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This page has been written for patients who are having radiotherapy to the head, mouth and neck area. It explains what the treatment involves, describes side-effects you may experience during and after treatment, and how best to cope with them.
We understand this is a worrying time for patients and their families, and we hope this page can help to answer any questions you have. If you have any questions about the treatment or information in this booklet, please speak to the team looking after you.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law, we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to having the procedure and understand what it involves.
Staff will explain all of the risks, benefits and possible alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak to the team looking after you.
During your time with us we aim to provide the highest standards of care and support you in your decisions regarding your treatment. We will respect your dignity, individuality and personal preferences.
Your care will be managed and given by therapeutic radiographers, doctors and nurses. You will meet both male and female healthcare professionals during the course of your treatment. If you have any concerns about this, please talk to the radiographers about it. We try to be sensitive to your needs, so please do not hesitate to discuss things with the team caring for you.
All individuals with internal reproductive organs (a uterus) of child-bearing ability (12-55 years old) will need to sign a form to confirm there is no possibility that you could be pregnant.
You must tell the staff immediately if there is any chance of you being pregnant at any time during your treatment. Individuals should not become pregnant for at least four months after radiotherapy treatment.
Individuals with external reproductive organs (testes) should not conceive a child for at least four months after radiotherapy treatment. All patients should use reliable contraception throughout this period. If you have any further questions or concerns about this please talk to your radiotherapy doctor, your specialist nurse or specialist radiographer involved in your care.
Dental appointments:
All take place in the Eastman Dental Hospital.
Chemotherapy:
Administered in the chemotherapy day unit on the second floor of the Macmillan Cancer Centre.
Radiotherapy appointments:
All take place in the Radiotherapy Department, basement floor, main UCH hospital building.
Proton Beam Therapy appointments:
All take place in the Proton Beam Therapy Department, floors B3 and B4, Grafton Way Building.
Radiotherapy is the specialised treatment of cancer (and some other diseases) using high energy radiation beams. These can either be x-rays (also called photons), electrons or protons. X-rays and electrons are delivered from a machine called a linear accelerator whilst protons are delivered from a machine called a cyclotron.
From 2021 University College Hospital Trust will have a proton beam therapy (PBT) service. However, it is not appropriate to treat all kinds of cancers or tumours with proton beam therapy. This will be decided by your clinical oncologist and discussed with you.
Radiotherapy works by damaging cancer or tumour cells in the part of the body being treated. The radiation stops the cells from dividing and growing. Radiotherapy can also damage nearby normal cells. The normal cells are more likely to recover from the effects of the radiation than the cancer or tumour cells. Doctors take great care to reduce the radiation dose to a person’s healthy cells.
Radiotherapy does not hurt, and it will not make you radioactive. You will be completely safe to be around family, friends and pregnant women. You will feel nothing from the treatment and the machine will not touch you. It is rather like having an ordinary x-ray. The most important thing is for you to lie very still for treatment.
A patient will normally receive their treatment as an outpatient, with a typical course lasting three to seven weeks attending Monday to Friday with weekends off. Your treatment schedule will be decided by your doctor and confirmed on your first treatment visit to the radiotherapy or proton beam department.
Before beginning radiotherapy, your treatment must be carefully planned. You may have several planning appointments.
Dental work
You will need to see our dentists at the Eastman Dental Hospital before your radiotherapy planning appointment. They will assess if you require any dental work before your radiotherapy planning scan. This is due to the increased potential of radiation damage to your teeth and jaw bones, which may affect the healing of any future dental work.
Your next appointment will be with our pre-treatment radiographers. This is to decide on the best treatment position for you. Most patients are treated lying on their back, with a headrest to support their neck and a sponge under their knees to help support their back. To ensure your treatment is accurate, you will have a personalised mask made of your head and neck. You will wear the mask each day during your treatment. The mask has three purposes:
- To help you keep still during your treatment
- To ensure you are in exactly the same position each day for treatment
- To prevent having to draw treatment marks on you, as they are drawn on the mask instead.
To make the mask, a thermo-plastic material is used which is hard when dry and is heated to allow it to soften. This is placed over your head and shoulders and held in position, for twelve minutes, until it begins to harden. After your mask has been made you will be taken to the CT scanner for a radiotherapy CT planning scan. This scan locates the exact area to treat in relation to surrounding normal tissue.
