Radiotherapy to the mouth & throat
This booklet gives information about radiotherapy to the mouth and throat. We recommend that you also read our booklet ‘Introduction to
radiotherapy’, which can be found in your radiotherapy information pack.
How radiotherapy works
Radiotherapy is the use of radiation to treat cancer. Most radiotherapy treatment is given on a machine called a linear accelerator, which produces very powerful X-rays. These X-rays are precisely measured and carefully directed to focus on the exact area that needs treatment. Radiotherapy will not make you become radioactive and it is quite safe for you to be near family and friends during your course of treatment.
Having radiotherapy treatment is a very simple and painless process. You will need to wear a special plastic mask (sometimes called a head shell) for a few minutes during treatment to make sure your head is kept absolutely still. You can read more about the mask in the section about planning (page 5).
When you arrive each day, the radiographers will greet you, check your identity, ask how you are feeling and escort you to the treatment room.
They will then place you on the couch and fit your mask into position. When they have lined you up correctly, they will leave the room to switch the machine on. You will be closely observed on closed-circuit T.V. during the short time you are left alone. When treatment is completed, they will remove the mask, take you off the couch and you will be free to go home. There should be no immediate after effects.
Treatment is usually given as an outpatient, attending Mondays to Fridays for up to six and a half weeks. Your oncologist will recommend a course of treatment and instruct our booking team to contact you with all the necessary appointments.
Having daily radiotherapy
Planning your treatment
Radiotherapy is a complex treatment, so it can take up to four weeks to make the necessary preparations or planning as it is called. You will need to attend for at least two sessions before you can have your first treatment. The first session will be to make your mask, which is a very simple and painless process. You will be able to breathe quite easily as the mask is made out of a lightweight plastic, which contains plenty of air holes. We will then do a quick C.T. scan of your head while you wear your new mask. This scan will give us all the technical information we need to plan your treatment. Both procedures take a total of about 30 minutes. Your second appointment will be to come back for a “plan check”, where
we will take a series of X-rays to check that your treatment plan is correct. You should continue to eat and drink before all appointments unless you are specifically told not to do so. You can read more information about masks and planning in our leaflets:-
; A Guide to radiotherapy headshells
; Radiotherapy planning
Your teeth, roots and gums need to be in good condition before we begin treatment, so you will almost certainly need a full check up and oral hygienist appointment as soon as possible. We will give you a letter to take to your dentist, if we are unable to arrange this at your referring hospital.
You may be recommended a weekly dose of chemotherapy (cancer drugs) to boost the effect of radiotherapy. If this is suggested, you will first need to have some blood tests (E.D.T.A.) to check that your kidneys are working well enough to tolerate the drug(s). This test is done in our isotope department and means having a small radioactive injection in your arm, followed by a series of blood samples. This would all be arranged at the North Middlesex.
Effects from treatment
Understandably, many people feel apprehensive about having
radiotherapy as it is a very powerful form of treatment. The cells in the mouth and throat are very sensitive to radiation, so you will probably be quite sore by the time treatment finishes. However, the discomfort will clear up quite quickly afterwards and you should expect to feel much better by the time you have your first check up about six weeks later. The type and amount of side effects will vary with the treatment field arrangement and (to a lesser extent) how well the individual copes with treatment.
Your clinical oncologist will talk about the risk of possible short and long-term side effects as part of your consent to undergo radiotherapy.
Listed below are some of the more common symptoms that you may well experience.
Treatment will almost certainly cause a local patch of soreness from the third week or so. This reaction is a bit like sunburn and will build up to peak at the end. There is a risk that it may break or „weep‟ for a short time at this stage. We will give you creams, dressings and painkillers to help
keep you as comfortable as possible during the healing period (about two weeks after you finish).
Dry and sore throat
After a couple of weeks, you will probably notice that your throat starts to feel quite dry. You may also experience a “lumpy” feeling when you
swallow. As treatment progresses, the linings of the throat will become more inflamed and swallowing may become quite difficult. We will make sure that you are prescribed mouthwashes and painkillers to keep you as comfortable as possible. These will be regularly reviewed in the weekly clinic (see care during treatment page 17).
Dry and sore mouth
If the oral cavity (mouth) is included in the treatment field you will almost certainly notice some changes by the beginning of the third week. Treatment will first dry up the saliva, which will probably make you feel a bit uncomfortable. See page 13 for advice about oral care to help with this. As the dose builds up, the soreness will increase and it may ulcerate near the end. Most people will require strong painkillers to help them over this difficult, but relatively short time.
Lack of saliva can lead to taste changes or even total loss of taste from about the third week. Chemotherapy can often compound this problem. The best way of coping is by experimenting with different things to try and find what suits you best. There should be a marked improvement by about six weeks after treatment, but there is a strong possibility that you may be left with some degree of altered taste perception.
Some people experience a build up of thick, sticky mucous in the mouth and throat. This sometimes causes nausea or sickness, so please ask for
some anti-sickness medication if you need it. Increasing your fluid intake and steam inhalations can be very helpful to break up the secretions.
Treatment may temporarily cause huskiness and loss of voice if the larynx (voice box) is included in the treatment field. If this happens, don‟t be
tempted to strain your voice as this could lead to permanent damage of the vocal cords. Your voice should improve substantially in the weeks following treatment. However, we cannot guarantee that it will return to absolute normal, especially if there was some vocal cord damage before treatment commenced.
Difficulty with swallowing
Local reactions will undoubtedly make it more difficult for you to eat your normal range of foods. Like skin soreness, this will be most problematical towards the end of treatment and for a couple of weeks following. See page 15 for advice about nutrition during this time.
