Side effects of radiotherapy for laryngeal cancer
Side effects tend to start a few days after the radiotherapy begins. They gradually get worse over the days and weeks of your treatment. They can continue to get worse after your treatment ends. They usually start to get better about 1 to 3 weeks after you finish your treatment.
Getting over a long course of treatment completely can take quite a few months. Everyone is different and the side effects vary from person to person. You may not have all of the effects mentioned.
In the video below, people affected by cancer who had head and neck radiotherapy discuss the side effects of radiotherapy. It is 8 minutes and 26 seconds long.
Voice over: Radiotherapy can cause many different side effects, such as tiredness. The side effects you get will depend on the area you're having treatment to.
This video is about the side effects you might have when having radiotherapy to the head and neck.
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.
Dry mouth
Charlie: My saliva glands were very close to some of the areas affected by cancer, so they did warn me that there was a high likelihood that my saliva glands would have some problems.
Louise: Radiotherapy can cause damage to the salivary glands. There are lots of things you can do to help with that. Small sips of water can ensure that your mouth stays moist. Little spritzer sprays or nebulisers, steam treatments can also help.
Charlie: Even now my saliva glands still don't work as well as they did beforehand. You'll find me sipping on water on a regular basis to offset the impact of the saliva gland limitation.
Changes in taste
Louise: You may find that your taste alters. If this is the case, you might find that food and drinks that you previously loved do taste very different. Sometimes people report they taste a bit metallic. If this is the case, please consult your dietitian and they will be able to support you with that.
Tasha: It's like a battery taste. I don't know how I know that, but that's how I'd best describe it. It’s very unpleasant. So anything you're eating, you can't taste that food. It's just metallic taste.
At the end of my treatment, it still carried on, but it was slowly dying down and then when it went, I was very happy because I ate as much as I wanted.
Weight loss
Louise: Unfortunately, weight loss with head and neck radiotherapy is very common. Obviously we don't want you to lose too much weight, so we would work very closely with the dietitian to support you.
Charlie: The clinical team in advance warned me I would lose weight. They told me to prepare for it. They told me to eat lot of calories in advance and I thought they were kidding, but the reality is, the weight did drop very, very quickly.
Louise: Initially, if you start to notice any problems eating, we would recommend you start to move to a slightly softer diet. Foods that are soft, easy to swallow, but highly nutritious.
Charlie: Soups and gravies and maybe move on to scrambled eggs and rice puddings.
Louise: If you then find that that starts to become problematic, we do have some special little drinks that you can use as a meal replacement.
Tasha: I had a smoothie drink that was given to me by the doctors. It's like a smoothie with calories in and it's a small bottle so you're just topping up what you’re missing not eating and drinking fully.
Charlie: My swallow mechanism just stopped working, so everything I had to take was being taken through the stomach tube.
Louise: Occasionally the radiotherapy can have a real impact on how easily you can swallow and if it starts to become very problematic, they may suggest they use feeding tubes to help ensure you are getting the right nutrients.
Looking after your teeth
Louise: Radiotherapy can cause some bone weakening, so as a result of that, we would recommend you are referred to a dentist before you start a course of radiotherapy.
They will look at all of your teeth and any teeth that already appear weak and damaged may be removed before you start treatment.
Tasha: The dentist and even the doctors and consultants said that after you've had radiotherapy and if it's been near the mouth area or teeth that it can make dental treatments more painful, and I did find that.
Charlie: Post treatment you have to really, really look after your teeth, so I go to the dentist every 3 months. Any problems with your teeth have to be nipped in the bud.
Changes to your voice
Charlie: They found cancer in my voice box so that was part of the treatment area. As the weeks progressed in treatment, I started losing it.
Louise: If you're having radiotherapy to your larynx, your voice box, you may well find that you end up with an altered voice. This can happen during treatment and we can't always guarantee your voice will be the same as it was after treatment.
Charlie: I lost it in total probably for maybe 2 weeks, so my wife had a peaceful couple of weeks for that period of time and it just came back. But it was quite fragile. So I learned to take it easy, and even now, 18-20 months after treatment, I can feel it if I talk too much.
Louise: We would recommend you rest your voice as much as possible and if needed, carry a pen and paper around with you, so you can continue to communicate.
Hair loss
Tasha: My hair loss from radiotherapy, you could see it weeks and months later, it slowly and gradually started to sort of go bald at the top.
