Side effects of radiotherapy for nasopharyngeal cancer
Most people have side effects from radiotherapy to the nasopharynx. The side effects usually appear gradually during your course of treatment. They are likely to be worse towards the end of your course.
About radiotherapy side effects
Side effects tend to start a few days after your radiotherapy begins. They often gradually get worse during treatment and can continue to get worse after your treatment ends. But they usually begin to improve 1 or 2 weeks after your treatment ends.
There is a possibility of having long term or late side effects. These can be side effects that don't go away after finishing radiotherapy. Or begin several months or years afterwards. Your doctor, radiographer, and nurse will talk through the possible side effects with you before you start treatment.
Everyone is different and the side effects vary from person to person. You might not have all of the side effects mentioned below.
Voice over: Radiotherapy can cause many different side effects, such as tiredness. The side effects you get will depend on the area you're having treatment to.
This video is about the side effects you might have when having radiotherapy to the head and neck.
Sore mouth
Louise: Mouth soreness and throat soreness with head and neck radiotherapy is very common unfortunately. If the soreness is on the outside on your skin, they might recommend particular creams that you can use to help with that.
If the pain is internal, you may be referred to the doctor and the doctor will suggest some medication to help control the pain.
Charlie: Probably I think it was from week 2 to week 3 when the radiotherapy side effects started really impacting me. At that point, really, I was unable to eat. The ability to take food down your food tract with that level of inflammation and ulcers was just too difficult.
Louise: Mouth soreness can continue for up to 3 months. The team will support you during that time, whether that be with some medication or some skin care advice. They'll also check your mouth quite regularly to make sure you don't have an infection which might be slowing down the recovery time.
Charlie: They always checked the condition of my mouth and made sure that it was in good health, recovering, and if there was any issues they just supported and advised me on the best way to deal with it.
Dry mouth
Charlie: My saliva glands were very close to some of the areas affected by cancer, so they did warn me that there was a high likelihood that my saliva glands would have some problems.
Louise: Radiotherapy can cause damage to the salivary glands. There are lots of things you can do to help with that. Small sips of water can ensure that your mouth stays moist. Little spritzer sprays or nebulisers, steam treatments can also help.
Charlie: Even now my saliva glands still don't work as well as they did beforehand. You'll find me sipping on water on a regular basis to offset the impact of the saliva gland limitation.
Changes in taste
Louise: You may find that your taste alters. If this is the case, you might find that food and drinks that you previously loved do taste very different. Sometimes people report they taste a bit metallic. If this is the case, please consult your dietitian and they will be able to support you with that.
Tasha: It's like a battery taste. I don't know how I know that, but that's how I'd best describe it. It’s very unpleasant. So anything you're eating, you can't taste that food. It's just metallic taste.
At the end of my treatment, it still carried on, but it was slowly dying down and then when it went, I was very happy because I ate as much as I wanted.
Weight loss
Louise: Unfortunately, weight loss with head and neck radiotherapy is very common. Obviously we don't want you to lose too much weight, so we would work very closely with the dietitian to support you.
Charlie: The clinical team in advance warned me I would lose weight. They told me to prepare for it. They told me to eat lot of calories in advance and I thought they were kidding, but the reality is, the weight did drop very, very quickly.
Louise: Initially, if you start to notice any problems eating, we would recommend you start to move to a slightly softer diet. Foods that are soft, easy to swallow, but highly nutritious.
Charlie: Soups and gravies and maybe move on to scrambled eggs and rice puddings.
Louise: If you then find that that starts to become problematic, we do have some special little drinks that you can use as a meal replacement.
Tasha: I had a smoothie drink that was given to me by the doctors. It's like a smoothie with calories in and it's a small bottle so you're just topping up what you’re missing not eating and drinking fully.
Charlie: My swallow mechanism just stopped working, so everything I had to take was being taken through the stomach tube.
Louise: Occasionally the radiotherapy can have a real impact on how easily you can swallow and if it starts to become very problematic, they may suggest they use feeding tubes to help ensure you are getting the right nutrients.
Looking after your teeth
Louise: Radiotherapy can cause some bone weakening, so as a result of that, we would recommend you are referred to a dentist before you start a course of radiotherapy.
They will look at all of your teeth and any teeth that already appear weak and damaged may be removed before you start treatment.
