If an oncologist has advised a course of radiotherapy to your mouth and/or face as part of your treatment for head/neck cancer, this page gives you general information and answers some of the questions you may have about the side effects of radiotherapy.
We hope you will find this helpful. If you have any further questions relating to your treatment, please do not hesitate to ask your radiographer, specialist nurse or oncologist.
Possible side effects during your treatment
Side effects can vary with each person and with the total dose of radiotherapy you receive. You may experience some and not others.
Side effects usually appear gradually during your course of treatment and may continue for a period after your treatment has finished, this can be discussed with your oncologist or specialist nurse.
Effects on the skin
Towards the end of treatment most patients experience some changes in the skin in the area that has been treated. The skin may:-
Most people will experience some of these changes in the treatment area after the first 10-12 days. Your skin reaction may be worse and happen earlier if you are also having chemotherapy.
Your skin will be monitored by your radiographers during radiotherapy and you will be given advice on skincare. You will also be seen once a week in a radiotherapy clinic by your specialist nurse and/or oncologist who will examine your skin and advise on any creams if necessary. On rare occasions the skin may become infected and a course of antibiotics may need to be prescribed by your oncologist.
The effects on the skin may continue for up to six weeks after treatment has ended.
Skincare- What can I do to help?
- Gently wash the treated area with warm water and a mild, unperfumed soap.
- Pat the area dry using a soft towel. Don’t rub. Avoid using flannels as they can harbour germs.
- Do not apply your own creams, make up, perfumes, lotions or aftershave to the treated area unless they are advised or prescribed by your specialist nurse or oncologist.
- Do not apply Vaseline or lip salve during your radiotherapy as this may result in a severe skin reaction.
- You may be given a moisturising cream from the radiographers or nurses to soothe the skin, or your oncologist may prescribe a cream if needed. Use it twice daily, after treatment and again at bedtime, gently smoothing the cream gently over your neck. Do not rub.
- It is advisable to wear loose, non-man-made (e.g. cotton) clothing around the neck without tight or stiff collars.
- Wherever possible, leave the area being treated open to the air.
- If you need to shave, please use an electric shaver. Try not to shave as often. Shaving involves rubbing the skin which can irritate. The hair in the treatment area will become sparse and fall out after two to three weeks. It should regrow after your treatment reactions have settled.
- On completion of treatment, you may be advised to apply a different cream to that used during treatment to help promote comfort and healing, if this is necessary it will be after end of treatment assessment by your specialist nurse/oncologist.
- Radiotherapy will make your skin more sensitive to the sun. Avoid exposing the area to strong sunlight during and after your course of treatment. Do not use a sun lamp or sun bed. It is advisable to use a sun block (factor 25 or above) or keep the area covered when in the sun.
Effects on the mouth and throat
Soreness of the throat
The lining of the throat will become sore and inflamed during the treatment which will make it difficult to swallow. This may happen after about 10-12 treatments. Your oncologist can prescribe painkillers to help and will give you advice about a softer diet. Some people manage to eat a soft diet until the soreness has settled. This usually occurs a few weeks after treatment has finished.
Towards the end of your course of treatment the throat can become too sore to eat and drink even soft foods. Your oncologist or specialist nurse may suggest increasing your painkillers – if required these can be supplied in liquid or dispersible form; and there is a dietician and a dental hygienist available if required.
For a few people, swallowing can become even more difficult, e.g. food sticking at the back of the throat or drinks going down the wrong way. Alert your oncologist, radiographer, specialist nurse or dietician if this is happening to you. In some cases a feeding tube may be required to ensure you are receiving full nutrition.
A speech and swallowing therapist is available in the weekly review clinic for more advice.
Dry mouth or throat
The radiotherapy may gradually make your mouth and throat dry. This is caused by damage to the salivary glands that produce saliva to keep your mouth moist. Your saliva may become thick and stringy. This may lead to taste changes. Everything may taste the same or food can taste metallic or like cardboard.
Radiotherapy can make your mouth more at risk to infections due to the lack of saliva. This can be seen as white patches on the inner surface of the cheeks or covering the tongue. (oral thrush)
Please speak to your radiographer, specialist nurse or oncologist for further advice.
Most people find that the salivary glands gradually recover, but for some it can be a permanent change.
What can I do to help?
Extra care must be taken with mouth care. You will be given a mouthwash to use during treatment. Please only use mouthwashes given to you at NCCC as some commercial mouthwashes can make your mouth more sore. You will be advised as to which is best for you.
Rinse your mouth with water or mouthwash after eating or drinking. Use a soft baby toothbrush to clean your teeth, gums and tongue brushing gently after each meal.
You may find it helpful to carry a bottle of water for sipping during the day to help keep your mouth moist.
You may be prescribed an artificial saliva or gel to help.
You may be seen by a dental hygienist who will give you further advice or you may have already been given a special leaflet on looking after your mouth at your referring hospital.