Louise: Hair loss is common, but only in the area exposed to the radiation beam.
Charlie: Every hair in the treatment area, whether it was on the back of my neck or the front of my throat/neck area, had just fallen out.
Louise: The majority of hair does grow back, but we can't always guarantee that it definitely will. And it doesn't always grow back in quite the same way that it used to.
Tasha: I try to embrace it because it's part of my cancer story, but I like having my fringe and I just think I'll probably keep it.
Voice over: If you're experiencing a side effect that hasn't been covered in this video, you can find more information on the Cancer Research UK website.
Short term side effects
The side effects of radiotherapy for laryngeal cancer can include:
Tiredness and feeling weak
You are likely to feel tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.
Tiredness can carry on for some weeks or months after the treatment has ended. But it usually improves gradually.
Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. It's important to balance exercise with resting.
Skin problems in the treatment area
Your skin might go red or darker in the treatment area.
The red or darker areas can feel sore. This may start after your radiotherapy treatment is completed. Your radiographers may give you creams to soothe your skin. The soreness usually goes away within 2 to 4 weeks of ending the treatment. But your skin might always be slightly darker in that area.
During your radiotherapy treatment, the skin might break down around the treatment area. Your nurse will use special dressings to cover and protect the area. The area usually heals up over a couple of weeks.
Tell the radiotherapy staff if you notice any skin changes.
Loss of appetite
You may lose your appetite because of radiotherapy. Having a sore, dry mouth can make eating difficult. You may also feel sick because of radiotherapy. This will make you feel less like eating.
Hair loss in the treatment area
Radiotherapy causes hair loss in the area of treatment. It may also cause hair loss where the radiation beam leaves the body (the exit site). Ask your radiotherapy team to show you where you might lose your hair.
It usually starts to grow back a few weeks after treatment. But for some people it might not. Your hair may not grow back in the same way that it used to.
Mouth problems
Mouth problems caused by radiotherapy may include:
The cells lining your mouth are sensitive to radiation. Radiotherapy is likely to make your mouth sore and you might have ulcers after a week or so. This is called oral mucositis.
The soreness usually lasts while you are having treatment and for a few weeks afterwards. Your radiotherapy team can give you painkillers to help. Following a mouthwash routine from the start of radiotherapy will also help.
Smoking and alcohol can make the soreness worse. Talk to your radiotherapy team, doctor or nurse about advice on giving up smoking.
Your mouth might get very dry, which can be uncomfortable. Radiotherapy can damage the glands that produce saliva. Saliva is important for taste, swallowing, and speech.
You can do several things to help with a dry mouth.
- Ask your doctor to prescribe medicines that stimulate saliva.
- Sip drinks often to keep your mouth moist.
- Moisten your food with sauces, gravy, cream, custard or ice cream.
- Chewing sugarless gum can make your salivary glands produce more saliva.
- Use lip balm to keep your lips moisturised.
- Use moistened cotton wool or a soft toothbrush to clean your tongue.
- Ask your doctor to prescribe artificial saliva sprays or gels.
- Ask your doctor about gels or lozenges that stimulate saliva and artificial sprays.
Having a dry mouth can become a long term side effect of radiotherapy. Speak to your doctor if this is a problem for you.
This can develop during treatment. Doing regular mouth care and using mouthwashes can help. Speak to your doctor or specialist nurse if you have bad breath.
Difficulty swallowing
Radiotherapy for laryngeal cancer can cause swelling and soreness in the throat. Your throat might be very sore, and you may find it difficult to swallow solid food (dysphagia). You might need to have strong painkillers if your throat is too sore to swallow food. Or have a feeding tube fitted.
You usually see a speech and language therapist (SLT) before you start treatment if this is likely to affect your swallowing. An SLT can assess your swallowing during and after treatment. They can teach exercises to support you with swallowing difficulties. And they work with a dietitian if you are finding it difficult to eat.
You can have feeds through a nasogastric tube that goes up your nose and down into your stomach. Or you can have a PEG tube (percutaneous endoscopic gastrostomy tube) that goes through the skin into your stomach. Your nurse or dietician will tell you more about this if you need to have one. They will also show you and your relatives how to give the feeds.
Problems with swallowing depends on the dose of treatment. It can be worse and last longer if you have chemotherapy at the same time as radiotherapy.
Weight loss
You can lose weight when you have radiotherapy to your head and neck area. This can be because you have mouth problems such as a sore or dry mouth, which can make swallowing difficult. You may also have a poor appetite.
