Treatment of oral cavity and oropharyngeal cancers can lead to side effects, depending on the type and intensity of therapy being used.

Radiation side effects

Radiation can cause several short-term side effects. These include skin changes like a sunburn or suntan that slowly fades away, hoarseness, and redness and soreness of the mouth and throat. Sometimes open sores develop in the mouth and throat, making it hard to eat and drink during the treatment. Liquid feeding through a tube placed into the stomach may be needed. This tube is known as a gastrostomy (see the "Surgery" section). Treatment affects the taste buds, and often leads to losing the sense of taste. This loss may be partial or complete, and can last for months after treatment stops.

Radiotherapy may also cause long-term or permanent side effects. Permanent damage to the salivary (spit) glands can result in a dry mouth. The lack of saliva promotes tooth decay (cavities). People treated with radiation to the mouth or neck need to practice careful oral hygiene to help prevent this problem. Fluoride treatments may also help. Newer radiotherapy techniques such as intensity modulated radiation therapy (IMRT) make it possible to aim radiation more precisely and may help reduce this side effect. A drug called amifostine (Ethyol) can also help reduce this side effect by limiting radiation damage to normal tissues. It is injected under the skin or into a vein a few minutes before each radiation treatment. Amifostine has side effects, such as nausea and vomiting that can make it hard to tolerate.

Osteoradionecrosis of the jaw can be a serious side effect of radiation treatment. This jaw bone damage is more common after tooth infection, extraction, or trauma, and it can be hard to treat. The main symptom is pain in the jaw. In some cases, the bone actually breaks. Sometimes the fractured bone heals by itself, but usually the damaged bone will have to be treated surgically.

Radiation side effects are likely to be more severe in people who are getting chemotherapy at the same time. These people also have to contend with the side effects of the chemotherapy itself, which can make this treatment hard to tolerate. For this reason, it's important that people getting both chemotherapy and radiation are in relatively good health before starting treatment, that they understand the potential for serious side effects, and that they are treated at a medical center with a lot of experience with this approach.

Surgery side effects

If the surgery is not too involved, the only symptom may be some pain afterward, which will go away. Sometimes surgery may be very complicated, in which case side effects may include infection, wound breakdown, problems with eating and speaking, or on very rare occasions even death during or shortly after the procedure. It also can be disfiguring. The surgeon's skill is very important in minimizing these problems, while removing all of the cancer.

Impact of laryngectomy: Laryngectomy, the surgery that removes the voice box, leaves a person without the normal means of speech. There are several ways to restore one's voice. See the American Cancer Society document Laryngeal and Hypopharyngeal Cancer to find out more about voice restoration.

After a laryngectomy, breathing is done through a stoma, or opening, placed in the front of the lower neck. Your health care team will teach you how to care for and adjust to your stoma. Since the air can't be purified by the nose's natural filter, a stoma cover is needed. Besides catching dust and particles, the stoma cover hides the mucus that the stoma secretes.

Impact of facial bone removal: Some cancers of the head and neck are treated by operations that remove part of the facial bone structure. Because the changes that result are so visible, they can be devastating. Surgery on the jaw, roof of the mouth, or tongue can also affect speech.

Recent advances in facial prostheses and in plastic (reconstructive) surgery now give many people a more normal look and clearer speech. Ears and noses can be made out of plastic, tinted to match the skin, and attached to the face. All of these things can be a great help to a person's self-esteem.

Chemotherapy side effects

Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles are also affected. This can lead to side effects.

The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects can include:

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• increased chance of infections (due to low white blood cell counts)
• easy bruising or bleeding (due to low blood platelet counts)
• fatigue (due to low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting. A few side effects that are only caused by certain drugs, such as some loss of kidney function or hearing, may persist.

Impact of side effects on quality of life

Everyday life can be very disrupted by treatment of these cancers. Many studies have found that the patient's quality of life tends to get worse in the first few months after treatment. After that, however, if the patient has given up smoking and drinking alcohol, things tend to get better. Within a year, many patients are feeling reasonably well and happy.

Last Medical Review: 09/24/2009
Last Revised: 09/24/2009