You will be positioned on the scanner couch lying on your back wearing your mask. The radiographers will mark lines on your mask. These will be used to ensure you are in the correct position each day for your treatment. The scan will take approximately five to ten minutes. You may need a cannula inserted into your arm to introduce some dye that shows up on the CT scan. If you need a cannula, the radiographers will explain what is happening before and during the process.
If you are having proton beam therapy you will also have an MRI whilst wearing your mask. The MRI scan takes a little longer than the CT scan but the radiographers will talk you through the process so you know what to expect.
You will feel nothing in either scan. All we ask is that you lie still and breathe normally. After the scan(s) is/are completed, you will be free to leave. Before you go, you will be given an appointment card with the date and time for your next visit, which will be your first radiotherapy treatment.
Treatment starts two to three weeks after your planning scan. The radiotherapy treatment is daily, Monday to Friday. Your radiotherapy doctor will have already told you how many treatments you will be having. The treatment radiographers will explain the procedure to you and answer any questions you may have.
For each treatment session you will be lying on your back, on the treatment bed, wearing your mask. The radiographers will ensure you are in the correct treatment position by aligning the marks on the mask with laser lights. They will then move the treatment machine and couch into position using your personal treatment plan. When final verbal checks have been made, the radiographers leave the room. To give you the best treatment you will be treated from several different angles.
The treatment machine will move around you, but will not touch you. You will not feel anything and you do not have to hold your breath. All we ask is that you keep still. The radiographers will be watching you at all times on a closed circuit television.
Treatment time is dependent on whether you are having radiotherapy with photons or with protons. If you are having photon treatment then each session takes approximately 15-20 minutes. If you are receiving proton beam therapy then the treatment may be a little longer and can last up to 45 minutes. The treatment radiographers will confirm with you how long the treatment is expected to take before they start.
Very occasionally, we may take you back to the CT scanner to make adjustments.
Rarely, we have to make a new mask in the middle of a course of treatment.
During treatment you will be seen twice a week in a special multi-disciplinary head and neck clinic. The clinics are attended by a doctor, nurse, speech and language therapist, dietitian and radiographer. Together, you will discuss any concerns you may have regarding your radiotherapy treatment. These may include pain control, nutritional advice, swallowing and communication advice, skin advice and support. You will be given a personal booklet to bring with you to the clinic in which you can write your experiences, questions and notes during your treatment.
Monday clinic: You will be seen by the specialist radiographer, review team and dietitian.
Thursday clinic: This clinic takes place on a Thursday morning and is scheduled around your treatment time. You will be reviewed by the dietitians, the speech and language therapist and a doctor.
Some patients will be given chemotherapy before and/or during their radiotherapy. The chemotherapy increases the activity of the radiotherapy against the cancer cells. Patients having chemotherapy in addition to radiotherapy/proton beam therapy may experience more severe or additional side effects to those listed here depending on the drug regime used.
With chemotherapy, there is a risk of infection known as neutropenic sepsis. If you feel unwell or have a temperature above 38 degrees please tell your team or call the UCLH 24 Hour Acute Oncology Number: 07947 959020.
You will be given detailed fact sheets about the chemotherapy drugs and their side effects by the chemotherapy nurses. If you have any concerns or questions, please speak to a member of staff.
Smoking during radiotherapy treatment
It is recommended that you should stop smoking not only during your radiotherapy treatment, but altogether. Continuing to smoke during treatment will worsen any side effects you may experience. Smoking has also been proven to decrease the effectiveness of treatment. Your specialist nurse will be able to offer practical support if you wish to stop smoking.
Side effects during treatment
Although you will not feel anything during treatment, there will be some side effects which will gradually appear during your course of radiotherapy. These effects will vary from patient to patient. There are side effects occurring during treatment, some happening soon after treatment, and some appearing months or years after radiotherapy.
The risk and severity of side effects occurring will depend on the dose of radiotherapy given and the exact area which receives the radiotherapy. Your doctor will discuss the risks of treatment with you before you sign a consent form. However, there will still be plenty of opportunity to talk about anything that you feel needs further discussion. The main side effects that occur during treatment are:
Skin changes
The skin in the area being treated will gradually change colour. Your skin will gradually become pink /red or darker, depending on your skin colour. You may get some dry peeling of the skin in the treatment area, which may become itchy. Some patients may experience peeling of the skin which can be sore.
During treatment we advise that you wash normally using warm water and the soap products you would normally use. Gently pat your skin dry with a soft towel.
