Preventing Side Effects Post Radiotherapy in Head and Neck Cancers

Radiotherapy is one of the mainstream modes of treatment in Head and Neck Cancers.

Head and Neck Cancer treatment was revolutionised when Henri Coutard, instead of giving a large single dose, gave smaller doses of radiation over multiple visits- designing a technique called fractionated radiotherapy.
What this meant now, was that with the lower doses, there were much lesser side effects than previous radiotherapy regimens.

The Birth of the RadioTherapist.

At the International Congress of Otology in Paris in 1922 Regaud, Coutard and Hautant presented 6 patients with advanced carcinoma of the Iarynx treated by radiation therapy and now free of disease.

Cured.


This was the first time radiation therapy was shown to be an independent speciality practised not by surgeons but by radiation therapists.

Beginning in 1919 Coutard treated incurable head and neck tumors with fractionated low dose roentgenotherapy. Coutard reported cures but also described reactions of the skin and mucosa showing that they depended for specific doses on the total duration of treatment.

Over the next years, Radiotherapists have worked in the field to improve this technique of providing you with the LEAST dose, yet get the BEST results.

However, Cancer is not something that gives in without a fight. It’ll try it’s best to hinder good treatment and cure, and hurt your normal cells.
And these are what we call side effects. Side effects occur because your Doctor is doing all he SHOULD to destroy the cancer, while protecting you the most.

You can’t completely eliminate side effects hence, but you can always train and learn to support your body against it’s fight against the dying cancer that’s causing them as retaliation.

What the patient should understand

I find it hard to eat‘, ‘I’m unable to taste my food‘, ‘I feel a burning sensation in my mouth‘ are some of the common complaints patients face while they are on radiotherapy to the head and neck region.

Patients on treatment must be informed about these symptoms so that they can bring these to the notice of their treating physician as soon as they appear so that prompt action may be taken.
When you tell your Doctor about these, he’ll already have a treatment ready, as this is what he’s already expecting to happen.

So, don’t worry, you have support.

Here’s a few symptoms you should be vary about:

  • Reddening of the tongue and membranes
  • Ulcers in mouth and throat
  • Cough
  • Bleeding may be present
  • Difficulty in swallowing and talking
  • Feeling of food sticking in the throat (Patients may require extra liquids to wash food down)
  • Dry mouth
  • Increased production of mucus or thick saliva
  • Change in voice- voice may sound wet and gurgly.
  • Whitish patches in the mouth, due to infection by a fungus(oral candidiasis)
  • Pus discharge
  • Cracks and ulcerations over the exposed skin, followed by bleeding in some cases
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Ulceration within oral cavity
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Oral candidiasis

A point to note is that these symptoms may not be seen during the first few days of treatment, and usually start appearing gradually during the course of treatment (from the second week or so).


Remember that this is the dying Cancer cells trying their last attempts to hurt you.

If you happen to have any of these symptoms while on radiotherapy, don’t worry- Just talk to your Doctor and he’ll let you know how to tackle them.


What would Happen if I ignored these symptoms and just stayed home?

It would not be wise to stay home and assume the symptoms will go away by themselves.

If you don’t deal with them at the prompt time, you could get into worse complications- Complications that are harder to treat and would make your Cancer cure take longer and be more unpleasant.

A few complications are listed here:

  • Weight loss
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Malnutrition and Severe weight loss
  • Pneumonia
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Pneumonia: Infection of the lungs
  • Severe dehydration
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  • Skin ulceration, which may lead to local infection
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Infected skin wound

To put it into perspective, if you stayed home in case of severe difficulty in swallowing and severe malnutrition- an oral feeding tube will have to be inserted, which can be very uncomfortable for the patient.

What can I do at home to decrease my chances of having such side effects?

As previously mentioned, side effects occur because the dying cancer, post radiotherapy, releases toxins that harm your body.
You can always support your body during these times, by following a few simple steps.

The following needs to be followed when on RadioTherapy:

  1. Maintain oral hygiene- This is of prime importance as it can drastically reduce the severity of oral mucositis.
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Benzydamine is an anti inflammatory agent, gargles with benzydamine 5-6 times daily during therapy helps in reducing inflammation and in maintaining oral hygiene.

Gargling daily will reduce your chances of infection by killing the germs in your mouth, and also helps by decreasing swelling and inflammation.

  1. Gargle with Baking soda Soda and Common Salt water- 8 – 10 times in a day
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Baking soda + salt dissolved in water – helps reduce inflammation by breaking down mucus and pulling out the excess water from oral membranes.

Both are very cheaply available.

  1. Drink 8-10 glasses of water
    Total intake should be atleast 2-3 litres of water per day.
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Nothing helps better to wash out the dying cancer cells from your body than good, home boiled water.

  1. Use only mild soap such as pears or dove soap while bathing.
    You don’t want to be any more harsh on your skin.

    After bathing, pat the area dry. Do not rub.
  1. Beard can be trimmed using zero machine.
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  1. Eat fresh home cooked food.
    Eating small quantities every 2 hours is helpful.

    Diet should consist mainly of vegetables and plenty of fluids. Milkshakes and ice cream can help in relieving symptoms.
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  1. Listen to music.
    It helps relieve stress and anxiety
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  1. Light exercise/yoga is beneficial in reducing stress and improves self esteem and confidence.
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  1. Listen to family members as they want what is best for you.
    Get involved in family activities more often so that the stress of treatment reduces.

    Never forget that even though YOU may be the one suffering from cancer, your close family members have the added emotional burden of seeing your suffering.
    It’s difficult for them too.

    Most times close family members may find it difficult to express this, as they may not want you to worry more, but acknowledge it and help out by being with them as a team.

    They’ll really feel better when you let them help you.
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Your family cares about you.
  1. Visit your doctor every 5-6 days.
    Feel free to visit earlier too if you have any queries. Don’t risk your treatment against the disease.
    Your Doctor wants to win against cancer as much as you want to.
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Kindly Avoid These

  1. Do not rub the treatment site.
  1. Do not shave using blade.
    If you cut yourself, there’s the chance of infection, which will make treatment course much harder and complicated.
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  1. Do not wear chain. ornaments, earrings at treatment site.
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  1. Avoid oily and spicy food
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  1. Avoid alcohol and smoking.
    Avoid smoking as it worsens symptoms and reduces the effect of treatment.
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  1. Avoid direct sunlight as it may damage the skin, already made sensitive by radiation.
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  1. Avoid using dentures during treatment.
    They may rub against and cause abrasions, allowing germs to cause infection.
  1. Do not stay isolated. Keep yourself in the company of others.

Remember:
To defeat cancer, you have to fight against all it throws at you.
And your Doctor and Family is here to do exactly that.

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