice or impaired speech, difficulty swallowing or talking, facial disfigurement, numbness in parts of the neck and throat following a laryngectomy and less mobility in the shoulder and neck area following a neck dissection. Surgery can also decrease functioning of the thyroid gland, especially after a total laryngectomy and/or radiation therapy. It is very important that patients be assisted in their rehabilitation of lost or altered functions.
Radiation Side Effects
- Radiation side effects can include:
- Redness or skin irritation to the treated area
- Dry mouth or thickened saliva, from damage to salivary glands
- Bone pain
- Mouth sores and/or sore throat
- Dental problems (usually preventable)
- Painful or difficulty swallowing (short and long-term)
- Loss of appetite, due to a change in the sense of taste
- Hearing loss, due to buildup of fluid in the middle ear
- Buildup of earwax that dries out because of the radiation therapy’s effect on the ear canal
- Fibrosis (scarring)
Chemotherapy Side Effects
Side effects of chemotherapy can include:
- Hair loss
- Dry mouth
- Loss of appetite, due to a change in sense of taste
- Weakened immune system
- Diarrhea and/or constipation
- Open sores in the mouth; this condition coupled with a low immunity can lead to infections