Please make sure you tell the staff if eating or drinking makes you cough or choke, as you could be at risk of developing a chest infection if food and drink goes down the wrong way. Our speech & language therapists will be seeing you regularly, to monitor your swallow and advise you about using your voice if this is affected.
Lethargy and tiredness
Travel for your daily radiotherapy, together with increasing side effects will probably make you feel quite tired, so don‟t worry if you spend a fair
amount of time resting or sleeping. The fatigue will be at its worst near the end, but you should feel a lot better by about a month after finishing. (see page 16 for advice about coping with this problem).
If your energy levels do not seem to be getting back to normal, please mention it to the doctors when you come back to the joint E.N.T. clinic for your check ups. You may need a quick blood test to check that your
thyroid gland has not been affected by the treatment. If there is a problem, it can easily be treated with thyroxine replacement tablets.
Infections in the mouth & throat
It is very common to develop oral thrush (candida) during treatment. Thrush appears as white lumpy looking patches on the tongue or the inner surface of the cheeks. It can be easily treated with some anti fungal medication, so please tell us if you think you have developed a problem of this nature.
If treatment is given near the ear canals, you may be troubled with blocked ear(s). This is due to fluid build up and usually settles afterwards.
Hair growth (men only)
Treatment will almost certainly slow up beard growth from about the third week and there is a very strong chance that this will lead to permanent damage to the hair follicles. Moustaches will not be affected unless the top lip is included in the treatment field.
Looking after yourself during treatment
It is important that you take good care of your skin to reduce skin soreness. You will be advised to wash very gently and apply a simple moisturizer (Aqueous cream) to stop the skin from becoming too dry.
Beard removal must be with an electric razor only, as wet shaving will make the reaction a lot worse. The radiographers will meet with you on your first day to give you information about skin & mouth care, as well as an information sheet containing general advice, contact numbers etc.
Good oral hygiene is extremely important during and after treatment. This includes simple things like regularly cleaning your teeth and doing lots of
oral rinses to keep your mouth clean and fresh. We will tell you more about this and emphasise the importance of it at the beginning of your treatment. We recommend that you avoid commercially prepared products, as many of these are far too harsh. We also strongly
recommend that you do not have any alcohol (particularly spirits) during treatment. If you think this may be a problem, please talk to your doctor so that you can be offered some help.
If you are a smoker, it is very important that you try to give up. Smoking will worsen side effects and may even reduce the effectiveness of treatment. It will also increase the risk of the disease coming back or developing another cancer. We appreciate that stopping smoking may be very stressful for you at this difficult time, but there is plenty of support available if you have the will to stop. We can give you advice and literature about local & national ‘Quit smoking’ clinics.
Eating and drinking
Taste changes and soreness from treatment are bound to have a negative impact on your desire to eat and the texture & amount that you are able to manage. However, it is still vitally important that you receive good nutrition to help you cope with treatment. You will also need to take a total of about four pints of liquid each day. Tea, squash, soups, etc. all count, but you should try to make some plain water part of your total intake. You should obviously take care not to burn your throat with overly hot food and drink. You will also need to be careful with chilli seasoning unless it is a very regular part of your diet.
Simple painkillers like paracetamol and gargling with soluble aspirin can be very helpful when you start to feel uncomfortable.
Our dietician will meet with you weekly to monitor your weight and nutritional intake. She will also make helpful recommendations like liquidising your food, adding extra milk, butter, etc. and will prescribe liquid food supplements when you need them.
Despite every effort, many people really struggle to meet their nutritional requirements from about the fourth week. At this point, weight loss can become very rapid, leaving the person less able to cope with treatment, due to their weakened state. For this reason, we often recommend placing a small tube (called a P.E.G.) directly into the stomach. This will temporarily allow a route to top up essential nutrients when you are unable to eat or drink enough to keep you healthy. It may also be advised if you have problems with your swallowing where there is a risk that food or liquids may go into the lungs. The tube will be removed as soon as you are able to manage an adequate amount of liquid supplements. We know that this will sound quite alarming and will probably come as a bit of a shock at this stage. However, we do have some specialist staff who will talk to you more and give you written information to take away, if the oncologist recommends one of these tubes.
Coping with tiredness
Your body will use extra energy just coping with treatment, so you will almost certainly experience quite a lot of tiredness. We can expect this to be at its worst during the last three weeks of the course and the subsequent four weeks or so. Most people are still able to cope with essential daily tasks such as washing, dressing, preparing their own food and doing some light housework. If you live independently, you may like to consider accepting offers of help, especially with things like shopping, heavier tasks and where possible, lifts to hospital.
Care during treatment
Your oncology doctor will see you each week to review your side effects and prescribe medication to help with them. The dietician and speech & language therapist will also see you regularly, to monitor your nutritional levels and swallowing function. There is also a specialist radiographer and nurses who give expert advice over and above the support provided by the daily treatment staff.
Complementary therapies are available in the Helen Rollason cancer
support centre, which is situated in the oncology waiting area. Please walk in and ask for an appointment if you would like some reflexology, aromatherapy or an appointment with the counsellor.
If you are worried about anything, feel depressed or are not sure how to manage, do not hesitate to ask for help. We are here to help you as much as possible.
After radiotherapy has finished
The worst of the side effects should settle about three to four weeks after treatment finishes. We will continue to see you weekly during this recovery period. You will need to continue your medication and skin care until all the reactions have settled. If you need dressings, we can arrange for the district nurses to do them at home. Your first check up will take place a couple of weeks after you are discharged from the North Middlesex hospital. This is usually at the joint clinic where you first saw your E.N.T. surgeon & the oncologist.
More information is available in the leaflets:-
; Finishing radiotherapy treatment
; Oral care after radiotherapy to the mouth & neck