Radiation side effects with H&N cancer. When will they ever end?

After receiving a full course of radiotherapy for squamous cell carcinoma to the left tonsil area, lingering side effects had to be faced. My very professional oncologist said I should snap back in a month or three however I was his first for an upper throat radiation. Aside from the normal expected side effects during and shortly after radiotherapy, some side effects can last for years.

Head and neck radiotherapy is unique in the fact that vital life areas are being attacked with radiation. The mouth, sinus, gums, salivary system, esophagus, airways, swallowing, vocal chords are all effected. It isn’t like we can stop breathing or swallowing to allow us time to heal. Other areas are usually less complicated.

Because the recovery years are hopefully behind me, I thought I would share with anyone interested and dealing with side effects and assure you that with time things usually get better. I will begin with four side effects and add a few over the next few weeks. This is not to say it is a complete list or that you have or may expect any or all of these side effects. We are all different in our treatments and recoveries.

Don’t be alarmed. I am in my sixties now, in very good health, and enjoying life.

1) Dry mouth. Probably the most common and bothersome. I keep water with me always and at my bedside. Mints help as well. This has improved over the last ten years but I wouldn’t win a spitting contest.
2) Nerve issues on the face and neck. Known as “creepy crawlies” or “bugs on the face” the feeling that something is there although that clearly is not the case. Sometimes rubbing the face or drinking cold water helped. This occurred initially several times per day but after a few years it became infrequent and lasted roughly seven years.
3) Nerve shocks on the left arm and shoulder or sometimes just a dull pain of the upper arm. The shocks would startle me and those around me I’ve been told. Lasted about five years.
4) Neck cramps. Some call this “lock jaw” but it is not the actual tetanus disease and only lasts for usually less than a minute. Mine was often initiated by yawning, a sneeze, a cough, and on occasion eating or talking. Rubbing the area helped and indeed it often felt like a cramped muscle in the neck. Unfortunately this stayed with me for roughly fifteen years.

More next week. If you have any questions or comments or wish to add I would welcome that input. Until then please know time heals all wounds as they say.

Interested in more discussions like this? Go to the Head & Neck Cancer Support Group.

Oh so many of the symptoms. After what seemed like an eternity, actually twelve months, they finally discovered I had a very aggressive squamous Cell Carcinoma radiating down from under my right jawline. The little sucker used my Tri-Geminal nerve as a very nice conductor. The pain apart from being weird, caused no end of pain. It is unsure if the Tumour or the radiation did the damage, but the Myeloid coating on the nerve has gone. I had what the technician called "The heaviest Radiation Dose he had ever dispensed"

I am left with lifelong pain as the coating won't recover, also the scaring on my larynx and constant problems with Infection and Fungal growths. I am presently on a new form of anti-fungal which seems to be improving the problem. The other is opposite to most of you. I have excessive saliva and a constant problem with Mucus.
The Mucus is so bad it forms and at times almost blocks my airway, which creates a huge coughing fit which aggravates my whole larynx and so the problem goes on.

This is now my 3rd year after Radiation and Chemo and each year a biopsy has been done as the ENT Docs believe my Larynx has gone rogue and needs to come out. Both the earlier times I have refused saying life is about quality not quantity and I will go with all the nasty bits still in. In all earlier tests it came back as negative for a tumour anyway. This year to be sure they have ordered a second biopsy as they expect to find the cancer with or without my help.

Between my constant cough and the ongoing extreme pain along with the excessive use of Kleenex now my complete loss of voice from all the above Life doesn't seem to hold any form of quality and it is just one ongoing trip to the doctor for no energy, pain management or referral for more pain killers. It is my firm hope the rest of you do not get into my situation.. Wishing all a speedy successful recovery.

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@hrhwilliam

Radiation side effects with H&N cancer. When will they ever end? Part II:
Members have reminded me of a couple of issues which I had forgotten about but actually still cannot ignore so I will include them here today. I live with these (6,7, and 8) and don't even think about it.
5) Neck/Throat Pain from a sneeze, severe enough to cause tears in the eyes. This lasted about 10 years. When I felt a sneeze coming on, it was terror. Now I actually enjoy a good sneeze.
6) Nose "Runs" when eating. This is probably a saliva re-route after radiation turned my mouth into raw hamburger. This continues to this day but has been improving over the past two years. Must always eat with a napkin to dab my nose. This can be done discreetly however.
7) Thyroid Bruised. The radiotherapy I had was Photon so as a result my thyroid was bruised. The thyroid went low about six weeks after treatment ended and suddenly too. Then it went high. A scan showed one enlarged wing (there are four like a butterfly). Twenty plus years out I continue to take a very small amount of medicine to reduce the thyroid output so I don't get jittery and have a shortness of breath. I can live without the medicine but with it life is easier. To have the thyroid ablated I would be totally dependent on thyroid replacement medicine. I take Methimazole 5mg twice per week, a very minimal amount.
8) Food Pockets. I once had a nice oral cavity the way God intended, but after radiation bombardment I was left with ridges and scarring. Within these folds and pockets food particles like to hide. Spices are the worst but it all needs to be delt with after eating. It improved within a year or so after treatment but never back to original so for that reason I brush after every meal regardless where I am and I travel with a water pick just in case it is necessary to use it. Often a good water swish will suffice. Oral care has been a top priority since early recovery.
9) Loss of specific memories. Radiation about four or five weeks in literally blew the hair off the back of my head in a very finite line. I have no doubt the brain took a bit of a hit as well. I had a photo and am still searching for that. Anyway I lost specific memories about people, places, math formulas, foreign languages, etc. One does not know what one does not know and that can be scary. When you don't recognize an old friend or swear you have never been to a certain town yet know exactly where the hardware store is, that can throw you off a bit.
More to follow. I appreciate the other members who have inputted their thoughts and comments. All any of us have been through has just been a difficult but not impossible road. I wish all of you could end up enjoying a new normal and I know many of you have. Time heals all wounds, even cancer.