Tasha: The dentist and even the doctors and consultants said that after you've had radiotherapy and if it's been near the mouth area or teeth that it can make dental treatments more painful, and I did find that.
Charlie: Post treatment you have to really, really look after your teeth, so I go to the dentist every 3 months. Any problems with your teeth have to be nipped in the bud.
Changes to your voice
Charlie: They found cancer in my voice box so that was part of the treatment area. As the weeks progressed in treatment, I started losing it.
Louise: If you're having radiotherapy to your larynx, your voice box, you may well find that you end up with an altered voice. This can happen during treatment and we can't always guarantee your voice will be the same as it was after treatment.
Charlie: I lost it in total probably for maybe 2 weeks, so my wife had a peaceful couple of weeks for that period of time and it just came back. But it was quite fragile. So I learned to take it easy, and even now, 18-20 months after treatment, I can feel it if I talk too much.
Louise: We would recommend you rest your voice as much as possible and if needed, carry a pen and paper around with you, so you can continue to communicate.
Hair loss
Tasha: My hair loss from radiotherapy, you could see it weeks and months later, it slowly and gradually started to sort of go bald at the top.
Louise: Hair loss is common, but only in the area exposed to the radiation beam.
Charlie: Every hair in the treatment area, whether it was on the back of my neck or the front of my throat/neck area, had just fallen out.
Louise: The majority of hair does grow back, but we can't always guarantee that it definitely will. And it doesn't always grow back in quite the same way that it used to.
Tasha: I try to embrace it because it's part of my cancer story, but I like having my fringe and I just think I'll probably keep it.
Voice over: If you're experiencing a side effect that hasn't been covered in this video, you can find more information on the Cancer Research UK website.
Possible side effects of radiotherapy
The side effects of radiotherapy to the nasopharynx can include:
Most people who have radiotherapy for nasopharyngeal cancer get a sore mouth and throat. It's likely to become increasingly sore during your treatment. This usually continues for a couple of weeks after your treatment and can take several weeks to get better.
The lining inside your mouth may break down (get ulcerated) as you go through your treatment. This might be worse if you're having radiotherapy with chemotherapy (chemoradiotherapy).
Your doctor might prescribe a gel. It forms a protective coating over the inside of your mouth, a bit like a dressing. This can make your mouth less painful and can make it easier to eat and drink. Your doctor or nurse may also suggest using a numbing spray or ointment on sore areas.
Your doctor might also give you painkillers to take regularly. If your throat becomes extremely sore you might need very strong painkillers such as morphine. Some people have these through a pump or skin patches. Your nurse and doctor will tell you more about the painkillers you have and the possible side effects.
Mouth care is important for this type of treatment. Your nurse or radiographer will give you mouthwashes and will tell you how to use them. Try to do this as often as they suggest. It is important to use them to help prevent infection.
At the first sign of infection (particularly high temperature with chills, a sore chest or cough), contact the hospital. You may need treatment, such as antibiotics through a drip.
It is important that you do this without delay if you are also receiving chemotherapy. Your immune system may be weakened, and you will not be able to fight an infection in the normal way. Most hospitals give you an emergency card. This will help you to know exactly what to do and who to contact if you develop a temperature or symptoms of an infection whilst receiving treatment.
You might feel tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.
Tiredness can carry on for some weeks after the treatment has ended. But it usually improves gradually.
Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. It's important to balance exercise with resting.
The skin in the area being treated may become sore and itchy. On white skin, the area may look red. On brown or black skin, the treatment area may darken slightly and have a different texture.
Your radiographer will give you advice on washing the area and creams to use to soothe your skin. It is important to get advice from your radiographer before you use anything on your skin in the treatment area.
During your radiotherapy treatment, the skin might break down around the treatment area. Your nurse will use special dressings to cover and protect the area.
It can take around 4 to 6 weeks after treatment or sometimes longer for the skin to get better.
You should avoid removing the hair around the treatment site. This includes shaving, waxing and hair removal creams. Your nurse can help if you have any questions about this.
Tell the radiotherapy team if you notice any skin changes.
As your course of radiotherapy goes on, you may have difficulty chewing and swallowing. This is because your mouth and throat might be sore.
Speech and language therapists play an important role during your treatment. They will help you with swallowing difficulties (dysphagia) and help you eat and drink safely. They can give information to your family or carer on how to support you with swallowing difficulties.
