Do What You Can to Ease Side Effects of Treatment for Oral Cancer

It's likely that you will have physical concerns. Your cancer may cause symptoms. Your treatment may cause side effects.

Here are some common side effects from treatment for oral cancer and how to ease them. You may not have all of these. The treatment you receive--surgery, radiation therapy, chemotherapy--determines which side effects you may experience. We've listed them in alphabetical order so you can find help when you need it.

Anemia (Low Red-Blood-Cell Levels)

Your doctor will take blood samples from you for blood tests throughout your treatment. One thing he or she is checking for is your red-blood-cell count. Red blood cells carry oxygen throughout the body. If your body does not have this oxygen, you may feel tired. Decreased red-blood-cell counts can be caused by small amounts of blood loss, by chemotherapy, radiation, or by the cancer itself.

If your doctor tells you that you have anemia, take these actions to feel better.

• Take short rests when you're tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, such as walking, to your daily routine.

• Balance activity with rest. Save your energy for important tasks.

• Drink plenty of water. Dehydration adds to fatigue.

• Talk with your doctor about medications or treatments that may help manage your anemia.

Anxiety and Depression

Many people may feel blue, anxious, or distressed after being told they have cancer. These feelings may continue or come back throughout treatment.

Taking these actions may ease your mental stress:

• Talk with your family or friends

• Consider joining a cancer support group or finding a cancer "buddy" who can help you cope.

• Ask your doctor about medications and other strategies for dealing with depression and anxiety.

Appetite Loss

Eating well during cancer treatment can help you maintain your strength, stay active, and lower your chances of infection. When you're being treated for cancer, a diet high in calories and protein is best. The problem is that side effects of treatment can change the way food tastes to you or reduce your appetite. In addition, treatments to your oral cavity may make it hard to eat.

You may receive a gastronomy tube temporarily or permanently to administer nourishment. If so, you'll work with a nurse to learn how to use and care for the tube. If you don't use a gastronomy tube, ask your doctor for a referral to a registered dietitian if you are having trouble eating enough healthy foods. Also, try these tips to stimulate your desire to eat.

• If you can, eat foods high in protein several times a day. These foods include: milk, cheese, cottage cheese, yogurt, meat, fish, eggs, beans, peanut butter, and nuts. Protein helps build and repair tissue, and cancer treatments cause you to use more protein than usual. A nutritionist can help you learn what is best for you to eat and drink during your cancer treatment.

• If you can, eat high calorie foods to help you maintain your weight, such as margarine or butter, sugar, honey, jams, jellies, cream cheese, dried fruit, gravies or sauces, mayonnaise, and salad dressing.

• Get plenty of fluids to help control your body temperature and improve food elimination. In addition to water, apple juice, and other liquids, try these foods to increase fluids: gelatin, pudding, soups, Popsicles, and ice cream.

• If your mouth is irritated, avoid foods that may cause more irritation. Foods that are acidic like vinegar, orange juice, lemonade, or foods that can be chafing, such as crusty bread may cause pain.

• Eat small meals throughout the day instead of 3 large ones.

• Keep snacks handy to eat when you are hungry.

• Eat with friends or play your favorite music at mealtime to boost your appetite.

• Eat your biggest meal in the morning. Many people getting treatment for cancer find this is when they have their biggest appetite.

• If you can, increase your activity level. Doing so may stimulate your appetite.

• On days you don't feel like eating at all, don't worry about it. Try again the next day. If you find your appetite doesn't improve in several days, talk with your doctor or nurse.

Bloating and Swelling

You may have swelling after surgery or radiation. Also, some chemotherapy drugs cause your body to retain water. This water retention will go away when your treatment ends. Here's what you can do for relief.

• Ask your healthcare team for suggestions on ways to relieve facial swelling.

• Elevate the area that is swollen for temporary relief. Sleep with your head higher with more pillows for facial swelling. If your legs are swollen, keep them raised.

• Some people find massage and physical therapy helpful for swelling. Ask your doctor if this might help you.

• If bloating is severe, your doctor may prescribe a diuretic or water pill.

Breathing Difficulty

You may find it hard to breathe because of swelling from the surgery or pressure from a tumor. Depending on the location of the cancer, you may have a hole placed in your neck, called a tracheostomy. The hole makes breathing easier. You can also try these tips. 

• Sit upright because it will give your lungs room to expand.

