Find out about the side effects of radiotherapy for nasal and sinus cancer and how to cope with the effects.
When you get side effects
The side effects of radiotherapy usually come on gradually during your course of treatment. Most people do have side effects with radiotherapy to the nasal cavity and paranasal sinuses. They will usually be at their worst at the end of the course of treatment.
Over the weeks following your treatment the side effects should slowly get better. Most people find the soreness has completely gone within 8 weeks of finishing their treatment. Completely getting over a long course of treatment can take quite a few months, sometimes longer.
It is a good idea to discuss possible side effects with your specialist, nurse or radiographer before you start the treatment. You may feel more confident if you know that plans have already been made, to help you through the treatment. For example, you might need medicines to control soreness and liquid food to make sure you are getting the nutrition you need to get better.
General side effects
Some people having radiotherapy to the head or neck area get very tired during their treatment course. This is partly due to the radiotherapy but many people also find it hard to eat properly and tend to feel weak.
Check with your radiotherapy department before putting any lotions, powders or creams on skin in the area being treated with radiotherapy. If you have any soreness, some creams or lotions might make things worse. Your nurses or radiographers at the radiotherapy department can give you helpful creams to soothe your skin.
Your mouth and throat are likely to become increasingly sore and the lining may break down (get ulcerated) as you go through your treatment. If you are having radiotherapy with chemotherapy you are even more likely to get a very sore mouth and throat.
You might need strong painkillers such as morphine. Some people have morphine through a pump.
Your doctor might also prescribe a gel that forms a protective coating over the inside of your mouth, a bit like a dressing. This can make your mouth less painful and can make it easier to eat and drink.
Mouth care is very important with this type of treatment. Your nurse or radiographer will give you mouthwashes and will advise you on how to use them. Try to do this as often as you are asked to. The temptation is to leave it if your mouth is very sore. But it is very important to use them to prevent infection.
As your course of radiotherapy goes on, you may have a lot of difficulty chewing and swallowing because your mouth and throat are sore. You can have a liquid diet if you feel it would help.
Make sure you tell the staff in the radiotherapy department about any problems you are having. They can arrange for you to see a dietitian and to have liquid feeds on prescription.
If you feel you can still swallow then you can have these feeds by mouth. But many people find they need tube feeding, just to keep their calorie intake up. You can have tube feeding by:
- nasogastric tube - your doctor can put a tube up your nose and down into your stomach
- PEG tube - a tube that goes through the skin into the stomach
Your nurse shows you and your relatives how to care for these tubes and how to give the feeds.
Some people feel quite upset if they have to have tube feeding. You may feel as if another part of normal life has been lost to you. But it is only temporary.
Your health is the most important thing and you will feel a lot better if you are getting the nutrition you need for everyday living, and for recovering from your treatment.
Radiotherapy to this area can cause damage to the glands that produce your spit (salivary glands). This can come on within a couple of weeks of starting your treatment.
Some people say they are making saliva, but it is thicker and stickier. This can make it harder to chew and swallow.
After the treatment, you may have a temporary dry mouth for a while, but for some people this may be permanent. It can make eating and talking very uncomfortable.
If you have trouble with a dry mouth, your doctor can prescribe artificial saliva to keep it moist. This is not just to make you more comfortable.
You are more likely to get an infection or tooth decay if your mouth is dry. So you’ll need to keep an eye on this and have regular check ups with your dentist.
There is some evidence to suggest that having acupuncture may help with a dry mouth, caused by radiotherapy to the head and neck area.
You may lose your sense of taste, have strange tastes or dulled taste. People often describe a metallic taste in their mouth with radiotherapy and some chemotherapy drugs.
Loss of taste will affect your appetite. This doesn’t help when you are finding it difficult to eat anyway. Although you can recover your sense of taste, some people may find it is permanently dulled.
Because the eyes are so close to the nose and paranasal sinuses, having radiotherapy to this area sometimes means that your eye is in the path of the radiotherapy.
If it is, the radiotherapy may damage some parts of your eye and change how well you can see.
If your eye and sight could be damaged, your doctor will discuss this with you in detail before your treatment.
Radiotherapy to the nasal cavity or paranasal sinuses can damage the cells in your nose that give you your sense of smell. This may be while you have your treatment, and during your recovery.
Some people may find their sense of smell never quite gets back to normal.
Radiotherapy to the nasal cavity or paranasal sinuses can affect your hearing. You may find it hard to hear soft sounds or to tell different sounds apart.
This may only be a temporary problem whilst you have your treatment and are recovering from it. Occasionally the hearing loss can be permanent.
Radiotherapy to the neck can damage the thyroid gland. If this happens, you will need to take pills to replace thyroid hormones.
Your specialist will test how well your thyroid is working after your course of radiotherapy.
Radiotherapy causes some hair loss to the area being treated. It can also cause hair loss on the opposite side of the head where the radiotherapy beam leaves the body (the exit site).
Radiotherapy can damage the nerve controlling the muscles which move your mouth. This can make it difficult for you to open it.
This is called trismus. If it happens, your doctor or nurse will give you exercises to do to help relieve the problem.
After radiotherapy to treat a head and neck cancer, you are at risk of getting swelling called lymphoedema in your neck or face.
Lymphoedema in the head or neck area might also cause swelling of your tongue and other parts of your mouth.
Tell your doctor if you:
- have any swelling in the head or neck area or a feeling of fullness or pressure
- find it difficult to swallow
- have changes in your voice