A lecture about life challenges after laryngectomy that includes discussion of late side effects of radiation can be viewed on YouTube.
Individuals with head and neck cancer should receive counseling about the importance of smoking cessation. In addition to the fact that smoking is a major risk factor for head and neck cancer, the risk of cancer in smokers is further enhanced by alcohol consumption. Smoking can also influence cancer prognosis. When smoking is continued both during and after RT, it can increase the severity and duration of mucosal reactions, worsen the dry mouth (xerostomia), and compromise patient outcome. Patients who continue to smoke while receiving RT have a lower long-term survival rate than those who do not smoke.
· Eating small, frequent meals throughout the day instead of three large meals. Nausea is often worse if your stomach is empty.
· Eating slowly, chewing the food completely, and staying relaxed.
· Eating cold or room temperature foods. The smell of hot or warm foods may induce nausea.
· Avoiding difficult to digest foods, such as spicy foods or foods high in fat or accompanied by rich sauces.
· Resting after eating. When lying down, the head should be elevated about 12 inches.
· Drinking beverages and other fluids between meals instead of drinking beverages with meals.
· Drinking 6-8 ounce glasses of fluid per day to prevent dehydration. Cold beverages, ice cubes, popsicle, or gelatin are adequate.
· Eating more food at a time of the day when one is less nauseous.
· Informing one's health care provider before each treatment session when one develops persistent nausea.
· Treating persistent vomiting immediately as this can cause dehydration.
· Administering anti-nausea medication by a health care provider.
· Small amount of urine
· Dark urine
· Rapid heart rate
· Flushed, dry skin
· Coated tongue
· Irritability and confusion
Other side effects
Osteoradionecrosis of the jaw
Repair of nonrestorable and diseased teeth prior to RT may reduce the risk of this complication. Mild osteoradionecrosis can be conservatively treated with debridement, antibiotics, and occasionally ultrasound. When necrosis is extensive, radical resection, followed by microvascular reconstruction is often used.
One teaspoon added to 12 oz. of water. The baking soda rinse can be used throughout the day.
Fibrosis and trismus
Fibrosis in the head and neck can become even more extensive in those who have had surgery or further radiation. Post radiation fibrosis can also involve the skin and subcutanous tissues, causing discomfort and lymphedema.
Partial or total oropharyngeal stricture can occur in severe cases.
Some laryngectomees may manifest wound healing problems following surgery, especially in areas that have received RT. Some may develop a fistula ( an abnormal connection between the inside of the throat and the skin). Wounds that heal at a slower pace can be treated with antibiotics and dressing changes by specialists.
Damage to the middle ear (ototoxicity)
Carotid artery stenosis: The carotid arteries in the neck supply blood to the brain. Radiation to the neck has been linked to carotid artery stenosis or narrowing, representing a significant risk for head and neck cancer patients, including many laryngectomees. Stenosis can be diagnosed by ultrasound as well as angiography. It is important to diagnose carotid stenosis early, before a stroke has occurred.
Treatment includes removal of the blockage (endarterectomy), placing a stent (a small device placed inside the artery to widens it) or a prosthetic carotid bypass
Hypertension due to baroreceptors damage: Radiation to the head and neck can damage the baroreceptors located in the carotid artery. These baroreceptors help in regulating blood pressure by detecting the pressure of blood flowing through them, and sending messages to the central nervous system to increase or decrease the peripheral vascular resistance and cardiac output. Some individual treated with radiation develop labile or paroxysmal hypertension.
More information about complications of RT can be found at the National Cancer Institute Web site.