• Sleep with the head of your bed raised or sleep in a recliner.

• Avoid things that make your breathing harder, such as high humidity, cold air, pollen, and tobacco smoke.

• Ask your doctor or nurse to show you how to breathe through the trach hole, if you have one. They can also give you suggestions for how to keep the airway open and clean.

Bruising or Bleeding

Your doctor will take blood samples from you for blood tests throughout your treatment. One thing he or she is checking for is your platelet levels. Many types of chemotherapy can cause low platelet levels, as can the cancer itself. Lowered platelet levels is called thrombocytopenia. Without enough platelets, your blood may not be able to clot. And this may lead to bruising or bleeding.

If your doctor tells you that your platelet count is low, take these actions to stay healthy:

• Protect your skin from cuts, scrapes, and sharp objects.

• Shave with an electric razor because it is less likely to cut you.

• Use a soft toothbrush to prevent bleeding gums.

• Take steps to prevent constipation, which can lead to hemorrhoids and bleeding.

• Call your doctor if you develop a rash, bleeding, or easy bruising.

• Tell your doctor if you take medications that can affect platelet function, including aspirin or ibuprofen.

Chewing, Swallowing, or Talking Difficulty

The tumor itself, the surgery to remove the tumor, and chemotherapy or radiation therapy all may make chewing, swallowing, or talking more difficult. Some of these side effects are temporary. Some may be permanent. Try these steps to make chewing, swallowing, or talking easier.

• Ask your surgeon about steps to rebuild areas of your oral cavity. This can help restore your ability to chew, swallow, or talk. Rebuilding parts of your oral cavity may be done during the surgery to remove the tumor. Or it may be done after you have gone through treatment for oral cancer.

• Ask your dentist for help with dentures or other prostheses that can restore your ability to talk and chew.

• Work with your healthcare team to learn ways to make chewing, swallowing, or talking easier. Many head and neck cancer teams include a speech and swallow therapist who can work with people to overcome these difficulties. Speech and swallow therapy can yield excellent results over time.

• You may benefit from the placement of a feeding tube in the stomach, called a G-tube or PEG, which can be used for food, water, and medicines if you have serious trouble eating and drinking. Feeding tubes are usually temporary. They are inserted just during your treatment and recovery period. In rare cases, the feeding tube will stay in place if you are not able to fully eat and drink after your therapy is complete.

• Occasionally people who have had radiation develop difficulty swallowing because of narrowing of the upper part of the esophagus, called esophageal stricture. Special tests, such as evaluation by a speech and swallow therapist, a video swallow study, or both, can help identify this problem. If identified, esophageal stricture can often be corrected by a dilation procedure. Your doctor can explain more about this.

Constipation

Constipation, or difficult or infrequent bowel movements, can range from mildly uncomfortable to painful. Taking pain medications can lead to constipation, so it's wise to take these preventative actions. These same steps will give you relief if you are already constipated.

• Drink plenty of fluids, especially water and prune juice.

• Eat foods high in fiber, such as fresh fruits and vegetables and whole-grain cereals.

• Exercise

• Take stool softeners or a laxative as prescribed by your doctor.

Diarrhea

Diarrhea is loose or frequent bowel movements, or both. Diarrhea may be caused by medications or a change in your eating habits. It may lead to dehydration if you don't take these precautions.

• Avoid milk and milk products.

• Eat low-residue, low fiber foods such as the BRAT diet (bananas, rice, applesauce, and toast).

• Increase your intake of fluids, such as water and broth, to prevent dehydration.

• Ask your doctor about medications that may help.

Hair Loss (Alopecia)

Losing your hair can be upsetting because baldness is a visible reminder that you are being treated for cancer. Not every type of chemotherapy or radiation will make you lose your hair. Keep in mind, your hair will grow back after chemotherapy; however, it may not grow back in an area that has received radiation. Try these coping tips.

• Consider cutting your hair before treatment starts.

• Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair.

• Because your scalp may be more sensitive to temperature and sun, protect it with sunscreen and hats or scarves.

Infections

Your doctor will take blood samples from you for blood tests throughout your treatment. One thing he or she is checking for is your white-blood-cell count. Many types of chemotherapy can cause low white-blood-cell counts, as can the cancer itself. Lowered white cell counts is called neutropenia. Without enough white blood cells, your body may not be able to fight infection.

If your doctor tells you that your white-blood-cell count is low, take these actions to stay healthy.

