cancer and side effects : overcoming side effects of radiotherapy

Most nasopharyngeal or nose cancer patients will experience some side effects of radiotherapy. The side effects usually appear gradually during the course of radiotherapy & might be at their worst at the end of the treatment. Different people react differently to radiotherapy. The intensity & severity of the side effects may be influenced by the following factors ** :

• radiation dose
• energy source
• volume of tissue treated
• radiotherapy techniques & regimen
• pre-treatment periodontal condition (area around the teeth)
• the patient's body constitution (eg size, weight, health status, muscle buffer)

There are early & late side effects of radiotherapy.

Early Side Effects

Some early side effects may vanish when treatment ends but some may linger for weeks, months or even years. Early side effects of radiotherapy include the following ** :

• oral mucositis (mouth ulcers)
• taste dysfunction
• reduced sense of smell
• xerostomia (dry mouth)
• skin blisters & burns
• difficulty chewing & swallowing (due to pain & inflammation)
• fungal infections in oral cavity

Late Side Effects

Late side effects can appear months or years after the end of radiotherapy. Late side effects of radiotherapy include the following ** :

• oral complications
• otologic (ear) complications
• opthalmic (eye) complications
• radiation induced cancers
• pituitary (endocrine) problems
• swallowing problems
• neck stiffness & ache
• numbness of hands, neck, face
• loss of sense of smell

My experience with early side effects

1. Xerostomia (dry mouth caused by radiation damage to the salivary glands). My mouth became dry gradually as radiation progressed from Day 1 to Day 33. By the end of the 33 sessions of radiation, my mouth had near-zero saliva, as dry as the Sahara desert. It was unbearable. Today, almost 4 years later, I would say my saliva has come back about 80%. The salivary glands, which were destroyed & damaged by radiation, had healed gradually over the years, although not to the 100% pre-cancer level.
2. Oral mucositis (mouth ulcers). By Day 8 of radiotherapy, the first ulcer appeared in my mouth. Over the next 2 months, the ulcers multiplied by the hundreds all over my mouth -- walls of the mouth, palate, tongue, throat, gums. It was painful. I found it difficult to eat or drink through the mouth.
3. Saliva. My glue-like saliva became thicker by the day. By Day 13, my salivary glands had been bombed so badly by radiation that volumes of thick saliva were flowing out of my mouth 24/7 for about a month. I had to continuously spit it out as it was impossible to swallow the sticky saliva. As I could not eat or drink, I had to reluctantly agree to have a feeding tube inserted through the nose. My main concern at this time was that even if I didn't die of cancer, I might die of starvation or malnutrition. I survived through liquid food fed through the tube. I became very self-conscious of my looks as the feeding tube made me look like a monster from outer space. It affected my self-esteem. I felt lousy.
4. Difficulty talking. The non-stop outflow of saliva affected my ability to talk. I had to use pen and paper method to communicate with others. Sleeping was a problem as I had to slant my face sideways to allow the saliva to flow out onto pieces of tissue paper. I had broken sleep every night.
5. Fungal infection in oral cavity. The dry mouth effect caused fungus to grow on my tongue. I was put on Nystatin & Fluconazole medication to minimise infection.
6. Nausea. I suffered from nausea throughout the radiotherapy. By Day 18, the nausea became so bad that I had to be hospitalised for acute dehydration.
7. Constipation. I was put on medication to relieve the pain caused by ulcers. As a result, I suffered from constipation which became so serious by Day 25 that I had to be hospitalised a second time.

My experience with late side-effects

1. Dental caries (tooth decay). One to two years after radiation, I began to experience some signs of tooth decay. I suffered from toothache, cavities & broken teeth. I had undergone several root canal operations & dental treatments at the Singapore National Dental Centre. To protect my teeth from further decay, I use a tooth tray to apply tooth mousse on my teeth & gums when I sleep at night. The tooth mousse also helps to keep my mouth moist throughout the night. As a result, I experience less dental problems now.

References

** Notes taken from a talk presented by Dr Tham @ NPC support group in 2007 on "Coping with the side effects of radiotherapy for Nasopharyngeal Cancer".

CancerHelp UK

http://www.cancerhelp.org.uk/type/nasal-cancer/treatment/radiotherapy/side-effects-of-nasal-and-sinus-cancer-radiotherapy