Radiotherapy to the ear, nose & throat
Radiotherapy is a localised treatment and side effects depend on the area of your body receiving the X-rays (in your case the head, mouth or throat). There are two types of side effects; those which come on during or immediately after treatment (acute side effects) and those which can be long term (late side effects). Your oncologists will have taken these into account when considering the benefits of treatment and will inform you of the side effects you are likely to get. Please discuss any concerns with your doctor, specialist nurse or radiographer at the time of consent or at any time during radiotherapy. This information sheet provides a brief introduction to radiotherapy and explains the common side effects you may experience. This does not mean you will definitely get them. It is also possible you may experience a side effect not mentioned here.
Your first appointment at the radiotherapy centre will be a planning session in the simulator or the mould room. Report to the reception desk, show them your card, and they will direct you. You will then be welcomed by a specialist radiographer, who are people who operate the machines to plan and give your treatment. You should not be embarrassed to ask them anything you are concerned about. The purpose of this visit is to plan and arrange the radiotherapy so you may not have a formal consultation with the doctor at this stage. Of course any urgent issues will be addressed but others should be saved for the regular consultations you will have during treatment. It is often difficult to judge exactly how long each patient will take - unfortunately it is possible that you will wait a long time
The mould room. In some cases a plastic shell is made for your head and neck area. This keeps your head still so you don't have to worry about moving during your radiotherapy. It also mean marks do not have to made on your skin. In the mould room you will have to lie on a couch while technicians make a plaster of Paris impression of your head. From this impression a plastic shell is made, which is fitted back on your head, at a later date, for final adjustments before you going to the simulator.
The simulator is a machine which is a direct copy of a therapy machine. It takes X-rays pictures to enable the oncologist to decide the exact area of your head and neck which needs treatment. While very accurate measurements are taken, you will have to lie on a fairly hard couch which may be slightly uncomfortable. A small tattoo about the size of a pin head is made on your body - giving a permanent record of the measurements.
The treatment machine looks similar to the simulator. You will not be required to do anything you haven't already done in the simulator. Although the radiographers are not in the room while you are being treated, you are being watched at all times on a video camera. If you feel any distress, the machine can be turned off and the radiographers will be at your side within seconds. There is also an intercom which is left on. Treatment usually lasts only 1 to 2 minutes. While the machine is on, there may be a slight smell of ozone but otherwise there are no new sensations. After treatment you will not be radioactive.
Additional general information The cancerbacup booklet "Understanding radiotherapy" can usually be obtained from the racks around the centre or alternatively by phoning cancerbacup directly on 0800 181199. A copy of the information film Chemotherapy & Radiotherapy can be ordered directly by email only firstname.lastname@example.org
Potential acute side effects
The skin in the treated area may get red, itchy, dry and slightly sore as the treatment progresses. You may splash the area with water but do not use soap, aftershave or make-up. E45 or aqueous cream may improve the condition of the skin. If it gets worse, with cracking and oozing, please tell the radiographers as you may require a cream, which can be prescribed for you. It is advisable to wear loose clothing around the neck. In men, when treatment is given to the beard area, you should use an electric razor rather than have a wet shave or stop altogether. The beard hair growth may be effected by radiotherapy.
Soreness of the mouth or throat is common and will usually require the use of soothing gargles and mouthwashes. These are best given by your doctor rather than those you can buy over the counter. We suggest you avoid; drinks which are very hot or cold, smoking (which can also can reduce the effectiveness of radiotherapy), alcohol, particularly spirits (although wine and beer in moderate amounts is tolerated better). If eating becomes a problem we can refer you to a dietician, please ask your radiographer.
If the voice box is being treated it is advisable to rest the voice as much as possible and to keep out of smoky atmospheres. You may lose your voice temporarily.
If the salivary glands are irradiated your mouth will get dry. This will gradually improve over many weeks but may be permanent. In this situation your taste may also be affected.
If the scalp is in the treatment field you will lose your hair in that area. The hair will come out gradually after 2 to 3 weeks of treatment. It will often re-grow in due course - but over a period of many weeks. During radiotherapy you can wash your hair in baby shampoo but no more than once a week.
Radiotherapy continues to have an effect on you after the course of treatment has finished. The reaction in your mouth & throat may get worse up to 10 days after treatment has finished. Reaction will gradually subside and are usually much improved 4 to 5 weeks after treatment.
Potential late side effects
These depend on the dose and the area of your
head and neck receiving radiotherapy:-
Damage to the salivary glands can cause dryness of the mouth and an increased risk of dental disease.
If you get dental abscess after radiotherapy there is an increased risk of damage to the underlying bone (it is important to keep the teeth very clean after radiotherapy).
Even a moderate dose of radiotherapy to the lens of the eye increases the risk of cataract.
Damage to the inner ear increases the risk of deafness, which may be permanent. Likewise, if the tube from the back of the mouth to the ear receives radiotherapy, the ears can get blocked (glue ear) but this is often treatable.
Higher doses to the soft tissues, particularly under the chin can cause some underlying thickening which may be uncomfortable.
Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.