Cancer of the Larynx : Radiation Therapy, Surgery, Chemotherapy

by National Cancer Institute

(Page 4 of 5)

Radiation Therapy

People treated with radiation therapy may have some or all of these side effects:

Dry mouth. Drinking lots of fluids can help. Some patients find artificial saliva helpful. It comes in a spray or squeeze bottle.

Sore throat or mouth. Your health care provider may suggest special rinses to numb your throat and mouth and help relieve the soreness.

Delayed healing after dental care. Many doctors recommend having a dental exam and any needed dental work before radiation therapy.

Tooth decay. Good mouth care can help keep your teeth and gums healthy and can help you feel better. If it's hard to floss or brush your teeth in the usual way, you can try using gauze, a soft toothbrush, or a toothbrush that has a spongy tip instead of bristles. A mouthwash made with diluted peroxide, salt water, baking soda, or a combination can keep your mouth fresh and help protect your teeth from decay. It may also be helpful to use fluoride toothpaste or rinse.

Changes in sense of taste and smell. During radiation therapy, food may taste or smell different.

Fatigue. During radiation therapy, you may become very tired, especially in the later weeks of treatment. Resting is important, but doctors usually advise their patients to stay as active as they can.

Changes in voice quality. Your voice may be weak at the end of the day. It may also be affected by changes in the weather. Voice changes and the feeling of a lump in your throat may come from swelling in the larynx caused by the radiation. The doctor may suggest medicine to reduce this swelling.

Skin changes in treated area. The skin in the treated area may become red or dry. Good skin care is important at this time. Try to expose this area to the air but protect it from the sun. Avoid wearing clothes that rub, and do not shave the treated area. You should not put anything on your skin before radiation treatments. Also, you should never use lotion or cream without your doctor's advice.

Surgery

People who have surgery may have any of these side effects:

Pain. You may be uncomfortable for the first few days after surgery. However, medicine can usually control the pain. You should feel free to discuss pain relief with the doctor or nurse.

Low energy. It is common to feel tired or weak after surgery. The length of time it takes to recover from an operation is different for each patient.

Swelling in the throat. For a few days after surgery, you won't be able to eat, drink, or swallow. At first, you will receive fluid through an intravenous (IV) tube placed into your arm. Within a day or two, you will get fluids and nutrition through a feeding tube (put in place during surgery) that goes through your nose and throat into your stomach. When the swelling goes away and the area begins to heal, the feeding tube will be removed. Swallowing may be difficult at first, and you may need the help of a nurse or speech pathologist. Soon you will be eating your regular diet.

If you need a feeding tube for longer than one week, you may get a tube that goes directly into the abdomen. Most patients slowly return to eating solid foods by mouth, but for a very few patients, the feeding tube may be permanent.

Increased mucus production. After the operation, the lungs and windpipe produce a lot of mucus, also called sputum. To remove it, the nurse applies gentle suction by placing a small plastic tube in the stoma. You will learn to cough and suction mucus through the stoma without the nurse's help.

Numbness, stiffness, or weakness. After a laryngectomy, parts of the neck and throat may be numb because nerves have been cut. Also, the shoulder, neck, and arm may be weak and stiff. You may need physical therapy to improve your strength and flexibility after surgery.

Changes in physical appearance. Your neck will be somewhat smaller, and it will have scars. Some patients find it helpful to wear clothing that covers the neck area.

Tracheostomy. Patients who have surgery will have a stoma. With most supraglottic and partial laryngectomies, the stoma is temporary. After a short recovery period, the tube can be removed, and the stoma closes up. You should then be able to breathe and talk in the usual way. In some people, however, the voice may be hoarse or weak.

After a total laryngectomy, the stoma is permanent. If you have a total laryngectomy, you will need to learn to speak in a new way.

Chemotherapy

The side effects of chemotherapy depend mainly on the specific drugs and the dose. In general, anticancer drugs affect cells that divide rapidly:

Blood cells: These cells fight infection, help your blood to clot, and carry oxygen to all parts of your body. If your blood cells are affected, you are more likely to get infections, may bruise or bleed easily, and may feel very weak and tired.

Cells in hair roots: Chemotherapy can lead to hair loss, but hair will grow back. However, the new hair may be different in color and texture.

Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Many of these side effects can be controlled with new or improved drugs.

Nutrition

Some people who have had treatment for cancer of the larynx may lose their interest in food. Soreness and changes in smell and taste may make eating difficult. Yet good nutrition is important. Eating well means getting enough calories and protein to prevent weight loss, regain strength, and rebuild healthy tissues.

If eating is difficult because your mouth is dry from radiation therapy, you may want to try soft, bland foods moistened with sauces or gravies. Thick soups, puddings, and milkshakes often are easier to swallow. The nurse and the dietitian will help you choose the right foods.

After surgery or radiation therapy, some people need feeding tubes placed into the abdomen. Most people slowly return to a regular diet. Learning to swallow again may take some practice with the help of a nurse or speech pathologist. Some people find liquids easier to swallow; others do better with solid foods. You will find what works best for you.

Living with a Stoma

Learning to live with the changes brought about by cancer of the larynx is a special challenge. The medical team will make every effort to help you return to your normal routine as soon as possible.

If you have a stoma, you will need to learn how to care for it:

Before leaving the hospital, you will learn to remove and clean the trach tube, suction the trach, and care for the skin around the stoma.

If the air is too dry, as it may be in heated buildings in the winter, the tissues of the windpipe and lungs may produce extra mucus. Also, the skin around the stoma may get sore. Keeping the skin around the stoma clean and using a humidifier at home or at the office can lessen these problems.

It is very dangerous for water to get into the windpipe and lungs through the stoma. Wearing a special plastic stoma shield or holding a washcloth over the stoma keeps water out when showering or shaving. Other types of stoma covers - such as scarves, neckties, and specially made covers - help keep moisture in and around the stoma. They help filter smoke and dust from the air before it enters the stoma. They also catch any fluids that come out of the windpipe when you cough or sneeze. Many people choose to wear something over their stoma even after the area heals. Stoma covers can be attractive as well as useful.

When shaving, men should keep in mind that the neck may be numb for several months after surgery. To avoid nicks and cuts, it may be best to use an electric shaver until the numbness goes away.

People with stomas work in almost every type of business and can do nearly all of the things they did before. However, they cannot hold their breath, so straining and heavy lifting may be difficult. Also, swimming and water skiing are not possible without special instruction and equipment to keep water from entering the stoma.

Some people may feel self-conscious about the way they look and speak. They may be concerned about how other people feel about them. They may be concerned about how their sexual relationships may be affected. Many people find that talking about these concerns helps them. Counseling or support groups may also be helpful.

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