A dietitian can also give advice on what to eat when you have swallowing problems. This might include having a liquid diet.
You can have these feeds by mouth if you feel you can still swallow. But many people find they need tube feeding to keep their calorie intake up. You can have tube feeding by a:
- nasogastric tube - a tube that goes up in your nose and down into your stomach
- PEG tube - a tube that goes through the skin of your tummy (abdomen) into the stomach
Your nurse shows you and your relatives how to care for these tubes and how to give the feeds.
It is understandable that you might feel upset if you need to have tube feeding. You may feel that another part of normal life has been lost to you. But it is only temporary.
Your health is the most important thing. You will feel a lot better if you are getting the nutrition you need for everyday living. It will also help you recover from your treatment.
Radiotherapy to the head or neck often affects taste. This can be a direct effect of your treatment. But poor mouth care, a sore mouth or an infection can also affect your taste. Having chemotherapy can also cause changes in your taste.
People often say they have a metallic taste in their mouth with radiotherapy and some chemotherapy drugs. You might lose your sense of taste or have strange tastes or dulled taste. Loss or changes of taste can affect your appetite.
In time, you are likely to recover fully from this. But this does vary from person to person. Some people might find their sense of taste is permanently dulled.
Radiotherapy to the nasopharynx can damage the glands that produce your spit (the salivary glands). This can happen within a couple of weeks of starting your treatment. Your doctor might call a dry mouth from lack of saliva xerostomia (pronounced ze-ro-stome-ee-ah).
Some people say they make as much saliva as before, but that it is thicker and stickier. This can make it harder to chew and swallow.
Long term
After the treatment, you might have a permanently dry mouth. This can make eating, swallowing and talking quite uncomfortable.
If you have trouble with a dry mouth, your doctor can prescribe artificial saliva to keep it moist. This will help make you more comfortable.
You are more likely to get an infection or tooth decay if your mouth is dry. So you’ll need to keep an eye on this and have regular check ups with your dentist.
There is some evidence to suggest that acupuncture might help with a dry mouth caused by radiotherapy to the head or neck. But we need more research to understand how well acupuncture works in treating a dry mouth.
Radiotherapy for nasopharyngeal cancer often affects hearing. You might find it hard to hear soft sounds. Or you might find it hard to tell different sounds apart. It may also make you feel dizzy.
Usually this is a temporary problem that happens during your treatment and recovery. But occasionally hearing loss or changes can be permanent.
You might be more likely to have hearing problems if you are having chemoradiotherapy. This is because some chemotherapy drugs can also affect hearing.
Radiotherapy can cause some damage to the muscles in your jaw. This makes the muscles tighter, which makes it harder to open and move your mouth.
This tightening of the mouth muscles is called trismus. It can make it difficult to eat and brush your teeth. Your doctor or nurse gives you exercises to help if you have this side effect.
Radiotherapy can sometimes damage the jawbone and break down the bone. This is because radiotherapy can reduce the blood supply to the bone. This is called osteoradionecrosis. This is rare but it can happen months or years after your treatment has finished. Symptoms include pain and swelling in your gums.
Radiotherapy might affect your sense of smell. This is because radiotherapy causes dryness of the mouth and nose. If your nose is very dry you might not be able to smell things normally for a while. This may be while you have your treatment and during your recovery.
Some people may find their sense of smell never quite gets back to normal.
Radiotherapy to the neck can damage the thyroid gland. If this happens, you will need to take pills to replace thyroid hormones.
You will have thyroid tests after your course of radiotherapy.
If your radiotherapy reaches the 
in your brain, it can stop this gland making enough hormones. This is called hypopituitarism.
You may have to take replacement hormones if your pituitary gland is affected. Your doctor will talk this through with you.
Your eyes are close to the nose and nasopharynx. Having radiotherapy in this area sometimes means that your eye is in the path of the treatment. If it is, the radiotherapy may damage some parts of your eye and change how well you can see.
Your doctor will discuss with you in detail how treatment may affect your eye and sight.
Your hair only falls out in the area where you are having treatment. You might also have some hair loss on the opposite side of the head or neck, where the radiotherapy beams pass through. This is called the exit site.
Most of the hair loss can recover but sometimes your hair might not grow back after treatment.