These effects might be temporary and gradually go back to normal after treatment ends. But for some people, the effects may be permanent. There are things you can do to help keep your weight up.
During your radiotherapy treatment, you might see a dietitian once a week who can help advise you on foods that are easier to eat.
Pain in the mouth and face
It is common to have pain in the mouth or face during and after radiotherapy. Speak to your doctor or specialist nurse if you have pain. They can prescribe painkillers.
Changes to your voice
Your voice might get hoarse if you have radiotherapy to your voice box to treat cancer of the larynx. It could disappear completely for a while during and after the treatment. Your voice should come back within a few weeks but may never sound quite the same as it was.
Taste changes
Radiotherapy to the head or neck often affects taste. This can be a direct effect of your treatment. But poor mouth care, a sore mouth or an infection can also affect your taste. Having chemotherapy can also cause changes in your taste.
People often say they have a metallic taste in their mouth with radiotherapy and some chemotherapy drugs. You might lose your sense of taste or have strange tastes or dulled tastes. Loss or changes of taste can affect your appetite.
In time, you are likely to recover fully from this. But this does vary from person to person. Some people might find their sense of taste is permanently dulled.
Voice over: When having radiotherapy to your head and neck, you can experience many different side effects. One of these might be changes to how things taste.
Louise: You may find that your taste alters. If this is the case, you might find that food and drinks that you previously loved do taste very different. Sometimes people report they taste a bit metallic. If this is the case, please consult your dietitian and they will be able to support you with that.
Tasha: It's like a battery taste. I don't know how I know that, but that's how I'd best describe it. It’s very unpleasant. So anything you're eating, you can't taste that food. It's just metallic taste.
At the end of my treatment, it still carried on, but it was slowly dying down and then when it went, I was very happy because I ate as much as I wanted.
Voice over: For information on other head and neck radiotherapy side effects visit the Cancer Research UK website.
Long term side effects
Swelling (lymphoedema)
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.
Unfortunately, it is not possible to cure lymphoedema. But things can be done to reduce the swelling and help you feel better. For example, positioning and lymphoedema exercises can help.
Feeling low in mood
Many people feel low in mood during or after radiotherapy treatment for the larynx. If you feel like this, make sure you get support early. Speak to your specialist nurse, members of your healthcare team or GP.
You may feel anxious about radiotherapy side effects and this is normal. It can help to talk through any worries you have with your doctor, nurse or radiographer.
Damage to the jawbone
Radiotherapy can sometimes damage the jawbone and break down the bone. This is because radiotherapy can reduce the blood supply to the bone. This is called osteoradionecrosis. This is rare but it can happen months or years after your treatment has finished. Symptoms include pain and swelling in your gums.
Before your radiotherapy, you usually see a specialist dentist. They can remove damaged or broken teeth and make sure your dentures fit properly.
They will also show you how to keep your mouth and teeth clean. You will need to do this during your radiotherapy and for a few months afterward, or sometimes longer.
Difficulty opening your mouth
Radiotherapy can damage the nerve that controls the muscles that move our mouth. Your doctor or nurse will give you exercises to help strengthen your muscles and to prevent this from becoming a long term problem.
An underactive thyroid (hypothyroidism)
Radiotherapy to the larynx might affect the thyroid gland. It may become underactive. This can happen many years after treatment.
If you are at risk of an underactive thyroid your GP will do regular tests to check your thyroid hormones.
Teeth problems
Your saliva normally forms a protective film over your teeth. Having a dry mouth increases the chance of tooth decay. So, you need to take special care and do regular mouth care throughout the day.
You'll also need to go for check ups at the dentist more often. Remember to tell your dentist that you have had radiotherapy to your mouth before you have any dental work. They may also need to talk to your radiotherapy doctor before giving you any treatment.
Getting help
You usually have regular checks by your head and neck cancer team during your course of radiotherapy and for a few weeks afterwards. They can check any side effects you have and give you advice and medicines to help. Between checks, do speak to your radiographer or nurse if you need help managing any side effects.
Smoking
If you smoke, your doctor will advise you to give up before you start treatment. Radiotherapy might not work as well and you may have more side effects if you continue to smoke.
Side effects if you have chemotherapy with radiotherapy
Chemotherapy combined with radiotherapy can make some side effects worse. Combining these treatments is called chemoradiotherapy.
