Chemotherapy for head and neck cancers

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1 Chemotherapy for head and neck cancers This information is from the booklet Understanding head and neck cancers. You may find the full booklet helpful. We can send you a free copy see page 7. Contents Having chemotherapy Possible side effects of chemotherapy Having chemotherapy Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy or damage cancer cells. Chemotherapy is usually given in combination with radiotherapy (the use of high-energy rays to destroy cancer cells) to treat locally advanced head and neck cancers. This is called chemoradiation. A cancer is called locally advanced if it has begun to spread into surrounding tissues and/or nearby lymph nodes. We have more information about chemoradiation that we can send you. Sometimes chemotherapy is given before radiotherapy to shrink the tumour and help to make the radiotherapy more effective. Very rarely, chemotherapy is given before surgery to shrink the tumour and make it easier to remove. Sometimes chemotherapy is given to relieve symptoms and improve quality of life if it s not possible to cure the cancer. This is called palliative chemotherapy. Chemotherapy drugs are usually given into a vein (intravenously), but some are given as tablets. The drugs circulate in the bloodstream and reach cancer cells all over the body. Questions about cancer? Ask Macmillan Page 1 of 7

2 Sometimes, intravenous chemotherapy is given continuously over a few days. The chemotherapy can sometimes be given through a small, portable pump. This allows you to go home during your treatment. The pump is attached to a thin tube that is inserted into a vein in the crook of your arm (PICC line) or your chest (central line). Chemotherapy drugs that are commonly used to treat head and neck cancer are: cisplatin carboplatin docetaxel (taxotere) capecitabine (Xeloda ) fluorouracil (5FU) gemcitabine. We can send you more information about having chemotherapy and individual chemotherapy drugs. We also have information about PICC and central lines. Visit be.macmillan.org.uk to order your free information. Page 2 of 7 Questions about cancer? Ask Macmillan

3 Possible side effects of chemotherapy Chemotherapy for head and neck cancers Risk of infection Chemotherapy can reduce the number of white blood cells, which help fight infection. If the number of your white blood cells is low you ll be more prone to infections. A low white blood cell count is called neutropenia. Always contact the hospital immediately on the 24-hour contact number you ve been given and speak to a nurse or doctor if: you develop a high temperature, which may be over 37.5 C (99.5 F) or over 38 C (100.4 F) depending on the hospital s policy, follow the advice that you have been given by your chemotherapy team you suddenly feel unwell, even with a normal temperature you feel shivery and shaky you have any symptoms of an infection such as a cold, sore throat, cough, passing urine frequently (urine infection), or diarrhoea. If necessary, you ll be given antibiotics to treat any infection. You ll have a blood test before each cycle of chemotherapy to make sure your white blood cells have recovered. Occasionally, your treatment may need to be delayed if the number of your white blood cells is still low. Bruising and bleeding Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. If you develop any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin, contact your doctor or the hospital straight away. Questions about cancer? Ask Macmillan Page 3 of 7

4 Anaemia (reduced number of red blood cells) If chemotherapy reduces the number of red blood cells in your blood, you may become very tired and feel you have no energy. You may also become breathless and feel dizzy and light-headed. These symptoms happen because the red blood cells contain haemoglobin, which carries oxygen around the body. If your haemoglobin is low you may be offered a blood transfusion. You ll feel more energetic and any breathlessness will be eased. Feeling sick Some chemotherapy drugs can make you feel sick (nauseated) or possibly be sick (vomit). Your cancer specialist will prescribe anti-sickness (anti-emetic) drugs to prevent this. Let your doctor or nurse know if your anti-sickness drugs are not helping, as there are several different types you can take. We have more information about nausea and vomiting. Sore mouth This is a very common side effect if you re having both chemotherapy and radiotherapy. Your mouth may become sore or dry, or you may develop mouth ulcers during treatment. Some people find that sucking ice is soothing. Drinking plenty of fluids can help if your mouth is sore. Tell your nurse or doctor if you have mouth problems. They can prescribe mouthwashes and medicine to relieve pain and to prevent or clear mouth infections. We have a more information about mouthcare during chemotherapy. You can download it from be.macmillan. org.uk Page 4 of 7 Questions about cancer? Ask Macmillan

5 Numbness or tingling in hands or feet If you have treatment with cisplatin, fluorouracil (5FU) or docetaxel, you may have changes in sensation in your hands and feet. This is due to the effect these drugs can have on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks. Tell your doctor if you notice these symptoms. You may need to have your chemotherapy dose lowered slightly or the drugs changed. Changes in sensation can continue to get worse for two to three months after stopping chemotherapy before slowly improving. It can take up to two years for symptoms to improve. Sometimes changes can be permanent. Changes in hearing If you have treatment with cisplatin, you may have changes in your hearing. You may have ringing in the ears (tinnitus), and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally, your sense of balance may be affected. Any hearing loss may be permanent. However, tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus. They may suggest altering the dose of your chemotherapy. Tiredness Chemotherapy affects people in different ways. Tiredness can build up over a course of treatment, and if you ve had a lot of chemotherapy or a combination of treatments, it can last for several months or more after your treatment has finished. Try to cut down on any unnecessary activities and ask your family or friends to help with jobs such as shopping and housework. Gentle exercise can sometimes help with the symptoms of fatigue. Questions about cancer? Ask Macmillan Page 5 of 7

6 Hair loss Some chemotherapy drugs may cause hair loss. Some people may have complete hair loss including eyelashes and eyebrows. Others may only experience partial hair loss or thinning. It depends on what chemotherapy drugs you are having (your doctor or nurse can tell you more about what to expect). If you do experience hair loss, your hair should start to grow back within about three to six months of the end of treatment. It may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss and how to look after your scalp. We have a booklet called Coping with hair loss, which has useful tips on wigs and head coverings, and dealing with the emotional effects of hair loss. We also have a booklet Coping with fatigue which has more more advice about dealing with fatigue. Call our support line on to order a copy. Changes in the way the kidneys work Cisplatin can affect how your kidneys work. You will have blood tests before and during treatment to check this. Your nurse will ask you to drink plenty of fluid. This is to protect your kidneys. Tell them if there are any changes in how much urine you are producing. Page 6 of 7 Questions about cancer? Ask Macmillan

7 More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding head and neck cancers or any other cancer information, visit be.macmillan.org. uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN JULY 2015 Planned review in 2018 Questions about cancer? Ask Macmillan Page 7 of 7

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