The side effects of radiotherapy, such as a dry mouth can increase your risk of problems with your teeth. You may need to go for check ups at the dentist more often. Fluoride treatment may help to protect your teeth.
Remember to tell your dentist that you’ve had radiotherapy before you have any dental work.
They may also need to talk to your radiotherapy doctor before giving you any treatment.
You might need to have some teeth taken out before you start treatment. Your doctor may refer you to a restorative dentistry consultant before your radiotherapy. A restorative dentist is a specialist in replacing lost tissues and teeth.
After radiotherapy to treat a head and neck cancer, you are at risk of getting swelling called lymphoedema in your neck or face. Lymphoedema is pronounced lim-fo-dee-ma.
Lymph fluid is in all body tissues. It comes from the tiny blood vessels into the body tissues. Usually, it drains back into the bloodstream through channels called lymph vessels. These are part of the lymphatic system.
A build up of lymph fluid in an area of the body can happen if lymph drainage channels or lymph nodes are blocked, removed, or damaged.
Lymphoedema in the head or neck can also cause symptoms inside your mouth and throat. For example, swelling of your tongue and other parts of your mouth.
Tell your doctor or nurse straight away if you:
- have any swelling in the head or neck area or a feeling of fullness or pressure
- find it difficult to swallow
- have changes in your voice
Lymphoedema is easier to control if treated early. It's important that you are referred to a lymphoedema specialist if you have signs of swelling. This is usually a nurse or physiotherapist.
Radiotherapy can cause many different side effects, such as tiredness. The side effects you get will depend on the area you're having treatment to, but there are some general side effects you might experience regardless of where your cancer is. This video is about the general side effects you might have.
On screen text: Tiredness and weakness
Martin (Radiographer): As the normal cells repair themselves from the treatment this can use a lot of the body's resources, causing tiredness.
David: After about four weeks, I started to get tired. The body was starting to weaken.
Laurel: I was tired, day and night. Getting up in the morning was like a chore. I couldn't talk for 5 minutes. I would just sleep and just sleep and just wake up and sleep again.
Martin (Radiographer): Listen to your body. Take rests if you need to. Try not to overdo things.
Laurel: Don't fight with yourself too much. Just like go at a pace and just work with your body. If you can't make it today, you can't make it today.
David: You've got to rest. You have to take the time to rest.
Mary: Just going for them small walks. They really do help you. And even if it is just walking around your house or just walking around the block.
Martin (Radiographer): Doing exercise can help with tiredness by helping you maintain energy levels.
Mary: Being outside, that's a big, massive thing as well because you're feeling the fatigue and I think getting outside, just getting a bit of fresh air that really, really did help me.
Martin (Radiographer): The tiredness you can expect to begin within the first few weeks of treatment. Once it reaches its peak, about two weeks after treatment it recovers quite quickly after that.
Mary: It's not forever. You're not going to be like this forever and I did have to tell myself that.
Laurel: Two months after treatment, I start to feel less tired and that was a way forward because things start to really improve.
On screen text:
- Rest and have short naps when you need to
- Drink plenty of water
- Eat a balanced diet
- Do some gentle exercise
- Get some fresh air
On screen text: Sore skin
Martin (Radiographer): The radiotherapy can cause soreness of the skin. This only affects the area that you are having treated. This usually starts to appear about two weeks after you start treatment. You may notice this becoming more red and may become more itchy and sore as treatment continues.
David: After about ten days I started to get red on the area that they were targeting and it just progressively got redder and redder.
Laurel: My skin was dry and at the back was just like this triangle shape thing where it was like, okay, I'm a woman of colour, but it was really, really black.
David: Wasn't too painful, it was sort of annoying, rather than painful.
Martin (Radiographer): After treatment’s finished, the skin will remain sore for up to two weeks, but then recovers quite quickly.
Laurel: I haven’t got no scarring now at all.
David: It was maybe three or four weeks and then all the blemishes disappeared front and back.
Martin (Radiographer): When you start treatment we would advise you to carry on with your normal skincare routine but as the side effects develop, then your team will advise you on which products you can use on the skin safely.
Laurel: When I'm washing myself I use a sponge and you're just literally as it were just squirt it down, you don't rub the skin at all because it's already damaged. Pat dry, don't rub.
