Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells.
Radiotherapy can be given on its own with the aim of curing an early-stage cancer. It may also be used with surgery, chemotherapy or targeted therapy to treat bigger cancers and cancer that has spread to the lymph nodes.
Radiotherapy can also be used after surgery to reduce the risk of the cancer coming back. The lymph nodes in the neck are often treated if there are no signs of cancer there. This is because some of the lymph nodes may contain some cancer cells that cannot be seen on scans.
Chemoradiation is often used as the main treatment for locally advanced oropharyngeal cancer. It may also be given after surgery. Having chemoradiation is more effective than having chemotherapy or radiotherapy alone, but it can cause more severe side effects. It is important that you are well enough to cope with having both treatments together.
Planning your radiotherapy treatment
To make sure that your radiotherapy is as effective as possible, it has to be carefully planned. Planning your treatment makes sure the radiotherapy is aimed precisely at the cancer, so it causes the least possible damage to the surrounding healthy tissue. The treatment is planned by a specialist doctor called a clinical oncologist.
You usually need to have a clear plastic mould or mask made before your treatment is planned. This helps keep your head in the same position for each session of radiotherapy. The mask should not be uncomfortable and does not affect your breathing. We have a video that shows how radiotherapy masks are made. If you are worried about the mask, let your radiotherapy team know so they can help.
Having radiotherapy
Radiotherapy is normally given as a series of short, daily outpatient treatments with a rest at the weekend. Each treatment only takes a few minutes. It is given in the radiotherapy department using equipment similar to a large x-ray machine. Radiotherapy only treats the area of the body the rays are aimed at. It does not make you radioactive.
There are different types of radiotherapy. The type of radiotherapy usually used to treat head and neck cancers is called intensity-modulated radiotherapy (IMRT). IMRT uses high-energy rays that are shaped very precisely to target the area of cancer. This means a higher dose of radiation is given to the tumour, and healthy areas nearby get a lower dose. This can reduce side effects.
The number of treatments you have depends on the aim of your treatment. Your doctor or nurse will tell you how many treatments you are likely to have.
Side effects of radiotherapy
You may have side effects during radiotherapy. These usually get better slowly over a few weeks or months after treatment finishes, but many people continue to have a dry mouth.
Some side effects develop later on after treatment finishes and can last longer. These are less common, but can happen months or even years after your treatment. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help.
Sore and sensitive skin
The skin over your face and neck will slowly redden or darken, depending on your skin tone. It may also feel sore and itchy (a bit like sunburn). This starts after about 2 weeks of treatment and lasts for up to about 4 weeks after radiotherapy has finished.
When you wash your face and neck, it is important to use only the soaps, creams and lotions your radiotherapy team recommend. This is because chemicals in some products can make the skin more sensitive to radiation. Moisturisers need to be sodium lauryl sulphate (SLS) free. Your radiotherapy team can give you more information about how to care for your skin when you have radiotherapy and after you have finished treatment. They can also tell you when and how to use sun-protection cream after your treatment.
We have more information about skin care when you have radiotherapy to the head and neck area.
Sore mouth
It is important to look after your mouth during radiotherapy. Following a mouth care routine to keep your mouth clean helps prevent problems. Your mouth and throat may become sore after a couple of weeks of treatment. You may develop mouth ulcers. You might also find it difficult to speak, or notice changes to your sense of taste and smell. Eating food can become difficult and you may find it painful to swallow. Your doctor can prescribe medicines to help.
We have more information about coping with a sore mouth.
Dry mouth
Radiotherapy to the head and neck may reduce the amount of spit (saliva) you make. It can make the mouth and throat dry. This can affect eating, speaking and sleeping. It also makes you much more likely to have tooth decay. So it is really important to care for your teeth during and after treatment.
It also helps to carry a bottle of water with you so you can take frequent sips of water. Or you could use a water spray instead. Artificial saliva can also help moisten your mouth and throat. It comes in different forms, such as gels, sprays, mouthwashes, pastilles or tablets. Your doctor or dentist can prescribe artificial saliva, or you can buy it from a chemist.
We have more information aboutcoping with a sore mouth.
Thick, sticky saliva (mucus)
Radiotherapy to the head and neck affects the salivary glands. Your saliva may become thicker, stringy and sticky. Your mouth and throat may also feel dry. This can make eating and talking difficult.
Rinsing your mouth regularly can help with this. Your specialist head and neck team can give advice on the type of mouth rinse that might be best for you. Sometimes a build-up of mucus can cause coughing, especially at night. Your nurse or doctor may prescribe a nebuliser to help to loosen the mucus. A nebuliser is a machine that changes a liquid medicine into a mist or fine spray. Your nurse or doctor can also prescribe mouthwashes, lozenges, artificial saliva sprays or gels to help.
Changes in the saliva usually get better within about 8 weeks of radiotherapy ending, but sometimes it continues for several months or longer.
Difficulty eating
If you find it hard to eat and drink because of any side effects, let your doctor or nurse know. They can give you advice and medicines to help. They may refer you to a dietitian for more advice. You may need food supplements to add extra energy or protein to your diet. Some supplements can be used to replace meals, and others are used in addition to your normal diet. You can get some of these from your chemist or the supermarket. Your doctor, nurse or dietitian can also prescribe them for you.
Some people need to be fed through a tube if they cannot eat and are losing lots of weight. This is known as nutritional support or tube feeding. It is usually only done for a short time until treatment is finished and their swallowing is back to normal.
Tiredness
This is a common side effect that may last for a couple of months after treatment. Try to get plenty of rest and pace yourself. Balance this with some physical activity, such as short walks. This will give you more energy.
Late effects of radiotherapy
Your doctor, specialist nurse or therapy radiographer can tell you whether your treatment may cause any late effects. They will also tell you what you can do to help reduce your risk of problems. And they can tell you what support is available.
Our general information about head and neck cancers has more about:
- radiotherapy
- coping with side effects
- late effects
- mouth care
- how to cope with eating problems.