• Avoid crowds or people with colds.

• Wash your hands often or use hand sanitizer throughout the day to kill germs.

• Call your doctor right away if you have any of these signs of infection: a temperature of 100.5 degrees Fahrenheit or higher, severe chills, a cough, pain, a burning sensation during urination, or any sores or redness.

Insomnia (Trouble Sleeping)

Insomnia can be caused by anxiety, depression, or your cancer treatment. Use these tips to improve your rest.

• Keep a regular bedtime schedule.

• Use your bed only for sleeping, not watching TV.

• If you don't fall asleep in 15 minutes, get up, do something else, and try again later.

• Avoid stimulants such as caffeine and tobacco, especially close to bedtime.

• Don't eat, drink fluids, or exercise close to your bedtime.

• Avoid long naps during the day.

Mouth Dryness (Xerostomia)

Radiation to your head or neck can cause changes in your saliva and in the amount you produce. Because saliva protects your teeth, tooth decay can be a problem after treatment. And, you can have dry mouth. These actions ensure good mouth care and can help keep your teeth and gums healthy and make you feel more comfortable.

• If it is hard to floss or brush your teeth in the usual way, use gauze, a soft toothbrush, or a special toothbrush that has a spongy tip instead of bristles.

• Use a salt water mouthwash to keep your mouth fresh and help protect your teeth from decay.

• Use a toothpaste with fluoride, a fluoride rinse, or both to reduce your risk of cavities.

• Stay well-hydrated and take small, frequent sips of water. Or suck on sugarless candies.

• Avoid medications, such as Benadryl (diphenhydramine), that can cause dry mouth as a side effect.

• Use a humidifier in dry weather to help decrease the discomfort associated with dry mouth.

• Ask your doctor and dentist about medications and other treatments for dry mouth. You may want to use a special spray of artificial saliva to relieve the dryness.

Mouth Sores (Mucositis)

Mouth sores can be a side effect of chemotherapy or radiation to your oral cavity. These sores may hurt and make eating an unpleasant experience. Taking these actions can ease the pain.

To prevent sores, take these actions.

• Brush your teeth after meals and before bedtime.

• Rinse your mouth with lukewarm water plus salt or baking soda several times a day.

• Keep your mouth and lips clean and moist.

• Use sugar-free candies or gums to increase moisture in your mouth.

To ease the pain if you get sores in your mouth, take these actions.

• Avoid alcohol and mouthwashes containing alcohol because they may irritate the sores.

• Avoid hot, rough, or spicy foods because they may irritate the sores.

• Avoid tobacco because it may irritate the sores. Smoking can also make you more susceptible to sores.

• Ask your doctor about topical mouth medications.

• Take over-the-counter pain medication, such as Tylenol (acetaminophen), if necessary. Talk to your doctor about whether prescription pain medication might be necessary.

• Call your doctor or nurse if your temperature reaches 100.5 degrees Fahrenheit or higher.

Nausea or Vomiting

Nausea or vomiting as a result of chemotherapy or radiation treatment for cancer may range from barely noticeable to severe. It may help you to understand the different types of nausea.

• Acute-onset nausea and vomiting occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be 5 to 6 hours after treatment, and the symptoms end within the first 24 hours.

• Delayed-onset vomiting develops more than 24 hours after treatment.

• Anticipatory nausea and vomiting are learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did previously, which triggers the actual reflex.

• Breakthrough vomiting occurs despite treatment to prevent it. It requires additional treatment.

• Refractory vomiting occurs after one or more chemotherapy treatments--essentially, you're no longer responding to antinausea treatments.

To prevent nausea, take these actions. Most nausea can be prevented.

• Ask your doctor about getting a prescription medicine to control nausea and vomiting. Then make sure you take it as directed. If you are vomiting and cannot take the medicine, call your doctor or nurse.

• If you have bothersome nausea and vomiting even though you are taking your medicine, call your doctor or nurse. Your medicine can be changed or new medicines can be added.

• Avoid constipation.

To help ease nausea or vomiting if you have it, try these tips.

• Try eating foods and drinking beverages that were easy to take or made you feel better when you've had the flu or were nauseated from stress. These might be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or other things.

• Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

• Eat room-temperature or cold foods. The smells from hot foods may make your nausea worse.

• Ask your doctor or nurse if he or she can help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.

Neutropenia (Low White-Blood-Cell Levels)

See "Infections."