David: I spoke to the hospital about it and it was them that recommended this cream to put on, just to alleviate the symptoms.
Martin (Radiographer): We'd recommend wearing loose clothing and keeping the treatment area covered up against the sun and wind.
Laurel: I had to change most of my wardrobe. I only wore cotton.
David: Wearing T-shirts, soft clothing, nothing that would rub.
Mary: It's important when you go outside to make sure that you do wear that headscarf, or you do wear a hat or whatever it is.
Laurel: I wouldn't go in the sun at all, at all because my skin was - I know it was too delicate.
On screen text:
- Don’t rub the area, press if it is itchy and dab your skin dry
- Don’t use perfume, perfumed soaps or lotions on the area
- Don’t shave the area
- Only use creams or dressings advised by your specialist or radiographer
- Wear loose fitting clothing
- Avoid strong sun or cold winds
- Make sure you wear sunscreen
On screen text: Hair loss
Martin (Radiographer): Radiotherapy can cause hair loss in the area that's being treated, whereas chemotherapy can cause hair loss all over the body.
Mary: 2 to 3 weeks after the radiotherapy, I was brushing my hair and loads came out on the brush. I knew it was going to happen, but it was just hard when it happened.
Martin (Radiographer): In most cases the hair will grow back. This can take a couple of months and the hair may have a slightly different colour or texture.
Mary: Mine did grow back and there's a lot of grey in it so I have to dye it. This is not my original colour. It's very slow growing back.
Martin (Radiographer): Use a simple soap to clean the area. Be gentle with the skin in that area and after washing pat the area dry with a soft towel.
On screen text:
- Radiotherapy can make hair fall out in the treatment area
- It won’t cause hair to fall out in other parts of your body
- Your hair might grow back a few weeks after treatment ends
- If your hair won’t grow back, then your doctor should tell you
- Don’t use perfume, perfumed soaps, or lotions on the area
On screen text: Your mental health
Laurel: I felt frustrated. Some days were really, really challenging where there were just tears without words.
Mary: It's a mixture of emotions. You feel angry and you feel frustrated. You lose your confidence.
Martin (Radiographer): Radiotherapy can cause a lot of emotions at various times during the treatment. You may feel sad or anxious or depressed, which is quite normal. It's good to talk to people about your experiences, whether that's your team at the hospital or friends and family.
David: I couldn't praise the team highly enough. Everybody that was involved were unbelievable and if it hadn't been for them, I just don't think I would have gotten through with it.
Mary: I did have a nurse as well and she had the experience of dealing with people that went through brain surgery, went through radiotherapy so it was just great that I could reach out.
Martin (Radiographer): Your team will be able to give you information about local patient support services that are available, that includes things like counselling and complementary therapies.
Laurel: A referral from the hospital counselling, which I attended for about a year.
Martin (Radiographer): There's also lots of support available online and in your local area.
Mary: I went on loads of different forums and I spoke to loads of different people and it really, really helped me. If I didn't do that, I don't think I would have got through most days.
Laurel: If you get a bit cranky or feel a bit low, go for it. But there's so much help out there and that's why I'm pushing forward like don't sit down in silence. It's the same thing, just get the help you need.
On screen text:
- There is help available – ask the hospital for support
- Talk to your friends and family about how you are feeling
- Ask about local support groups
- Your GP or hospital can provide counselling
- You can get help and support online through forums
If you're experiencing a side effect that hasn't been covered in this video, you can find more information on the Cancer Research UK website.
On screen text: For more information go to: cruk.org/radiotherapy/side-effects
Possible side effects of chemoradiotherapy
Having chemotherapy with radiotherapy (chemoradiotherapy) can make some side effects worse.
Smoking
If you smoke, your doctor will advise you to give up before you start treatment. Radiotherapy might not work as well and you may have more side effects if you continue to smoke.
Getting help
You usually have regular checks by your head and neck cancer team during your course of radiotherapy and for a few weeks afterwards. They can check any side effects you have and give you advice and medicines to help. Between checks, do speak to your radiographer or nurse if you need help managing any side effects.
Sometimes the side effects of radiotherapy can be particularly severe. If this happens, your doctor may need to stop your treatment to allow you to recover.
Worries about treatment side effects
You may feel anxious about radiotherapy side effects and this is normal. It can help to talk through any worries you have with your doctor, nurse or radiographer.
