Head and Neck Cancer: Radiation Therapy

Radiation kills cancer cells by focusing beams of X-rays or other particles at the tumor.

When radiation therapy is used

Your healthcare provider may use radiation for any of these reasons:

• As the main treatment instead of using surgery

• To treat the cancer if a person isn't healthy enough to have surgery

• To shrink a large tumor before surgery

• To kill cancer cells that might be left in the area after surgery

• For a tumor that grows back after surgery

• To help ease symptoms caused by advanced cancers 

Radiation to the head and neck area can cause problems with tissue healing if you have poor dental hygiene. For this reason, your healthcare provider may suggest you have a full dental exam before starting radiation. If you have dental problems, the healthcare provider will want you to have an exam as soon as possible before radiation starts. Some or all of your teeth may need to be removed. This is because any dental problems you have can get worse after radiation. After radiation, you may need fluoride treatment and frequent dental cleanings and examinations.

How you get radiation

External beam radiation treatment (EBRT) is the type of radiation therapy most often used to treat head and neck cancer. The radiation comes from a large machine that focuses the radiation beams on the tumor. The machine doesn't touch you. Radiation treatment doesn't hurt. A mask or mold might be made to keep you in the same position for each treatment.

EBRT is done as an outpatient. That means you get it at a hospital or a clinic, but you go home the same day. Generally, you have radiation treatments 5 days a week, Monday through Friday, for several weeks in a row.

There are several types of EBRT. Some methods can target the tumor more precisely. This means they are less likely to damage nearby healthy tissue. These methods include:

• 3D-CRT (3D conformal radiation therapy). Computers and CT or MRI scans are used to match the radiation beams to the tumor’s shape from different angles. This means fewer side effects for healthy tissue.

• IMRT (intensity-modulated radiation therapy). This is a similar method. It uses a computer to focus the radiation’s direction and strength more precisely on the tumor. This can also decrease side effects for healthy tissue. This is the most common technique used nowadays for treating cancer in the head and neck.

Internal radiation is another radiation delivery method, but it's rarely used now. With this method, radioactive materials are placed inside or near the tumor. The radiation travels a short distance for a certain amount of time to kill cancer cells. This type is given while you are in the hospital. The radiation is taken out before you go home. Some people get both this and EBRT.

Preparing for radiation

Before your first treatment, you’ll have a session to find exactly where on your body the radiation beam needs to be directed. The process is called simulation. This session may take up to 2 hours. During this session, you may have imaging tests such as CT, MRI, or PET scans to help healthcare providers know the exact spot of your tumor to better aim the radiation. Also at this session, you may have body molds or a head and neck mask made to help keep you from moving during the treatment. Then you’ll lie still on a table while a radiation therapist uses a machine to define your treatment field. The field is the exact place on your body where the radiation will be aimed. Sometimes it’s called your port. The therapist may mark your skin with tiny dots of semi-permanent ink. This is so the radiation will be aimed at the exact same place each time.

On the days you get radiation

Radiation treatment is like getting an X-ray. The radiation is stronger so it can kill cancer cells. You can’t feel radiation, so the process will be painless. Also, you will not be radioactive afterward.

On the days you have treatment, you’ll lie on a table. A radiation therapist may place blocks or special shields to protect healthy parts of your body. The therapist then lines up the machine. You may see lights and laser lines projected from the machine lined up with the marks on your skin. These help the therapist know you are in the right position. The radiation machine may be used to take X-rays or CT scans before treatment. This is done to help with alignment.

The therapist will leave the room while the machine sends radiation to your tumor. The machine may whir and buzz and will move, but it won't touch you. During this time, the therapist can see you, hear you, and talk to you. The treatment itself often takes only a few minutes.

Side effects

Radiation therapy affects normal cells as well as cancer cells. That means you may have side effects. What they are and how strong they are depends on:

• The amount and type of radiation

• If you are also getting chemotherapy

• What part of your body is being treated

Radiation to the neck and throat area can cause painful sores in your mouth and throat. These sores may make it hard to eat because it’s painful to chew and swallow. Sores often go away a few days to a few weeks after radiation ends. But to help you take in enough food, your healthcare provider may insert a feeding tube into your stomach. This tube, called a PEG tube, is put in through a small cut or incision in your belly. The PEG tube will be taken out when it's no longer needed.

Other side effects from radiation therapy may include:

• Skin reddening or irritation around the neck

• Dry mouth or thick saliva (which can be permanent)

• Sore throat

• Hoarseness

• Swelling and scarring

• Appetite loss

• Trouble swallowing

• Decreased sense of taste

• Breathing problems caused by swelling

• Voice changes

• Earaches or hearing loss

• Hair loss

• Tiredness

• Upset stomach or nausea

• Weight loss

• Hair loss on the face or sometimes the head, depending on the location of the cancer

Radiation side effects can be more severe when you have it along with chemotherapy. In rare cases, radiation may lead to a breakdown of cartilage in the voice box (larynx).

Radiation to the neck area might damage your thyroid gland. This can make you feel tired, gain weight, feel cold, and have dry skin or hair. If this happens, you might need to take thyroid hormone pills.

Radiation near the salivary glands may cause dry mouth. This is called xerostomia. It can also affect taste and swallowing function. Rarely, you may need to have a permanent feeding tube placed to have nourishment. You may have this even after treatment is done, because of lasting damage to your salivary glands. If you have dry mouth after radiation, be careful with your oral and dental health. Dry mouth can cause problems with tooth decay.

Talk with your healthcare provider about what short- and long-term radiation side effects you might have and how these side effects might be prevented or managed. Ask what side effects you need to report and how to get in touch with your healthcare team after hours and on weekends and holidays.