5 Side Effects of Head and Neck Cancer Radiation Treatment You Must Know About

by GregP_WN

Head and neck cancer includes cancer from the throat up, including salivary cancer, tonsil cancer, tongue cancer, thyroid cancer, laryngeal, esophageal cancer, adenoid cancer, including subtypes of each. There are specific types of diagnoses for these also, making for a large group of head and neck cancer diagnoses. 

Head And Neck Cancer Stat

The treatments for each will vary, but often include a variety of chemo regimens, surgery, and radiation. While chemo has it's own set of side effects, and many of them can be very serious,  this article is focusing on the long-term side effects of radiation that are often not discussed with you by your oncologist. 

If you were diagnosed with head and neck cancer more than ten years ago you may not have had any warning about the side effects listed below, and even if you were diagnosed more recently, you may not have been told. My diagnosis for Squamous Cell Carcinoma of the right tonsil was ten years ago and I wasn't told to look out for any of these. As they started happening I was surprised first, that I was having them, and second, that I wasn't told to expect them or to watch out for them. A couple of them can have life-threatening results. 

Dental Problems

Dental issues will sometimes start to appear within months after completing your radiation. The issue stems from your saliva glands being either killed or damaged to the point of not producing enough saliva to keep your mouth moist. For me, I had radiation 30 years ago for Hodgkins lymphoma that started my dental issues. Back then the radiation was given to a broad area of the body, not focused like it is done today. My radiation in 1988 was directed from my chest up to my lower jawbone. 

Osteonecrosis Of The Jaw

I had 28 treatments then which were much easier to tolerate, with fewer side effects than the radiation I received 20 years later in 2008. After that radiation cycle was done I started to have minor dental issues. A few cavaties, I had a few teeth that cracked, two root canals, etc. But the damage was nowhere near as bad as the cycle of treatments I received in 2008.

After that round of treatments, my mouth was always dry, my teeth immediately began to wear, crack, and just basically fall apart. Repeated trips to the dentist only produced the usual response of "we need to save these teeth at all costs". That's fine if you can afford "all costs". I kept asking for them to just be pulled, I didn't see the sense of putting thousands into my mouth when I knew that those teeth would eventually fall out. 

During a checkup with my oncologist, they told me that I couldn't just have my teeth pulled after having radiation due to the possibility of getting osteoradionecrosis , a condition that prevents the tooth socket from healing due to loss of blood flow and tissue and blood vessel damage from the radiation. 

I asked why they didn't say something about this before treatments and they just said, we usually do, but in the past, not always. But now, every head and neck cancer patient is referred to the oral surgery department as soon as their appointment with oncology is over. In many cases, it is recommended that all teeth be pulled prior to treatments. If that had been recommended to me, I would have agreed. 

I eventually had all of my teeth pulled in oral surgery so that they could be extremely careful while pulling them, but also do any extra treatment to the area that would allow it to heal as quickly as possible. I had over 6 surgeries to pull all of them, followed by dental implants being put in, followed by dentures. All of this was an expensive side effect, and for me, it wasn't even mentioned as a possibility. 

Carotid Artery Stenosis

This side effect showed up one day about 5 years after radiation was over. One day while walking into my office, my left hand acted like it was numb and drunk. I tried to open a door and my hand acted like it wouldn't work. After I finally got in the office, I sat down at my desk and begun to type on my computer. My fingers on that hand wouldn't hit the right keys. I also had a bright light in the upper area of my vision, which was also slightly blurred. 

Carotid Artery Stenosis Caused From Radiation

This combination of symptoms was only with me for about fifteen minutes, then I was back to normal. I blew it off as something that was caused by my usual daily list of small issues I have. In an attempt to be cautious, I did contact my oncologist's office the next day to let them know what had happened, in case they wanted to order any extra tests during a routine office visit I had scheduled two days later. 

The nurse asked me to sit down and immediately call 911 and tell them I was showing signs of a stroke. I was slightly in shock hearing this and blew that off too, for a day. Then I started thinking about what the nurse had said and decided I would go to the emergency room at the major hospital where I was being treated instead of my small town ER.

After a battery of tests that took most of the night and into the next day, they did finally decide that I had an 80% blockage of my interior carotid artery on the right side, and what I had experienced was a TIA (trans ischemic attack), they also scolded me for not going to the ER immediately when the symptoms presented and proceeded to tell me about the odds that when a person has a TIA that they often will have a full blown stroke if not treated quickly. 

The cause of this is from the radiation simply cooking the artery and causing it to shrink. This combined with a slightly high cholesterol level caused a build up of placque in that area, causing the TIA.

