Head and Neck Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemo can harm those cells. This can cause side effects.

When might chemotherapy be used for head and neck cancer?

Chemo might be used for head and neck cancer:

• Along with radiation therapy as the main treatment instead of surgery

• Alone or with radiation therapy before surgery to shrink the tumor. This can make it easier to remove and cause less damage to nearby healthy tissues.

• Along with radiation therapy after surgery to kill any cancer cells that may have been left behind

• Alone or with radiation therapy for tumors that are too big or too widespread to remove with surgery

Chemo is often given along with radiation to treat head and neck cancers. It helps the radiation work better. This is called chemoradiation.

How is chemotherapy given for head and neck cancer?

Chemotherapy is most often given right into your blood through an IV. These medicines can also be taken by mouth as a pill, or given as an injection. The treatment may be done as an outpatient visit to a hospital. This means you go home the same day. Or it may be done at your healthcare provider’s office, a chemotherapy clinic, or you might take it at home. In some cases, you may stay in the hospital during treatment.

You get chemotherapy in cycles over a period of time. That means you get the medicine for a set amount of time, and then you have a rest period. Each period of treatment and rest is one cycle. You may have several cycles. Having treatment in cycles helps by:

• Killing more cancer cells. The medicine can kill more cancer cells over time because cells aren't all dividing at the same time. Cycles allow the medicine to fight more cells.

• Giving your body a rest. Treatment is hard on other cells that divide quickly. This includes cells in the lining of the mouth and stomach. This causes side effects like mouth sores and upset stomach. Between cycles, your body can heal and get a rest from the chemo.

• Giving your mind a rest. Getting chemo can be stressful. Taking breaks between cycles can let you get an emotional break between treatments.

You might get only one chemotherapy medicine. But more often, several medicines are used together. The medicines used will depend on things like:

• The exact type of cancer you have

• Where the cancer is

• How big the tumor is

• Your overall health

• If radiation therapy will be used at the same time

What common medicines are used to treat head and neck cancer?

The chemo used will depend partly on the exact type of head and neck cancer. Some of the medicines most often used are:

• Carboplatin

• Cisplatin

• Docetaxel

• Doxorubicin

• Fluorouracil (5-FU)

• Paclitaxel

• Gemcitabine

What are common side effects of chemotherapy?

Chemo affects normal cells as well as cancer cells. The possible side effects depend on which medicines are used and the dose.

These are common side effects of chemo:

• Upset stomach (nausea) and vomiting

• Hair loss

• Mouth sores

• Diarrhea

• Extreme tiredness (fatigue)

• Loss of appetite

• Skin and nail changes

Other common side effects are related to a decrease in blood counts, such as:

• A decrease in white blood cells. This puts you at higher risk for infections. If you have a fever during chemo, tell your healthcare provider or nurse right away.

• A decrease in platelets. This puts you at risk for bleeding. Tell your healthcare provider or nurse about any bleeding or easy bruising you have during chemo.

• A decrease in red blood cells. This causes fatigue, weakness, and a lack of energy. These symptoms can be treated. Tell your healthcare provider or nurse about them.

Certain chemo medicines cause specific side effects. For example, fluorouracil tends to cause diarrhea. Cisplatin, docetaxel, and paclitaxel may cause tingling and numbness in the hands and feet (neuropathy). Cisplatin can harm your kidneys. Cisplatin, carboplatin, paclitaxel, and docetaxel may cause hearing problems, such as ringing in your ears.

Many chemo side effects can be treated to keep them from getting worse. There may even be things you can do to help prevent some of them. Most side effects go away over time after treatment ends. Others may last longer or be permanent. Be sure to tell your healthcare team about any side effects you have.

Working with your healthcare provider

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what symptoms to watch for and when to call them. For instance, chemo can make you more likely to get infections. You may be told to check your temperature and stay away from people who are sick. Make sure you know what number to call with questions. Is there a different number for evenings, holidays, and weekends?

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.