What are the side effects of treatment?

• Surgery
  • Surgery for large head and neck cancers often changes the patient’s ability to eat, talk and breathe.  Specific side effects will be based on where the tumor is located and what is removed to get it out.  The surgeon will try and remove the entire cancer while keeping function as much as possible (preserving major nerves and vessels and muscles).
  • There will be scars (these will fade with time), and the face and neck may be swollen.
  • Swelling after surgery usually goes away within a few weeks.  However, when lymph nodes are removed and scar is created from an operation, the flow of lymph in the neck may be slow and can build up in the tissues causing a swelling called lymphedema.  Many people need therapy to help resolve lymphedema.  Lymphedema can be a long-term problem.
  • Another problem after surgery can be skin numbness. This can return with time or may be permanent if nerves are cut.  
  • Shoulder and lower lip weakness can also occur based on the location of your tumor and surgery.
  • Please talk to the surgeon to discuss the expected functional side effects of surgery.
• Radiation Therapy
  • Radiation therapy has side effects such as redness, irritation, thick saliva, loss of taste, and sores in the mouth during treatment.
  • The sores can be painful and limit you from taking in a normal meal.  However, they should resolve within a month of completing therapy.
  • The dry mouth and thickened saliva will likely persist after treatment (can be permanent).  This dry mouth can cause dental issues, and it is important to have a dental evaluation before starting radiation.
  • Other long-term side effects are earaches and changes in hearing, changes in the feeling of the skin, and hardening of the muscles (neck feels “woody” or stiff). Sometimes it is harder to open the mouth as wide as before radiation.
• Chemotherapy
  • Chemotherapy also has side effects based on which medicine is given.
  • Most chemotherapy for head and neck cancer does not cause hair loss.  However, chemotherapy does change the body’s ability to fight infection and weakens the immune system, can cause fatigue, nausea, vomiting, loss of appetite, and changes in the sensation in the hands and feet.
  • When chemo is given with radiation, the side effects of both intensify.
• Immunotherapy
  • Immunotherapy can also cause side effects during treatment.  Some of the common side effects are fatigue, nausea, vomiting, diarrhea, as well as skin rashes.
  • Immunotherapy uses the body’s own defenses to fight cancer, and sometimes the immune system can go into overdrive and start to work against the body (including lung, brain, liver, kidney, and intestines).  This is rare but can cause trouble breathing, hepatitis, pancreatitis, and thyroid problems.  Usually, these can be controlled with medications such as steroids and antihistamines.
• Specific Side Effects
  • Patients should report any side effects to their doctor or nurse to discuss how to deal with them.
    • Dry Mouth (Xerostomia)
      • Radiation and chemotherapy can damage the glands in your mouth that produce saliva, reducing or eliminating their ability to keep your mouth moisturized.
      • Learn more at headandneck.org
    • Oral Mucositis
      • Painful sores in your mouth or throat, caused by cancer treatment, can impact your ability to eat, increase your risk of infection, and temporarily reduce your quality of life. 
      • Learn more at headandneck.org
    • Lymphedema
      • When the lymph system is damaged by radiation or surgery, lymph fluid cannot flow back to the heart the way that is should.  It collects under the skin, causing swelling.
      • Learn more at headandneck.org
    • Neuropathy
      • Nerve damage and nerve pain can be caused by cancer treatments, including radiation, surgery, and some chemotherapy drugs. It often doesn’t appear for years following treatment.
      • Learn more at headandneck.org
    • Osteoradionecrosis
      • Bone death is caused when radiation therapy damages the blood vessels that supply the jawbone with nutrients and oxygen, causing it to no longer heal itself when faced with infection or trauma
      • Learn more at headandneck.org
    • Trismus
      • Radiation and/or surgery can cause scarring or damage to the jaw muscle or joint or nerve damage, resulting in decreased range of motion and making it difficult, painful, or impossible to open your mouth.
      • Learn more at headandneck.org
    • Radiation Fibrosis
      • Increased production of a protein called fibrin can accumulate due to radiation treatment and eventually cause tissue damage, resulting in the shortening of tissues.
      • Learn more at headandneck.org
• Other Considerations
  • Cancer surgery may require having a laryngectomy (surgery to remove the voice box).  Adjusting to life after laryngectomy surgery is often a challenge for survivors.
  • The Laryngectomee Guide, available in several languages, can help make the transition easier.
  • Maintaining adequate nutrition before, during, and after cancer treatment is critical to your recovery.

Get tips and recipes designed for head and neck cancer patients here.