The remedy for this was to put a stent in that artery all the way up behind my ear, just before that artery reaches the brain. I was put on a couple of cholesterol preventatives and an aspirin a day and told to watch for any of those symptoms in the future. 

If I had been told about them during radiation, I wouldn't have put off going to the doctor, or calling 911!

Esophagus Stricture

Similar to carotid artery stenosis, the life-threatening esophageal stricture is caused by the radiation also. This is basically like a piece of bacon getting fried and watching it shrink. I know, that's pretty radical explanation, but it's close!

Radiation Induced Esophageal Stricture A Esophagogram Shows 5 Cm Long Stricture Arrow

After about having the radical neck dissection on the right side of my neck, and the subsequent radiation to both sides of my neck, I was never able to swallow as I did prior to diagnosis. I had several occasions where I choked on something as small as a pill. Many times I would get something down the wrong way which caused me to cough violently to the point of losing air and passing out. 

After several years of enduring this, I brought it up with my oncologist, again during a routine yearly checkup. She told me that "it's a common problem" and that many head and neck cancer patients have to have their esophagus dilated to ease the choking/swallowing problem. Again, this was information I could have used years prior.

The procedure to stretch (dilate) your esophagus is a fairly quick procedure. It takes much longer to get in a holding room, get prepped, and IV started, and ready for the ER than it does for the actual procedure. 

Immediately after having the procedure done, I had a slight sore throat, but that night, on the way home from the hospital we stopped for supper and I could immediately tell a difference in my swallowing. It was much easier, and I could also tell that I was even able to breathe easier. 

This is something that all head and neck cancer patients should ask their ENT oncologist or radiation oncologist about to be prepared.

Damaged Saliva Glands

I touched on this already as a contributing factor to the dental issues, but there are also a few other problems lack of saliva causes. In addition to dental issues, no saliva causes your mouth to be dry and encourage more bacteria in your mouth. We don't realize it, but your saliva glands produce from .75 to 1.5 liters per day. That's a lot of slobber! 

Saliva Glands Damaged From Radiation

Without this, you will try to eat something like a twinkie, which you would assume there would be no problem swallowing, only to have it ball up in your mouth like a handful of feathers. You don't realize this until you don't have saliva glands. I now have to select my food based on the "slide factor". How easy will it slide down. I can easily eat caseroles, mashed potatoes and gravy, ice cream, and other foods that are similar. But the average hot dog on a bun is difficult to eat unless it's smothered in ketchup and relish. 

There is a medication that will help your saliva glands produce more, if they are not totally gone. After my first radiation treatments in 1988 I took salagen for a few years, then quit. After a few years, they started working enough to allow almost normal function. But after the treatments in 2008 I had no function and taking the prescription made no difference. So now, I just keep a bottle of water, tea, or soft drink handy when eating. 

Hypothyroidism

Or, hypothyroidism is simply a damaged thyroid caused by radiation treatments.  Symptoms can include

 Fatigue

 Increased sensitivity to cold

 Constipation

 Dry skin

 Weight gain

Hypothyroidism Causes 722x406

 Puffy face

 Hoarseness

 Muscle weakness

 Elevated blood cholesterol level

 Muscle aches, tenderness, and stiffness

 Pain, stiffness or swelling in your joints

 Heavier than normal or irregular menstrual periods

 Thinning hair

 Slowed heart rate

 Depression

 Impaired memory

The common cure for this is a drug like Levothyroxine which brings your TSH levels back to where they should be. This is the one side effect that was described to me that I would likely have, and early on my TSH levels were checked regularly and my prescription changed to match until they balanced out. 

Only one of these five fairly serious side effects was described to me during or after treatments. Nothing was said until I had symptoms and asked my oncologists about it. So this is another example of asking your doctor lots of questions, and anytime you have any of the symptoms listed be sure and let your team know right away. 

I am happy to say that in spite of enduring all of these side effects, that I am now 10 years out past my diagnosis date and except for these side effects, I am doing great. I have had to learn to eat different things and learn how to twist my neck, grunt and help food to go down and recognize if I'm having a coughing spell serious enough to cause me to blackout. But otherwise, after two diagnoses with Hodgkin's Disease, and one with Head and Neck cancer,  I'm doing good, and I will gladly take life as it is dealing with these side effects rather than the alternative had I of chose to not have treatments. As I said in my book "Cancer You Will Not Get Me, 3 Times is Enough!" I am privileged to be alive. 

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The Hidden Side Effects of Radiation

Radiation - How it Can Effect Your Body

What to Expect From Radiation Treatment

Preventing the Dental Side Effects of Head and Neck Cancer Treatments

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