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The methods used to treat cancer are very powerful. It is hard to limit the effects of therapy so that only cancer cells are removed or destroyed; healthy cells also may be damaged. That’s why treatment often causes unpleasant side effects.

The side effects of cancer treatment vary. They depend mainly on the type and extent of the treatment.

Also, each person reacts differently. Doctors try to plan the patient’s therapy to keep problems to a minimum. Doctors, nurses, dietitians, and speech pathologists can explain the side effects of treatment and suggest ways to deal with them. It may also help to talk with another patient. In many cases, a social worker or another member of the medical team can arrange a visit with someone who has had the same treatment.

Effects Of Radiation Therapy

During radiation therapy, healing after dental treatment may be a problem. That’s why doctors want their patients to begin treatment with their teeth and gums as healthy as possible. They often recommend that patients have a complete dental exam and get any needed dental work done before the radiation therapy begins. It’s also important to continue to see the dentist regularly because the mouth may be sensitive and easily irritated during cancer therapy.

In many cases, the mouth is tender during treatment, and some patients may get mouth sores. The doctor may suggest a special rinse to numb the mouth and reduce the discomfort.

Radiation to the larynx causes changes in the saliva and may reduce the amount of saliva. Because saliva normally protects the teeth, tooth decay can be a problem after treatment. Good mouth care can help keep the teeth and gums healthy and can make the patient feel more comfortable. Patients should do their best to keep their teeth clean. If it’s hard to floss or brush the teeth in the usual way, patients can use gauze, a soft toothbrush, or a special toothbrush that has a spongy tip instead of bristles. A mouthwash made with diluted peroxide, salt water, and baking soda can keep the mouth fresh and help protect the teeth from decay. It may also be helpful to use a fluoride toothpaste and/or a fluoride rinse to reduce the risk of cavities. The dentist may suggest a special fluoride program to keep the mouth healthy.

If reduced saliva makes the mouth uncomfortably dry, drinking plenty of liquids is helpful. Some patients use a special spray (artificial saliva) to relieve the dryness.

Patients who have radiation therapy instead of surgery do not have a stoma. They breathe and talk in the usual way, although the treatment can change the way their voice sounds. Also, their voice may be weak at the end of the day, and it is not unusual for the voice to be affected by changes in the weather. Voice changes and the feeling of a lump in the throat may come from swelling in the larynx caused by the radiation. The treatment can also cause a sore throat. The doctor may suggest medicine to reduce swelling or relieve pain.

During radiation therapy, patients may become very tired, especially in the later weeks. Resting is important, but doctors usually advise their patients to try to stay as active as they can. It’s also common for the skin in the treated area to become red or dry. They skin should be exposed to the air but protected from the sun, and patients should avoid wearing clothes that rub the area. During radiation therapy, hair usually does not grow in the treated area; if it does, men should not shave. Good skin care is important at this time. Patients will be shown how to keep the area clean, and they should not put anything on the skin before their radiation treatments. Also, they should not use any lotion or cream at other times without the doctor’s advice.

Some patients complain that radiation therapy makes their tongue sensitive. They may lose their sense of taste or smell or may have a bitter taste in their mouth. Drinking plenty of liquids may lessen the bitter taste. Often, the doctor or nurse can suggest other ways to ease these problems. And it helps to keep in mind that, although the side effects of radiation therapy may not go away completely, most of them gradually become less troublesome and patients feel better when the treatment is over.

Effects Of Surgery

Keeping the patient comfortable is an important part of routine hospital care. If pain occurs, it can be relieved with medicine. Patients should feel free to discuss pain control with the doctor.

For a few days after surgery, the patient isn’t able to eat or drink. At first, an intravenous (IV) tube supplies fluid. Within a day or two, the digestive tract is getting back to normal, but the patient still cannot swallow because the throat has not healed. Fluids and nutrition are given through a feeding tube (put in place during surgery) that goes through the nose and throat to the stomach. As the swelling in the throat goes away and the area begins to heal, the feeding tube is removed. Swallowing may be difficult at first, and the patient may need the guidance of a nurse or speech pathologist. Little by little, the patient returns to a regular diet.

After the operation, the lungs and windpipe produce a great deal of mucus, also called sputum. To remove it, the nurse applies gentle suction with a small plastic tube placed in the stoma. Soon, the patient learns to cough and to suction mucus through the stoma without the nurse’s help. For a short time, it may also be necessary to suction saliva from the mouth because swelling in the throat prevents swallowing.

Normally, air is moistened by the tissues of the nose and throat before it reaches the windpipe. After surgery, air enters the trachea directly through the stoma and cannot be moistened in the same way. In the hospital, patients are kept comfortable with a special device that adds moisture to the air.

For several days after a partial laryngectomy, the patient breathes through the stoma. Soon the trach tube is removed; within the next few weeks, the stoma closes. The patient then breathes and speaks in the usual way, although the voice may not sound exactly the same as before.

After a complete laryngectomy, the stoma is permanent. The patient breathes, coughs, and "sneezes" through the stoma and has to learn to talk in a new way. The trach tube stays in place for at least several weeks (until the skin around the stoma heals), and some people continue to use the tube all or part of the time. If the tube is removed, it is usually replaced by a smaller tracheostomy button (also called a stoma button). After a while, some laryngectomees get along without either a tube or a button.

After a laryngectomy, parts of the neck and throat may be numb because nerves have been cut. Also, following surgery to remove lymph nodes in the neck, the shoulder and neck may be weak and stiff.

Effects Of Chemotherapy

The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect rapidly growing cells, such as blood cells that fight infection, cells that line the digestive tract, and cells in hair follicles. As a result, patients may have side effects such as lower resistance to infection, loss of appetite, nausea, vomiting, or mouth sores. They may also have less energy and may lose their hair.

Effects Of Treatment On Eating

Loss of appetite can be a problem for patients treated for laryngeal cancer. People may not feel hungry when they are uncomfortable or tired.

Patients who have had a laryngectomy may lose their interest in food because the operation changes the way things smell and taste. Radiation therapy also tends to affect the sense of taste. The side effects of chemotherapy can also make it hard to eat. Yet good nutrition is important. Eating well means getting enough calories and protein to prevent weight loss, regain strength, and rebuild normal tissues.

After surgery, learning to swallow again may take some practice with the help of a nurse or speech pathologist. Some patients find liquids easier to swallow; other do better with solid foods. If eating is difficult because the mouth is dry from radiation therapy, patients may want to try soft, bland foods moistened with sauces or gravies. Others enjoy thick soups, puddings, and high-protein milkshakes. The nurse and the dietitian will help the patient choose the right kinds of food. Also, many patients find that eating several small meals and snacks during the day works better than trying to have three large meals. The National Cancer Institute booklets Radiation Therapy and You, Chemotherapy and You," and Eating Hints suggest a variety of other ways to deal with eating problems.

Source:  "What You Need To Know About Cancer Of The Larynx," Brochure, NIH Publication No. 95-1568, National Cancer Institute, March 1995.

MSI-NCI119