Radiotherapy side effects for nasopharyngeal cancer

The side effects of radiotherapy usually appear gradually during your course of treatment. Most people do have side effects from radiotherapy to the nasopharynx. If you’re going to get them, they are likely to be worse towards the end of your course. But over the 2 to 3 weeks following your treatment they will slowly get better. It may take up to 6 weeks before any soreness has entirely gone. Getting over a long course of treatment completely can take quite a few months.

If you need help with side effects, speak to your radiographer or nurse at the radiotherapy department where you have treatment. They can help you manage the side effects and speak to the doctor if necessary. Very rarely, side effects can be particularly severe. If this happens to you, your doctor will stop your treatment to allow you to recover.

Radiotherapy for nasopharyngeal cancer can cause the following side effects. 

Tiredness

Radiotherapy causes tiredness because the body has to repair any damage caused by the radiotherapy to healthy cells. If you have to travel to your treatment each day, you may get even more tired. There is more information about radiotherapy tiredness in the main radiotherapy section.

Sore skin

The area being treated may become red and sore. Using lotions, powders or creams on your treatment area may make things worse. Remember – if you need something to soothe your skin it is important that you get advice from the radiotherapy department first. 

Thyroid problems

Radiotherapy to the neck may damage the thyroid gland. Your doctor will check whether your thyroid is working properly after the radiotherapy treatment. If it is not working properly you will need to take pills to replace your thyroid hormones.

Radiotherapy to the nasopharynx will cause damage to the glands that produce your spit (the salivary glands). This may appear within a couple of weeks of starting your treatment. Some people say they make as much saliva, but it is thicker and stickier. This can make it harder to chew and swallow. Your doctor may call a dry mouth from lack of saliva xerostomia (pronounced ze-ro-stome-ee-ah).

After the treatment, you may have a permanently dry mouth. It can make eating and talking quite 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 more information about coping with a dry mouth in the page on diet after nasopharyngeal cancer treatment.

There is some evidence to suggest that having acupuncture can help with a dry mouth caused by radiotherapy to the head and neck area. There is more information about acupuncture to help a dry mouth on the nasopharyngeal cancer research page.

As you go through your treatment your mouth and throat are likely to become increasingly sore. You may have ulcers. Most people having radiotherapy for nasopharyngeal cancer develop a sore mouth and throat. If it is very sore, you may need strong painkillers such as morphine. Some people have these strong painkillers through a pump or skin patches. Your doctor may also prescribe a mouth gel that forms a protective coating over the inside of the mouth, a bit like a dressing. This can make the 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 may give you mouthwashes to use and will talk you through your mouth care regime. Do try to do this as often as you are asked to. Doing mouthwashes regularly will help to keep your mouth clean and avoid infection. Infection can make make your mouth even more sore.

As your course of radiotherapy goes on, you may have difficulty chewing and swallowing because your mouth and throat are sore. You can have a liquid diet if you feel it would help. So make sure you tell the staff in the radiotherapy department about any problems you are having. They can arrange for you to see a dietician.

Most people find they need feeding through a tube, to make sure they get enough calories. There are a couple of ways of tube feeding. Your doctor can put a tube up your nose and down into your stomach. This is called a nasogastric tube. Or you can have a tube that goes through the skin into the stomach. This is called a PEG tube. If you have either of these tubes, your nurse will show you and your relatives how to care for the tube and how to give the feeds.

Some people feel quite upset if they need to have tube feeding. It may feel as if another bit 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 every day living. Good nutrition also helps you to recover better from your treatment. Eating can become a strain during this type of treatment and tube feeding will take away that extra stress.

There is detailed information about nasopharyngeal cancer and diet in the living with nasopharyngeal cancer section. There is general information about tube feeding in our section on diet problems and cancer.

Radiotherapy can damage the muscles that you use to open and close your mouth. It may make the muscles tighter, making it harder for you to open and move your mouth. This contraction (tightening) of the mouth muscles is called trismus. It can make it difficult for you to eat and brush your teeth. If this happens, you will be shown exercises to do, to keep the effects to a minimum.

Radiotherapy to the head or neck often affects taste. People often say they have a metallic taste in their mouth with radiotherapy. You may lose your sense of taste, or have strange tastes or dulled taste. Not surprisingly, loss of taste will affect your appetite.  

In time, you are likely to recover fully from this, although some people may find their sense of taste is permanently dulled. There is more about how to cope with loss of taste in the page on diet after treatment for nasopharyngeal cancer.

Radiotherapy for nasopharyngeal cancer can often affect hearing. If you are having chemoradiation then hearing problems may be more likely. This is because the drug cisplatin can affect hearing too. You may find it hard to hear soft sounds. Or you might find it hard to tell different sounds apart. Sometimes this is a temporary problem that happens during your treatment and recovery. But occasionally hearing loss can be permanent. There is more about changes to your hearing in the living with nasopharyngeal cancer section.

If your radiotherapy reaches the pituitary gland in your brain, it can stop this gland making enough hormones (hypo pituitarism). These hormones affect growth and sex drive. If your pituitary gland is affected, you will have to take replacement hormones for the rest of your life. This could happen years after your radiotherapy.

You can find out more about the side effects of combination treatment for nasopharyngeal cancer on the page about chemoradiation. For more information about general side effects of radiotherapy to the head and neck look in the main radiotherapy section.