Numbness, Tingling, or Muscle Weakness in Your Hands or Feet (Peripheral Neuropathy)

If you have numbness, tingling, or weakness in your hands or feet, you may have nerve damage called peripheral neuropathy. This can be a side effect of chemotherapy or a symptom of the cancer itself. Other signs of this problem are ringing in your ears or trouble feeling hot or cold. If you have symptoms such as these, your doctor may adjust your dose. Or your doctor may prescribe medicine or some vitamins. You should also take these precautions to protect yourself.

• Take extra care walking and moving so that you don't fall. Wear only well-fitting shoes at home and away from it.

• Use warm, not hot, water for bathing to prevent burns because you aren't as sensitive to water temperature. Consider using a shower chair or railing to improve your stability.

• If your daily activities become too difficult, ask your doctor for a referral to an occupational therapist or a physical therapist. They can help teach you new ways of doing things so that you can stay as active as possible.

• Take extra care when driving (you may have trouble feeling the gas and brake pedals). Ask friends and family to drive you places.

Pain

Pain might be from the tumor, from the surgery, or from other treatments. Try these tips to ease pain.

• Take your pain medications regularly; don't wait for your pain to become severe. (Take steps to avoid constipation, a common side effect of pain medications.)

• Change your activity level. See if you feel better if you rest more or move around more--either may help.

• Distract yourself with music, funny videos, or computer games.

• Use heat, cold, relaxation techniques (like yoga or meditation), or guided imagery exercises. Ask your doctor or nurse where you can learn more about these.

Sexuality/Reproductive Issues

Chemotherapy and the stress of dealing with cancer can have effects on your sexual health. Sexuality issues may include reduced libido (interest in and ability to have sex) and infertility. Taking these actions may help you cope with these changes.

• Talk to your partner about changes in your desire or ability to have sex.

• Explore new ways to share affection and intimacy.

• See a counselor who specializes in sexual problems.

• If childbearing is an issue, talk with your doctor about this before your treatment. There may be ways to store sperm in a bank or protect your ovaries.

• Talk with your doctor about birth control options. Women receiving chemotherapy and radiation should not get pregnant, and men receiving chemotherapy should not get anyone pregnant.

Skin Dryness or Irritation

Radiation treatment can cause dry or red skin in the area being treated.

• Protect your skin from sun exposure by wearing sunscreen of at least 15 SPF (sun protection factor).

• Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don't use any lotion, soap, deodorant, sun block, cologne, cosmetics, or powder on your skin within 2 hours after treatment because they may cause irritation.

• Wear loose, soft clothing over the treated area.

• Don't scratch, rub, or scrub treated skin. After washing, gently blot dry.

• Don't bandage skin with tape. If you must bandage it, use paper tape, and ask your nurse to help you place the dressings so that you can avoid irritation.

• Don't apply heat or cold to the treated area. Bathe only with lukewarm water.

• If you must shave the treated area, use only an electric shaver because it is less irritating to your skin. Don't use lotion before shaving. And don't use hair-removal products. Both can irritate your skin.

• Keep your nails well trimmed and clean so you don't accidentally scratch yourself.

Thinking and Remembering Problems

You may have mild problems with concentration and memory during and after chemotherapy. Being tired can make this worse.

Taking these actions may help.

• Make lists and write down important information.

• Use other tools to help organize your life, such as calendars, pill dispensers, or alarm clocks.

• Take advantage of family or friends who offer to go to your doctors visits with you--an extra person along for the visit can help remember detailed information you might receive.

Thrombocytopenia (Low Platelet Levels)

See "Bruising."

Tiredness

Tiredness or fatigue is a very common side effect from chemotherapy and radiation treatments. It is also a symptom of anemia, which is a low red-blood-cell count as noted from blood tests. Whatever the cause, you may feel only slightly tired, or you may suffer from extreme fatigue.

Taking these actions may help increase your energy level. Fatigue can last four to six weeks after treatment ends.

• Take action to treat a poor appetite, because eating improperly can make you tired.

• If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.

• After radiation to the head and neck area, many people develop low thyroid gland function. The thyroid gland normally makes a hormone that is associated with the body's metabolism. Radiation can eventually cause low thyroid function, called hypothyroidism. Hypothyroidism can cause fatigue. If appropriate, your doctor can test you for this. Treatment for hypothyroidism is available and highly effective.

• Follow tips under "Anemia."