Eating and drinking
It is important that you eat well during your treatment. You may have to eat a softer diet or have supplement drinks when your mouth or throat becomes sore. Avoid rough or dry foods such as toast, bacon, hot, spicy or acidic foods.
It is important to drink plenty of fluids (between one to two litres daily). This can include water, milk, squash, soups, tea and coffee, avoid fizzy drinks as these may sting your mouth. Drinks should not be too hot or too cold
Drinking alcohol during your radiotherapy (particularly spirits) should be avoided as it has a drying effect and may make your symptoms worse.
If your lips are sore you may find it easier drinking through a straw.
Some people lose their appetite, sense of smell and taste during treatment.
Please ask to see the dietician for further advice.
Smoking during radiotherapy
It is recommended that you stop smoking during your treatment. Smoking reducesthe effectiveness of radiotherapy, and increases the associated side effects. It is appreciated that stopping smoking may be difficult for you. Please ask your radiographer, specialist nurse, oncologist or GP for help with smoking cessation.
You may experience some temporary hearing difficulties. Radiotherapy can cause fluid to accumulate in the ear if your ears are in or near the area being treated. An appointment with your oncologist or G.P. at the end of treatment would be advised.
Effects to the eye
If the eye is treated it may be more at risk to damage and infection as radiotherapy can stop tears being produced, or block the duct that drains them. You can help by following these tips from the start of treatment.
- Bathe them gently and regularly using cooled boiled water
- If the eye becomes itchy, sore or red, or has a discharge, please let us know as you might have an infection. This should be treated as soon as possible. Your doctor can prescribe something for you.
- If your tear ducts become blocked the tears will run down your face. Try to pat the area rather than wipe as this can irritate the skin if it is being treated.
- Try to avoid smoky or dusty environments and exposing the area to high winds which can irritate the eyes.
Effects on the nose and sinuses
Radiotherapy to the nose and cheek area can make your sinuses feel blocked and uncomfortable causing irritation, discharge, crusting and blockage. The nose can feel very sore and you will lose your sense of smell.
- Be gentle when washing and cleaning around the nostrils.
- Don’t blow your nose harshly to clear it.
- Steam inhalations may be helpful: ask your specialist nurse/oncologist.
Your doctor may be able to prescribe some medication to help relieve the blockage.
Tiredness / Fatigue
Radiotherapy can sometimes make you feel very tired especially towards the end of your course of treatment. This may continue for a number of weeks following treatment. You should rest as much as you need to. It may be some time before you feel able to do some of your usual activities. Gentle exercise may help.
Fatigue is something nearly everybody with cancer feels. It affects people differently and it is important to tell the health care team if you are feeling much more tired, fatigued or lethargic. There are some physical causes, such as anaemia that are readily treatable. However, some other causes are unavoidable, so it is important to learn to manage it.
Please ask for a booklet on Fatigue at our Information Centre that may give you tips to help with this.
It is important to make time for yourself. Radiotherapy can make you feel tired or low in mood towards the end of your treatment. Don’t worry if you feel low – this is normal. If you need to talk to someone, please ask, we are here to help. We have a wide range of support services within the department, such as Macmillan nurses, dietician and social worker.
A Clinical Psychology service is available at NCCC on referral from your oncologist.
There are other services available that you might find of benefit, and contact details for these are given at the end of this page.
Sexual activity is personal to each individual and may be an aspect of your life about which you have concerns relating to your disease or treatment. You may have questions you wish to ask. Please talk to your oncologist, specialist nurse or radiographer if you would like to discuss these issues confidentially.
It is very important that women are not and do not become pregnant whilst undergoing treatment. Please inform a member of staff immediately if you think you may be pregnant. You will be asked (if appropriate) to confirm that you are not pregnant by one of the radiographers before starting treatment.
Your oncologist and/or specialist nurse will see you once a week in a radiotherapy clinic during your treatment. You may also see the dietician, the speech and swallowing therapist and the dental hygienist here.
They will discuss any concerns you may have regarding your radiotherapy such as pain control, dietary requirements, swallowing, communication advice, mouth care, skincare and psychological support.
You may find it helpful to write down any questions you may have.
After your radiotherapy has finished
Following completion of treatment, the side effects can continue, these vary from person to person and may last for several months. Continue with your skin and mouth-care routine until advised otherwise.
You will be given a discharge letter with a copy for your GP summarising any side effects you may have and any creams or medication you have been prescribed at NCCC.
Your own specialist team at Sunderland or the Freeman Hospitals will address any longer term problems.
You will be sent a follow up appointment to see your specialist team shortly after treatment at the Head and Neck Multi-disciplinary Clinic at the Freeman Hospital or Sunderland Royal Hospital.
If you are worried about your side effects after your radiotherapy has finished, please contact your specialist nurse, the NCCC Information Centre or your own GP for further advice.
Head and Neck Nurse Specialists at Sunderland Royal Hospital, Ward C33, Sunderland Royal Hospital, 0191 5699733
Northern Centre for Cancer Care Macmillan Information and Support Centre, 0191 2138611
Opening hours Monday to Friday from 9am to 4.30pm