What are the short and long term side effects that throat cancer patients can continue to experience after treatment?
Throat cancer is a difficult disease, not just due to the nature of aggressive treatments used, but also for the side effects that patients continue to live with after their treatment has been completed. In cases of patients who have undergone a complete tracheostomy, for example – normal breathing behaviour is replaced by breathing in and out through a plastic tube and a stoma. These are not the only long-term effects of throat cancer treatment.
Surgical complications and side effects arising out of throat cancer treatment
Like every other type of surgery, throat cancer surgery also carries extensive risks such as the possibility of blood clots, infections, complications arising out of anaesthesia, and even pneumonia.
Patients who undergo a partial or complete pharyngectomy usually lose the ability to speak normally. Some patients need a tracheostomy after surgery, which needs them to breathe through a plastic tube and a stoma (hole near the neck).
Some of the less aggressive surgeries (such as a neck dissection) can also affect the ability of normal speech in patients.
Surgeries near the throat can lead to a gradual narrowing of the throat or voice box. This process is called stenosis. If stenosis affects the patient’s breathing ability, then a temporary or permanent tracheostomy may be needed. Throat surgeries can also sometimes affect the patient’s ability to swallow. This affects their long-term dietary habits. Sometimes, throat cancer patients need a permanent feeding tube.
Other possible surgical complications include:
- The development of a fistula in the neck (A fistula is an abnormal opening between two areas that are not normally connected)
- Rupture of the carotid artery (this is a very rare surgical complication)
Side effects of chemotherapy in throat cancer patients
Chemotherapy drugs work by killing all cells that are dividing rapidly. This is exactly why chemotherapy drugs are effective against cancer cells. But due to the same nature of these drugs, they also end up destroying healthy cells such as cells present in the bone marrow (that produce blood cells), cells within the lining of the mouth and the intestines, and cells in the human hair follicles. Accordingly, people experience side effects (ranging from short to long term), such as:
- Nausea and/or vomiting
- Loss of appetite and weight loss
- Mouth sores and ulcerations
- Diarrhoea and constipation, loose stools
- Hair loss (partial or full)
- Immunosuppression or myelosuppression (due to a lack of white blood cells)
- Problems with blood clotting or severe bleeding/bruising (due to a shortage of blood platelets)
- Persistent fatigue or shortness of breath (due to low red blood cell counts)
In addition to these risks, some chemotherapy drugs such as cisplatin, docetaxel, and paclitaxel can also cause nerve damage (called neuropathy), which leads to numbness, tingling, or phantom pain felt in the hands and feet. The nerve damage caused by cisplatin can also magnify into hearing loss. Some of these side effects are temporary, but depending on the extent of damage, some may last for a very long time. It is important to consult a team of oncologists to understand the possible severity of side effects before a particular chemotherapy drug is accepted in treatment.
Side effects of radiation therapy in throat cancer patients
Many throat cancer patients who receive radiation to the neck and throat area continue to have painful sores and ulcerations in the mouth and throat, that can make it very difficult to eat and drink. This can also lead to weight loss. The sores and ulcers heal with time after the radiation cycles are completed, but some patients complain of swallowing problems even months or years after their treatment is complete. Swallowing exercises and supplements can provide some relief in such cases.
Radiation aimed at the neck can also damage the salivary glands, leading to dry mouth syndrome (this generally does not get better with time) which can be prevented to some extent, by applying intensity modulated radiation therapy (IMRT). Throat cancer patients are advised to pay special attention to their dental hygiene, as there is a possibility of tooth decay in patients who have been exposed to radiation.
Radiation can also damage the patient’s thyroid gland. Thyroid levels should be monitored long after treatment, and appropriate hormonal supplements should be administered to minimize the adverse effects on an individual’s metabolism.
Lastly, in some very rare cases, radiation exposure can lead to the breakdown of the cartilage (soft bone tissue) present in the throat. Such patients may need surgery to remove the voice box, and/or the attachment of a plastic tube to facilitate breathing (tracheostomy).