Chemotherapy for head and neck cancer

Chemotherapy drugs work by disrupting the growth of cancer cells. The chemotherapy drugs are usually given by injection into a vein (intravenously). As the drugs circulate in the bloodstream, they can reach cancer cells all over the body. Our section on chemotherapy| discusses the treatment and its side effects in more detail. We also have information about individual drugs| and their particular side effects.

For the treatment of head and neck cancers, chemotherapy is normally given at the same time as radiotherapy|. This is known as chemoradiation. 

Chemotherapy may also be given before chemoradiation treatment, which is known as induction chemotherapy.

Very occasionally chemotherapy is given before surgery| to shrink the tumour and make it easier to remove.

Side effects of chemotherapy

Chemotherapy can cause some temporary side effects, which are described below. Although these may be worse with combined radiotherapy treatment, they will usually gradually disappear after the treatment has finished.

Lowered resistance to infection (neutropenia)

Chemotherapy can temporarily reduce the production of white blood cells in your bone marrow, making you more prone to infection|.

This effect can begin about seven days after treatment has been given and your resistance to infection usually reaches its lowest point about 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal before your next cycle of chemotherapy is due.

• You should contact your doctor or the hospital straight away if:
• your temperature goes above 38°C (100.4°F)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if your blood count is still low.

Bruising or bleeding

The chemotherapy can reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells)

While having chemotherapy you may become anaemic. This may make you feel tired and breathless|. Blood transfusions may be given if you become anaemic due to chemotherapy.

Feeling sick (nausea) and vomiting

Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting|. If the sickness is not controlled, or continues, tell your doctor, who can prescribe other anti-sickness drugs which may be more effective.

Hair loss

Not all chemotherapy drugs cause hair loss|. Hair may be lost completely or may just thin. You can ask your doctor if the drugs you are having are likely to cause hair loss. If you do lose your hair, you may want to wear a wig| – you can ask your doctor or nurse to arrange for you see a wig specialist.

You may prefer to wear a bandana, hat or scarf|.

If your hair does fall out, it will almost always grow back over a period of 3-6 months once the chemotherapy has finished.

We have more information on coping with hair loss|, which has useful tips on wigs and head coverings, and dealing with the emotional effects of hair loss.

Sore mouth and small mouth ulcers

Some chemotherapy drugs cause your mouth to become sore| and you may also develop mouth ulcers. Regular mouthwashes are important and your nurse will show you how to use these properly.

If you don’t feel like eating meals|, you can supplement your diet with nutritious drinks or soups. A wide range of drinks is available and you can buy them at most chemists. You can ask your doctor to refer you to a dietitian for advice about diet.

Tiredness

Chemotherapy affects different people in different ways. Some are able to lead a normal life during their treatment, while many find they become very tired| and have to take things more slowly. Just do as much as you feel like doing and try not to overdo it.

Although they may seem hard to bear at the time remember that these side effects are temporary and will usually disappear, in time, once your treatment is over.