Chemotherapy for head and neck cancer
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy drugs work by disrupting the growth of cancer cells.
Chemotherapy drugs are usually given into a vein (intravenously). As the drugs circulate in the bloodstream, they can reach cancer cells all over the body.
When chemotherapy is given to treat head and neck cancer, it’s usually given in combination with radiotherapy. This is called chemoradiation.
Very occasionally, chemotherapy is given before surgery to shrink the tumour and make it easier to remove. Sometimes chemotherapy is given to relieve symptoms and improve quality of life if it’s not possible to cure the cancer. This is called palliative chemotherapy.
The most commonly used chemotherapy drug for head and neck cancer is cisplatin. Other chemotherapy drugs that may be used include carboplatin, docetaxel (taxotere), gemcitabine and fluorouracil (5FU).
Possible side effects of chemotherapy
Risk of infection
Chemotherapy can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow. If your number of white blood cells is low, you will be more prone to infections. A low white blood cell count is called neutropenia. This begins seven days after treatment and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
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 check the number of your white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising and bleeding
Chemotherapy can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Anaemia (low number of red blood cells)
Chemotherapy can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of your red blood cells becomes too low.
Feeling sick (nausea) or being sick (vomiting)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea or vomiting. If the sickness isn’t controlled or continues, tell your doctor as they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
This is a very common side effect if you’re having both chemotherapy and radiotherapy. Your mouth may become sore or dry, or you may develop mouth ulcers during treatment. Some people find that sucking ice is soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help if your mouth is sore. Tell your nurse or doctor if you have mouth problems. They can prescribe mouthwashes and medicine to relieve pain and to prevent or clear mouth infections.
Numbness or tingling in hands or feet
If you have treatment with cisplatin, fluorouracil (5FU) or docetaxel, you may have changes in sensation in your hands and feet. This is due to the effect these drugs can have on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice these symptoms. You may need to have your chemotherapy dose lowered slightly.
Changes in sensation can continue to get worse for 2-3 months after stopping chemotherapy before slowly improving. It can take up to two years for symptoms to improve. Sometimes changes can be permanent.
Changes in hearing
If you have treatment with cisplatin, you may have changes in your hearing. You may have ringing in the ears (tinnitus), and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally, your sense of balance may be affected.
Any hearing loss may be permanent. However, tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t operate machinery or drive.
Most chemotherapy drugs used to treat head and neck cancer don’t cause hair loss, although some people may notice hair thinning. You can ask your doctor if the drugs you’re having are likely to cause hair loss.
If you’re having treatment with the chemotherapy drug taxotere, you’re likely to temporarily lose your hair. Hair almost always grows back within 3-6 months once the chemotherapy has finished.
If you do lose your hair, you may want to cover up and protect your scalp with a hat, scarf or wig. You can ask your doctor or nurse to arrange for you see a wig specialist.
We have more information about coping with hair loss, which has useful tips on wigs and head coverings, and dealing with the emotional effects of hair loss.
Hear what helped David to cope with the side effects of treatment for throat cancer. He explains how his physiotherapist, Cathy, has helped him to rediscover his independence.