Complications of Head and Neck Cancer Treatment

Head and neck cancers start in or near your lips, tongue, tonsils, mouth, nose, sinuses, throat, salivary glands, or voice box. Surgery, radiation, and other treatments can fight the cancer in these areas and protect the important jobs they do. But some therapies can also cause long-term health problems, or complications. They might change the way you eat, talk, hear, and breathe. They can also affect the way you look.

It’s common for cancer treatments to have side effects, which get better over time or with help from your care team. But complications can last or even appear months or years after treatment ends. Your doctor can work with you to plan treatment that saves as much of your healthy tissues as possible while getting rid of the cancer.

As you make your treatment decisions, be sure to talk with your doctor about how each treatment can affect your body.

Eating Problems

Many people with head and neck cancers have trouble eating and drinking because of the disease itself. But cancer treatments also can cause mouth issues and trouble swallowing.

For example, surgery to remove a tumor may also damage nerves, muscles, and other tissues that help you chew and swallow. Nerve damage may make parts of your jaw, throat, or neck numb. Over time, scar tissue may form and cause problems, too.

Some chemotherapy drugs cause nerve damage, too. Radiation can also damage muscles, nerves, joints, and bones in your jaw. You may notice changes in how food smells and tastes. Other complications, like dry mouth and dental problems, also make it hard to eat and drink enough to get the nutrients and fluids you need.

If you’re already having a hard time getting nutrition, or you’re likely to have trouble eating, you might get a feeding tube before you start treatment. It’s a flexible plastic tube that goes in through your nose or a small cut in your belly to get nutrients to your stomach. You’ll keep it in as long as you can’t eat or drink enough to get the calories and fluids your body needs, or if you lose too much weight.

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Talk with your care team about how your treatment will affect how you eat. Ask to see a registered dietitian to learn more about your nutrition needs and what you can do to meet them.

Even if you can’t swallow food at some point during treatment, it’s important to keep your swallowing muscles strong and flexible. A speech language therapist can teach you exercises that can help. But you need to do them every day. Stretching exercises and devices that open your mouth can also help keep your jaw working the way it should.

For some people, plastic surgery can rebuild bones or tissues to make swallowing easier. Devices called prostheses, specially made to fit your body, also can help you swallow or talk. Your doctor can tell you about each of these options and what they’ll mean for your health and lifestyle.

Dry Mouth

Radiation often damages the glands that make saliva. This causes dry mouth and thick, stringy saliva, which can get worse over time. That means you can have tooth and gum damage, wounds that heal slowly, and painful sores and cracks in your mouth. It can also affect the way you speak and eat.

When you don’t make enough saliva, it’s important to keep your mouth clean and moist. Artificial saliva or saliva replacements, special rinses, and other medicines can help. Using alcohol-free mouthwash, drinking a lot of fluids, and sucking ice chips can ease symptoms. You may find that sugar-free hard candies or sugarless gum work for you. If some of your salivary glands still work, acupuncture might ease dry mouth, too.

Tooth Loss

Radiation can damage your teeth and the bones of your jaw. This can lead to cavities and tooth loss.

It’s very important to see a dentist and address any dental problems at least a month before you start radiation. This gives your mouth time to heal if you have any dental work.

Ask your dentist what you can do to keep your mouth clean and healthy during and after treatment. Regular brushing and flossing can help. You may also get a fluoride rinse or gel to put on your teeth. After cancer treatment, it’s important to see your dentist regularly so she can treat any problems that come up ASAP.

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Lymphedema

Your lymph system is a network of vessels and nodes throughout your body. It carries clear fluid with cells that fight infections and other diseases. Radiation and surgery can damage your lymph system. That means lymph fluid can’t flow back to your heart the way it should. It builds up under your skin. This can lead to swelling in your face, neck, or chest. It can make your neck and shoulders hurt and feel stiff. It also can change the way you look. Swelling inside your head and neck can also affect how well you hear, breathe, talk, and eat.

Ask your doctor what you can do to prevent lymphedema. Watch for any swelling, tightness, heaviness, or fullness in your face, chin, neck, and shoulders. Notice if these feelings start inside your mouth, nose, throat, and ears, too. Let your doctor know about it right away because lymphedema tends to get worse if you don’t treat it. Exercises and massage techniques can ease lymphedema and keep it from getting worse.

Self-Esteem and Body Image

Head and neck cancer treatments might affect the way you feel about yourself. Surgery, as well as complications like lymphedema and weight loss, can change the way you look. It might be hard to handle having trouble with the way you eat, hear, and talk because of treatment complications. You might feel stressed, sad, or anxious, or you might shy away from socializing with others.

It’s important to get help for these feelings. Talk to your treatment team about any problems you’re having. Many times, there are treatments and solutions for these complications. For instance, you could get a prosthesis to restore the way you look.

Counseling can help, too -- it can give you and your family a chance to talk about your cancer and treatment and find ways to handle the emotions you might be feeling.

Less Common Side Effects

Hypothyroidism . If you get radiation in your neck, it could damage your thyroid gland, affecting how well it can make thyroid hormones. Low levels of these can lead to weight gain and can make you feel tired. If you need radiation in this area, your doctor will keep an eye on your thyroid hormone levels after treatment. If they get too low, you can take pills to replace them.

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Hearing problems. Surgery, radiation, and some types of chemotherapy can damage the nerves, blood vessels, or structures that allow you to hear. The amount of hearing loss differs -- for instance, you may not be able to hear certain frequencies, but still hear well enough to get by. For some people, it’s reversible. Hearing aids help. If you have lost your hearing in both ears, cochlear implants might be an option.

Jawbone damage. Radiation can damage the blood vessels that support your bones. The bone tissue can die and break or get infected. It’s not common, but certain drugs can also cause bone tissue around your mouth to break down. This is called osteonecrosis of the jaw. Pain and infection in your jaw are the most common symptoms. Ask your doctor if your treatment could cause this and what you can do to make it less likely.

Chronic pain. Some people have pain after treatment that lasts a long time, particularly in the neck, jaw, or shoulders. It might be linked to tissue damage or even nerve damage. Your doctor will talk with you about different pain medicines that can help.

What You Can Do

After treatment, you will see your care team every few months. Your doctor will use tests and exams to watch for long-term complications and check for signs of problems.

Use these visits to tell your providers about any changes you’ve noticed. Treating complications right away can help keep them from getting worse and causing other problems.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on September 17, 2018

Sources

SOURCES:

American Academy of Otolaryngology -- Head and Neck Surgery: “50 Facts about Oral, Head and Neck Cancer.”

The Oral Cancer Foundation: “Complications of Treatment,” “Dysphagia.”

National Cancer Institute: “Head and Neck Cancers,” “Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ) -- Patient Version.”

Cancer Treatment Reviews: “Treatment of late sequelae after radiotherapy for head and neck cancer.”

National Comprehensive Cancer Network: “Head and Neck Cancers.”

Current Opinion in Otolaryngology & Head and Neck Surgery: “The Role of Lymphedema Management in Head and Neck Cancer.”

Toronto Physiotherapy: “Patient Guide: Head and Neck Lymphedema Following Cancer Treatment.”

Head and Neck Cancer Alliance: “What Rehabilitation or Support options are Available for Patients with Head and Neck Cancers?”

SPOHNC (Support for People with Oral and Head and Neck Cancer): “News from SPOHNC, Vol. 21 No. 2.”

American Society of Clinical Oncology: “Head and Neck Cancer: Treatment Options.”

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