Side effects of mouth and oropharyngeal cancer chemoradiotherapy
Having chemotherapy with radiotherapy (chemoradiotherapy) can cause more severe side effects. This is compared with having these treatments on their own. Everyone is different and the side effects vary from person to person. You might not have all of the effects mentioned by your doctor or radiographer. Side effects depend on the type of chemotherapy you have. They also depend on the radiotherapy treatment area.
The side effects gradually get worse during the treatment. They can continue to get worse after your treatment ends. But most of the side effects begin to improve after a few weeks.
Contact your doctor or nurse if any side effects are severe, or your temperature goes above 37.5C or below 36C. They can prescribe medicines and treatments or advise on what may help relieve symptoms.
Tests
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
Possible side effects
You are likely to get a very sore mouth and throat. This often starts after about 2 weeks of treatment. You may only manage soft food and liquid supplements. Some people find that their mouth is so sore that it is too difficult to swallow. If this happens, you are likely to need a feeding tube so that you can get enough liquid and calories.
You also have painkillers. You might need a strong painkiller such as morphine to help make your mouth more comfortable.
When you have a very sore mouth and throat, you must be very careful about infection. Try to keep your mouth clean and follow the advice of your nurse and dentist.
Contact the hospital at the first sign of infection – particularly a change in temperature, chills, or a cough.
During and after treatment, you might have difficulty swallowing.
You may 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.
A dry mouth can make eating and talking uncomfortable. Your doctor can prescribe artificial saliva for your mouth if it is a problem for you. People who have a dry mouth often find it helps to sip water regularly and carry a bottle of water with them all the time.
You are at risk of getting swelling called lymphoedema in your neck or face if the lymph nodes in your neck are in the treatment area. 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 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.
An increased risk of getting an infection is due to a drop in white blood cells. The chemotherapy affects cells, such as white blood cells, in your bone marrow. Symptoms of an infection include:
- a change in temperature
- aching muscles, headaches
- feeling cold, shivery and generally unwell
You might have other symptoms depending on where the infection is.
Contact your doctor or nurse immediately if you have signs of infection. This includes a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.
Your skin might go red or darker in the treatment area. You might also get slight redness or darkening on the other side of your head and neck. This is where the radiotherapy beams leave the body.
The red or darker areas can feel sore. Your radiographers will 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.
Tell the radiotherapy staff if you notice any skin changes.
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.
Sickness may be worse a few hours after the chemotherapy. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.
Tips
- Avoid eating or preparing food when you feel sick.
- Avoid hot fried foods, fatty foods or foods with a strong smell.
- Eat several small meals and snacks each day.
- Relaxation techniques help control sickness for some people.
- Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
- Try fizzy drinks.
- Sip high calorie drinks if you can’t eat.
