Side effects of nasal and paranasal sinus cancer radiotherapy
Side effects tend to start a few days after the radiotherapy begins. They gradually get worse during treatment. They can continue to get worse after your treatment ends. But they usually begin to improve 1 or 2 weeks after your treatment ends.
Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned. Side effects can include:
Voice over: When having radiotherapy to your head and neck, you can experience many different side effects. One of these might be a sore mouth.
Louise: Mouth soreness and throat soreness with head and neck radiotherapy is very common unfortunately. If the soreness is on the outside on your skin, they might recommend particular creams that you can use to help with that.
If the pain is internal, you may be referred to the doctor and the doctor will suggest some medication to help control the pain.
Charlie: Probably I think it was from week 2 to week 3 when the radiotherapy side effects started really impacting me. At that point, really, I was unable to eat. The ability to take food down your food tract with that level of inflammation and ulcers was just too difficult.
Louise: Mouth soreness can continue for up to 3 months. The team will support you during that time, whether that be with some medication or some skin care advice. They'll also check your mouth quite regularly to make sure you don't have an infection which might be slowing down the recovery time.
Charlie: They always checked the condition of my mouth and made sure that it was in good health, recovering, and if there was any issues they just supported and advised me on the best way to deal with it.
Voice over: For information on other head and neck radiotherapy side effects, visit the Cancer Research UK website.
Your mouth and throat are likely to become increasingly sore. The lining may break down (get ulcerated) as you go through your treatment. This might be worse if you're having radiotherapy with chemotherapy (chemoradiotherapy).
You might need strong painkillers such as morphine.
Your doctor might also prescribe a gel. It 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 important for this type of treatment. Your nurse or radiographer will give you mouthwashes and will tell you on how to use them. Try to do this as often. The temptation is to leave it if your mouth is sore. But it is important to use them to prevent infection.
At the first sign of infection (particularly high temperature with chills, a sore chest or cough), contact the hospital. You may need antibiotics through a drip.
It is important that you do this without delay if you are also receiving chemotherapy. Your immune system may be weakened, and you will not be able to fight an infection in the normal way. Most hospitals give you an emergency card. This will help you to know exactly what to do if you develop a temperature whilst receiving chemotherapy.
As your course of radiotherapy goes on, you may have difficulty chewing and swallowing. This is because your mouth and throat might be sore.
Speech and language therapists play an important role during your treatment. They will help you with swallowing difficulties (dysphagia) and help you eat and drink safely. They can give information to your family or carer on how to support you with swallowing difficulties.
A dietitian can also give advice on what to eat when you have swallowing problems. This might include having a liquid diet.
You can have these feeds by mouth if you feel you can still swallow. But many people find they need tube feeding to keep their calorie intake up. You can have tube feeding by a:
- nasogastric tube - a tube that goes up in your nose and down into your stomach
- PEG tube - a tube that goes through the skin of your tummy (abdomen) into the stomach
Your nurse shows you and your relatives how to care for these tubes and how to give the feeds.
It is understandable that you might feel upset if you need to have tube feeding. You may feel that another part of normal life has been lost to you. But it is only temporary.
Your health is the most important thing. You will feel a lot better if you are getting the nutrition you need for everyday living. It will also help you recover from your treatment.
Radiotherapy to this area can cause damage to the glands that produce your spit. They are also called 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 will 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.
You may lose your sense of taste, have strange tastes or dulled taste. People often describe a metallic taste in their mouth with radiotherapy. Some chemotherapy drugs may cause similar changes in your taste.
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.
Your eyes are close to the nose and paranasal sinuses. Having radiotherapy to this area sometimes means that your eye is in the path of the treatment.
If it is, the radiotherapy may damage some parts of your eye and change how well you can see.
Your doctor will discuss with you in detail how treatment may affect your eye and sight.
Radiotherapy 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 you may have problems to tell different sounds apart.
This may only be a temporary problem while you have your treatment and are recovering from it. In some people hearing loss can be permanent. A hearing aid may be recommended as well as regular checks for wax build up in your ear canal.
Radiotherapy to the neck can damage the thyroid gland. If this happens, you will need to take pills to replace thyroid hormones.
You will have thyroid tests after your course of radiotherapy.
Radiotherapy causes some hair loss to the area of treatment. It can also cause hair loss on the opposite side of the head. This is where the radiotherapy beam leaves the body (the exit site).
Most of the hair loss can recover unless the full radiation dose needs to be given to the underlying skin.
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 is pronounced lim-fo-dee-ma.
Lymph fluid is in all body tissues. It comes from the tiny blood vessels into the body tissues. Usually, it drains back into the bloodstream through channels called lymph vessels. These are part of the lymphatic system.
A build up of lymph fluid in an area of the body can happen if lymph drainage channels or lymph nodes are blocked, removed, or damaged.
Lymphoedema in the head or neck can also cause symptoms inside your mouth and throat. For example, swelling of your tongue and other parts of your mouth.
Tell your doctor or nurse straight away 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
Lymphoedema is easier to control if treated early. It's important that you are referred to a lymphoedema specialist if you have signs of swelling. This is usually a nurse or physiotherapist.
