Side effects of radiotherapy for nasopharyngeal cancer
Most people have side effects from radiotherapy to the nasopharynx. They gradually start during your course of treatment. They are likely to be worse towards the end of your course.
About radiotherapy side effects
Side effects tend to start a few days after your radiotherapy begins. They often gradually get worse during treatment and can continue to get worse after your treatment ends. But they usually begin to improve 1 or 2 weeks after your treatment ends.
There is a possibility of having long term or late side effects. These can be side effects that don't go away after finishing radiotherapy. Or begin several months or years afterwards. Your doctor, radiographer, and nurse will talk through the possible side effects with you before you start treatment.
Everyone is different and the side effects vary from person to person. You might not have all of the side effects mentioned below.
Possible side effects of radiotherapy
The side effects of radiotherapy to the nasopharynx can include:
Most people who have radiotherapy for nasopharyngeal cancer get a sore mouth and throat. It's likely to become increasingly sore during your treatment. This usually continues for a couple of weeks after your treatment and can take several weeks to get better.
The lining inside your mouth may break down (get ulcerated) as you go through your treatment. This might be worse if you're having radiotherapy with chemotherapy (chemoradiotherapy).
Your doctor might 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. Your doctor or nurse may also suggest using a numbing spray or ointment on sore areas.
Your doctor might also give you painkillers to take regularly. If your throat becomes extremely sore you might need very strong painkillers such as morphine. Some people have these through a pump or skin patches. Your nurse and doctor will tell you more about the painkillers you have and the possible side effects.
Mouth care is important for this type of treatment. Your nurse or radiographer will give you mouthwashes and will tell you how to use them. Try to do this as often as they suggest. It is important to use them to help prevent infection.
At the first sign of infection (particularly high temperature with chills, a sore chest or cough), contact the hospital. You may need treatment, such as 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 and who to contact if you develop a temperature or symptoms of an infection whilst receiving treatment.
You might 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 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.
The skin in the area being treated may become sore and itchy. On white skin, the area may look red. On brown or black skin, the treatment area may darken slightly and have a different texture.
Your radiographer will give you advice on washing the area and creams to use to soothe your skin. It is important to get advice from your radiographer before you use anything on your skin in the treatment 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.
It can take around 4 to 6 weeks after treatment or sometimes longer for the skin to get better.
You should avoid removing the hair around the treatment site. This includes shaving, waxing and hair removal creams. Your nurse can help if you have any questions about this.
Tell the radiotherapy team if you notice any skin changes.
As your course of radiotherapy goes on, you may have difficulty chewing and swallowing. This is because your mouth and throat might be sore. This can also affect your appetite.
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 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 taste. 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.
Radiotherapy to the nasopharynx can damage the glands that produce your spit (the salivary glands). This can happen within a couple of weeks of starting your treatment. Your doctor might call a dry mouth from lack of saliva xerostomia (pronounced ze-ro-stome-ee-ah).
Some people say they make as much saliva as before, but that it is thicker and stickier. This can make it harder to chew and swallow.
Long term
After the treatment, you might have a permanently dry mouth. This can make eating, swallowing and talking quite uncomfortable.
If you have trouble with a dry mouth, your doctor can prescribe artificial saliva to keep it moist. This will help 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 acupuncture might help with a dry mouth caused by radiotherapy to the head or neck. But we need more research to understand how well acupuncture works in treating a dry mouth.
Radiotherapy for nasopharyngeal cancer often affects hearing. You might find it hard to hear soft sounds. Or you might find it hard to tell different sounds apart. It may also make you feel dizzy.
Usually this is a temporary problem that happens during your treatment and recovery. But occasionally hearing loss or changes can be permanent.
You might be more likely to have hearing problems if you are having chemoradiotherapy. This is because some chemotherapy drugs can also affect hearing.
Radiotherapy can cause some damage to the muscles in your jaw. This makes the muscles tighter, which makes it harder to open and move your mouth.
This tightening of the mouth muscles is called trismus. It can make it difficult to eat and brush your teeth. Your doctor or nurse gives you exercises to help if you have this side effect.
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.
Radiotherapy might affect your sense of smell. This is because radiotherapy causes dryness of the mouth and nose. If your nose is very dry you might not be able to smell things normally for a while. 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 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.
If your radiotherapy reaches the in your brain, it can stop this gland making enough hormones. This is called hypopituitarism.
You may have to take replacement hormones if your pituitary gland is affected. Your doctor will talk this through with you.
Your eyes are close to the nose and nasopharynx. Having radiotherapy in 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.
Your hair only falls out in the area where you are having treatment. You might also have some hair loss on the opposite side of the head or neck, where the radiotherapy beams pass through. This is called the exit site.
Most of the hair loss can recover but sometimes your hair might not grow back after treatment.
The side effects of radiotherapy, such as a dry mouth can increase your risk of problems with your teeth. You may need to go for check ups at the dentist more often. Fluoride treatment may help to protect your teeth.
Remember to tell your dentist that you’ve had radiotherapy before you have any dental work.
They may also need to talk to your radiotherapy doctor before giving you any treatment.
You might need to have some teeth taken out before you start treatment. Your doctor may refer you to a restorative dentistry consultant before your radiotherapy. A restorative dentist is a specialist in replacing lost tissues and teeth.
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.
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.
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.
Sometimes the side effects of radiotherapy can be particularly severe. If this happens, your doctor may need to stop your treatment to allow you to recover.
Worries about treatment side effects
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.
Nasopharyngeal carcinoma: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up
P Bossi and others
Annals of Oncology, 2021. Volume 32, Issue 4, Pages 452-465
Long-term outcomes of interventions for radiation-induced xerostomia: A review
Sung Jun Ma and others
World Journal of Clinical Oncoligy,2019. Volume 10, Issue 1, Pages 1–13.
The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.