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I also had the hair on the back of my neck come off in a straight line. My wife asked me if I had cut it with clippers. My radiologist explained to me after I asked that the radiation went in. 360 arc around my head.

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Just a point that should be included on effects, teeth. Prior to my radiation I was told to get my teeth checked and any repairs needed to be done there and then. An accompanying letter was supplied for the dentist's to refer to.

I had this done with a clean and two fillings. Seems simple, I was happy to get that bit out of the way and get on with my treatment. Now three and bit years on, I realise what they were talking about. All my bottom teeth have gone to God. If they haven't fallen out, they are broken stubs of their former selves. I have had, must be around 14 dental visits now and am finally getting back to getting the end product of radiation a full bottom plate.

Not one Dentists would remove any of the damaged teeth. It was their supposition that removal could cause a break in the Jaw! Chewing food is a nightmare, but getting food in is nearly as bad. My incisor teeth are mere broken stubs. Wow for anyone who doesn't have them they know that biting food off is impossible, so it is cut everything up to the smallest bit possible before it gets into the mouth.

Now meals are a long drawn out process that is generally not finished anyway. Your weight needs to be monitored as in my case, I have lost 3 kilograms in the past two months. All good if i needed to, but I had already lost 30 kilograms after treatment and chemo. So be warned, try and save the teeth.

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@ntodd

Oh so many of the symptoms. After what seemed like an eternity, actually twelve months, they finally discovered I had a very aggressive squamous Cell Carcinoma radiating down from under my right jawline. The little sucker used my Tri-Geminal nerve as a very nice conductor. The pain apart from being weird, caused no end of pain. It is unsure if the Tumour or the radiation did the damage, but the Myeloid coating on the nerve has gone. I had what the technician called "The heaviest Radiation Dose he had ever dispensed"

I am left with lifelong pain as the coating won't recover, also the scaring on my larynx and constant problems with Infection and Fungal growths. I am presently on a new form of anti-fungal which seems to be improving the problem. The other is opposite to most of you. I have excessive saliva and a constant problem with Mucus.
The Mucus is so bad it forms and at times almost blocks my airway, which creates a huge coughing fit which aggravates my whole larynx and so the problem goes on.

This is now my 3rd year after Radiation and Chemo and each year a biopsy has been done as the ENT Docs believe my Larynx has gone rogue and needs to come out. Both the earlier times I have refused saying life is about quality not quantity and I will go with all the nasty bits still in. In all earlier tests it came back as negative for a tumour anyway. This year to be sure they have ordered a second biopsy as they expect to find the cancer with or without my help.

Between my constant cough and the ongoing extreme pain along with the excessive use of Kleenex now my complete loss of voice from all the above Life doesn't seem to hold any form of quality and it is just one ongoing trip to the doctor for no energy, pain management or referral for more pain killers. It is my firm hope the rest of you do not get into my situation.. Wishing all a speedy successful recovery.

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@ntodd, your symptoms could describe most of us that went through radiation for head and neck cancer. If you desire to go on my profile, you will see a detailed history of the symptoms and outcome I experienced...and still do. Ultimately, approximately two years ago I was given a tracheotomy. This has been a Godsend for getting that nasty mucus out. It is now accessible! I know that the thought of having a Trach-tube is nauseating, but it is a huge relief compared to the trapped mucus. Most days, I hardly notice it is there. Yet, the ongoing lung infections from trapped mucus have been alleviated. Best wishes to you.

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For the past several weeks since I started radiation and chemo treatment.and recently finishing A Galliume treatment, I’ve had an intense swnsation to anything even relatively cold in my mouth. It’s like the pain shoots through my molars and through my jabones. anyone else deal with this? What did you do? My dentist yesterday sold me Sensodyne. That seems like treating the symptoms but what about the cause??

