Radiation therapy to the head and neck

Some people who get radiation to the head and neck have redness and soreness in the mouth, a dry mouth, trouble swallowing, changes in taste, or nausea. Other possible side effects include a loss of taste, earaches, and swelling. You may lose your hair, your skin texture might change, and your jaw may feel stiff.

If you get radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth, and throat.

Here are a few tips that may help you manage mouth problems:

• Avoid spices and coarse foods such as raw vegetables, dry crackers, and nuts.
• Do not eat or drink very hot or very cold foods.
• Do not smoke, chew tobacco, or drink alcohol because tobacco and alcohol can make mouth sores worse.
• Stay away from sugary snacks.
• Ask your doctor or nurse to recommend a good mouthwash. The alcohol content in some mouthwashes has a drying effect on mouth tissues.
• Rinse your mouth with warm salt water every 1 to 2 hours as needed. (Use 1 teaspoon of salt in 1 quart of water.)
• Sip cool drinks often throughout the day.
• Eat sugar-free candy or chew gum to help keep your mouth moist.
• Moisten food with gravies and sauces to make eating easier.
• Ask your doctor or nurse about medicines to help treat mouth sores and control pain while eating.

If these measures are not enough, ask your dentist about artificial saliva. Mouth dryness may be a problem even after treatment is over.

Dental care

Radiation treatment of your head and neck can increase your chances of getting cavities. Mouth care to prevent problems will be an important part of your treatment. Before starting radiation therapy, get a complete check-up with your dentist. Ask your dentist to talk with your radiation oncologist before your treatments begin. If you have problem teeth, your dentist may suggest you have them removed before starting treatment. Radiation (and dry mouth) may damage them to the point where they will need to be removed. This may be harder to do after treatment has started.

If you wear dentures, they may no longer fit well because of swollen gums. If your dentures cause gum sores, you may need to stop wearing them until your radiation therapy is over because these sores can become infected.

Your dentist probably will want to see you during your radiation therapy to talk to you about caring for your mouth and teeth and help you deal with any soreness. Most likely, you will be told to do the following:

• Clean your teeth and gums with a very soft brush after meals and at least one other time each day.

• Use fluoride toothpaste that contains no abrasives.

• Use unwaxed dental tape to gently floss between teeth once a day.

• Rinse your mouth well with cool water or a baking soda solution after you brush. (Use 1 teaspoon of baking soda in 1 quart of water.)

Radiation therapy to the brain

Stereotactic radiosurgery is often used when cancer has only spread to a few sites in the brain. Side effects vary depending on where the radiation is aimed, and usually become most serious 1 to 2 years after treatment. Talk with your radiation oncologist about what to watch for and when to call for help.

Sometimes the whole brain is treated with radiation when cancer has spread into many sites. This may also be done to prevent cancer from spreading to the brain. Whole brain radiation can cause some of the following side effects:

• headaches
• swelling of the brain
• hair loss
• nausea
• vomiting
• fatigue
• hearing loss
• skin and scalp changes
• trouble with memory and speech
• seizures

Medicines are usually given to prevent brain swelling, but it is important to let your doctor know about headaches and other symptoms. Delayed effects (usually 1 or 2 years later) of whole brain radiation can be caused by death of brain tissue. These delayed effects can include serious problems such as memory loss, stroke-like symptoms, and poor brain function.

Radiation therapy to the breast and chest

Radiation treatment to the chest may cause swallowing problems, cough, or shortness of breath. Be sure to tell your doctor or nurse if you notice any of these side effects.

If you get radiation therapy after surgery (such as a lumpectomy or mastectomy) for breast cancer, try to go without wearing a bra whenever you can. If this is not possible, wear a soft cotton bra without underwire so that your skin is not irritated. If your shoulders feel stiff, ask your doctor or nurse about exercises to keep your arms moving freely.

Other side effects may include breast soreness and swelling from fluid build-up in the treated area. These side effects most likely will go away a month or 2 after you finish radiation therapy. If fluid build-up continues to be a problem (a condition called lymphedema), ask your doctor what steps you can take. You can also call us or visit our Web site for more information on lymphedema.

Skin in the treated area may turn red or get darker. This will most likely fade 1 or 2 months after you finish radiation.

Radiation therapy after breast surgery may cause other long-term changes in the breast. Your skin may be slightly darker, and pores may be enlarged and more noticeable. The skin may be more or less sensitive and feel thicker and firmer than it was before your treatment. Sometimes the size of your breast changes -- it may become larger because of fluid build-up or smaller because of the development of fibrous tissue. Many women have little or no change in breast size. These side effects may continue for a year or longer after treatment.

If your treatment includes internal radiation implants, you might notice breast tenderness or tightness. After the implants are removed, you are likely to have some of the same side effects that happen with external radiation treatment. If so, follow the advice given above and let your doctor know about any problems that persist.

After 12 months, you should not have any new changes. If you do see changes in breast size, shape, appearance, or texture after this time, report them to your doctor right away.

When radiation treatments include the chest area, the lungs can be affected. One early change is a decrease in the levels of surfactant, the substance that helps keep the air passages open. This keeps the lungs from fully expanding, and may cause shortness of breath or cough. These symptoms are sometimes treated with steroids.