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@brianhavefaith

For the past several weeks since I started radiation and chemo treatment.and recently finishing A Galliume treatment, I’ve had an intense swnsation to anything even relatively cold in my mouth. It’s like the pain shoots through my molars and through my jabones. anyone else deal with this? What did you do? My dentist yesterday sold me Sensodyne. That seems like treating the symptoms but what about the cause??

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@brianhavefaith, please research "red light therapy." I believe this light to be very, very healing in many conditions. Utilizing the light consistently may help alleviate your issue. My thoughts are with you.

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Radiation side effects with H&N cancer. When will they ever end? Part III final:
To finish off the list of side effects I experience(d) after radiotherapy we start with an easy one.
10) Sparse or limited beard on the left side of my face and neck. This is on-going. It is not a big deal and cuts down on my morning routine time but if I should wish to grow a beard, well that's not a sight anyone should see.
11) Difficulty swallowing > 1000mg meds and certain foods. Breads, white rice, white meat poultry and anything dry does not work in my throat so is either avoided or modified with liquids. After years of testing, I know what works and what doesn't and it becomes a way of life.
12) Osteoradionecrosis of the left mandible (death of the jaw bone). This required surgery which was done at Mayo , Rochester. All is very okay now. Thanks to Dr. Ettinger and crew. This is a story in itself but was probably the most difficult of all the post issues to deal with.
13) Cancer Free! The only good side effect from radiation treatment is I never had a re-occurrence of the initial cancer.
While some or all of these side effects were going on over the past twenty-some years I did not sit and wallow. I continued with life and made whatever accommodations were necessary to move on. I fought with the Federal Aviation Administration to maintain my pilot's medical requirement. My occupation as a traveling engineer (field engineer) continued with work all around the world. My family life continued. The lawn got mowed. The kid went to university. Despite setbacks and issues to deal with, I was still looking at the grass from the green side. We learn to cope and we continue with life. As the song says, " If you have the choice to sit it out or dance, I hope you dance".

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@sm22

Is still experience side effects from my radiation that ended in October. Stabbing pains and some fatigue. I am just keeping the faith that they will all subside soon - with time.

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I think you will see that those pains will subside, or at least I hope they will. This is one of those issues that cannot be explained to someone who hasn't had the experience.
As for the fatigue, your primary care physician can order up thyroid T3, T4 TSH blood tests easily along with perhaps other enzyme tests to possibly help get a grip on the cause of fatigue. radiation can damage the thyroid, which is located in the front base of the neck. It is not uncommon to want to sleep 9-10 hours per night during recovery but simple tests can put your mind at ease.

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@jdernburg

I had head and neck radiation 20 years ago at MGH. The treatment burned a hole in my face, caused problems with a number of teeth and I still have morphea around my abdomen. MGH never told me there were problems with some of the head/neck machines and I should have sued.

I also have a lot of scar tissue from radiation, mainly in my abdomen. The cancer did not return.

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Grateful the cancer never returned but what a horrible journey you had to endure to get here. As someone said, "What doesn't kill you makes you stronger." You no doubt have a wealth of advice for those just starting out. Thumbs up to you.

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@ltecato

The effects of radiation will continue for the life of the patient. In my case, they got to the point that I can’t eat food like a normal person of my age, which is mid-60s. I have to take antibiotics to mitigate the risk of osteoradionecrosis and I believe this is also why I stopped getting aspiration pneumonia.

The xerostomia never gets better and the trismus (lockjaw) also gets progressively worse. A new patient can probably mitigate trismus just by forcing their mouths open as physical therapy. I wish I had done this because now my teeth are in terrible shape and I can’t get dental work done because my mouth will not open more than a centimeter or so.

An old ENT doctor told me that in the early days of radiation therapy they would remove a patient’s teeth before starting radiation on the head-and-neck area. I was supposed to put fluoride on my teeth at bedtime for my entire life, but I was a teenager and didn’t think I would survive very long anyway, so I blew it off. Eventually I lost most of my teeth.

Another thing that I was not warned about is the risk of severe nosebleed. Doctors call it epistaxis. I had a completely unexpected nosebleed that put me in the hospital for nearly a week. The emergency room treatment for this kind of epistaxis is a form of torture that involves shoving something like a condom into the nostril and filling it with water. It was possibly the worst pain I have ever experienced and that includes a radical neck dissection. The pain was so bad that I kind of went into shock and thought incorrectly that I had gotten a shot of morphine or Demerol. But anyway, be careful about taking aspirin if you are using nasal steroids.

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Teeth issues are the worst to deal with. Mayo should be able to help you with the osteoradionecrosis and rebuild of your teeth and jaw if you are interested.
I took antibiotics for years although it does nothing to stop the bone death as I understand. Only to help with the constant infections around the tooth root.
It sounds like you have had a rough journey. Are you getting issues under control such as eating and getting on with life?

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