A possible late effect of radiation to the lungs is fibrosis (stiffening or scarring). When this happens, the lungs can no longer fully inflate and take in air. If a large area of the lungs is treated with radiation, these changes can cause shortness of breath and less tolerance for physical activity.

Radiation therapy to the stomach and abdomen

If you are having radiation treatment to the stomach or some part of the abdomen (belly), you may have vomiting, nausea, or diarrhea. Your doctor can give you medicines to help relieve these problems. Check with your doctor or nurse about any home remedies you are thinking about taking during your treatment.

Managing nausea

Some patients report feeling queasy for a few hours right after radiation therapy. If you have this problem, do not eat for several hours before your treatment. You may be able to handle the treatment better on an empty stomach. After treatment, you may want to wait 1 to 2 hours before eating. If the problem persists, ask your doctor about medicines to prevent and treat nausea. Be sure to take the medicine as prescribed.

If you notice nausea before your treatment, eat a bland snack, such as toast or crackers, and try to relax as much as possible. Here are some tips to help an upset stomach:

• Stick to any special diet your doctor or dietitian gives you.
• Eat small meals.
• Eat often and try to eat and drink slowly.
• Avoid foods that are fried or high in fat.
• Drink cool liquids between meals.
• Eat foods that don't have strong smells and can be served cool or at room temperature.
• For a severe upset stomach, try a clear liquid diet (broth and juices) or bland foods that are easy to digest, such as dry toast and gelatin.
• Learn deep breathing and relaxation techniques, and try them when you feel nauseated.

Please call us or visit our Web site for more information on how to manage nausea and vomiting.

How to handle diarrhea

Diarrhea most often begins a few weeks after starting radiation therapy. Your doctor may prescribe medicine or give you special instructions to help with the problem. He or she may also recommend changes in your diet, such as:

• Try a clear liquid diet (water, weak tea, apple juice, peach nectar, clear broth, popsicles, and plain gelatin) as soon as diarrhea starts or when you feel it is going to start.
• Avoid foods that are high in fiber or can cause gas or cramps, such as raw fruits and vegetables, coffee, beans, cabbage, whole grain breads and cereals, sweets, and spicy foods.
• Eat frequent small meals.
• Avoid milk and milk products if they irritate your bowels.
• When the diarrhea starts to improve, try eating small amounts of low-fiber foods such as rice, bananas, applesauce, yogurt, mashed potatoes, low-fat cottage cheese, and dry toast.
• Be sure you take in enough potassium (bananas, potatoes, apricots, peaches), an important mineral you may lose through diarrhea.

Diet planning is an important part of radiation treatment of the stomach and abdomen. Keep in mind these problems will get better when treatment is over. In the meantime, try to pack the highest possible food value into even small meals so you get enough calories, vitamins, and minerals.

Radiation therapy to the pelvis

If you get radiation therapy to any part of the pelvis, you might have one or more of the digestive problems already described. You may have some irritation of your bladder, too, which can be uncomfortable and cause you to urinate often. You may also have effects on your fertility and sex life.

Fertility

Women: Do not try to become pregnant during radiation therapy because radiation can harm the fetus. Women should talk to their doctor about birth control options and how radiation may affect their fertility. If you are pregnant, let your doctor know before beginning treatment.

Depending on the radiation dose, women having radiation therapy in the pelvic area may stop having their menstrual periods and have other symptoms of menopause. Treatment also can result in vaginal itching, burning, and dryness. Report these symptoms to your doctor so you can learn about options for relieving these side effects.

Men: For men, radiation therapy to an area that includes the testes can reduce both the number of sperm and their ability to function. This does not mean, though, that pregnancy cannot occur. If you want to father a child and are concerned about reduced fertility, talk to your doctor before starting treatment. One option may be to bank your sperm ahead of time.

Other than studies that looked at survivors of atomic bomb blasts, there is little information about radiation's effect on the children conceived by men during or after getting radiation therapy. Because of the uncertain risk, doctors often advise men to avoid getting a woman pregnant during and for some weeks after treatment, especially if there is radiation to or near the genital area.

Sexual relations

With some types of radiation therapy involving the pelvis, men and women may notice some change in their ability to enjoy sex or a decrease in their level of desire.

Women: During treatment to the pelvis, some women are advised not to have sex. Some women may find it painful. You most likely will be able to resume having sex within a few weeks after your treatment ends, but check with your doctor first. Some types of treatment may have more long-term effects, such as scar tissue that could affect the ability of the vagina to stretch during sex. Again, your doctor may be able to offer suggestions if this happens to you. You can also get more information from our booklet, Sexuality for the Woman with Cancer.

Men: Radiation may affect the nerves that make a man able to have an erection. If a man is having seed implant radiation therapy, he should check with his doctor about safety precautions, such as using condoms. If erection problems do occur, it is usually gradual over the course of many months or years. Talk with your doctor about treatment options if this is a concern for you. You can get more information from our booklet, Sexuality For the Man with Cancer.

Last Medical Review: 12/23/2008
Last Revised: 12/23/2008