Radiotherapy skin reactions cannot be prevented, but to minimise any skin irritation we recommend using a moisturiser of your choice. Use the moisturiser frequently and gently smooth it on to your skin until it is absorbed. You do not need to wipe the moisturiser off before treatment, but please do not apply moisturiser immediately before their treatment.
If your moisturiser starts to irritate your skin or your skin peels and is sore, stop using the moisturiser and let your team know. They will be able to provide an alternative product or refer you to the radiotherapy review team for appropriate skin care. If you do not currently use a moisturiser, then speak with your radiotherapy team and they will be able to suggest some options for you.
How can I help myself?
By following this advice, you may keep your skin in good condition and feel more comfortable. This only applies to the skin in the area being treated.
- Wear loose fitting, natural fibre clothing next to the skin. For example, a cotton T-shirt.
- Do not apply any cosmetics, perfumes, or aftershaves to the skin in the treated area.
- Avoid the use of plasters in the area being treated.
- Avoid rubbing or scratching the skin in the treatment area.
- Avoid extremes of temperature such as heating and cooling pads.
- Avoid sun exposure and protect the area from direct sunlight. You can wear a brimmed hat and/or cover up with clothing.
- Avoid wet shaving with a razor and shaving products. You may use an electric shaver for removing hair in the treatment area during your radiotherapy unless it is found to irritate the skin. Care should be taken not to ‘drag’ the skin too much as this could make the skin sore.
- Do not smoke. Smoking may reduce the effectiveness of treatment and can often make the side effects much worse. If you need help to stop smoking, please ask as we offer a stopping smoking service here.
- Try not to drink alcohol as this can also make the side effects worse.
Effects on the mouth
The cells lining the insides of the mouth and neck are very sensitive to radiation.
Some common problems you may experience during treatment include:
- Soreness and ulceration (also called mucositis) due to inflammation of the tissues. This usually begins 10 to 14 days into treatment and gradually increases in severity during the course of your treatment. It will be necessary to keep your mouth clean during treatment. The radiotherapy team will give you advice about mouth care during treatment.
- Dryness of the mouth due to radiation effects on the salivary glands. Radiotherapy can permanently damage the function of the salivary glands that are in the treatment area. This will be discussed with you before you start your treatment.
- Taste changes. This is due to the radiotherapy directly affecting the taste buds in your mouth, and the lack of saliva. You may find that certain foods will change in taste and, sometimes, you may lose your sense of taste completely. This can improve after treatment finishes, but it can be a long term problem. Your doctor will discuss this with you before treatment starts.
- Thick saliva. During treatment your saliva can get thicker and sticky. This can be worse in the mornings and can take some time to loosen and then remove. The production of thick saliva or mucus may also make you feel sick or vomit. If you are feeling sick, please inform the medical team as you can be prescribed anti-sickness medication.
- Infections due to lack of saliva. This can be seen as white patches on the inner surface of the cheeks or covering the tongue (oral thrush).
Eating and drinking
It is important that you try to eat a well-balanced diet during your radiotherapy treatment to help you feel stronger and more able to cope with treatment. If you are having treatment to your mouth and neck you may find that you have difficulty chewing and swallowing your food. The dietitian and speech and language therapist will advise you about your swallowing and nutrition issues.
It is also important to drink plenty of fluids during treatment, between one to two litres a day. This can include water, squash, or warm drinks. This will vary depending upon your individual needs. You will be advised accordingly by the team members. We suggest you avoid alcohol, particularly spirits. Please discuss alcohol with your doctor.
You may require a feeding tube to help support you through treatment. The dieticians will see you before starting radiotherapy to assess if this is necessary. The feeding tube will help you consume enough fluids and liquid food when it becomes too difficult to swallow.
Effects on your voice
If you are having radiotherapy to your throat, your larynx (voice box) will be in the treatment area. It is very likely that your voice will become hoarse during treatment. This can gradually worsen, and some patients may temporarily lose their voice.
It is advisable to rest your voice as much as possible during treatment. Do not strain your voice to make yourself heard. When your treatment has finished it may be a few weeks before your voice starts to recover, and in some cases, it may always remain husky. If your voice does not improve, you will need to see the speech and language therapist for voice therapy.
If you have had a tracheostomy (a breathing tube in your throat) or have had a laryngectomy (your voice box removed), your specialist nurse and the speech and language therapist will give you extra advice on how to cope during your radiotherapy.
Hearing problems
You may experience temporary hearing difficulties during treatment. There may be swelling in the inner ear due to the radiotherapy which can cause fluid to accumulate in the ear. You may also experience a hardening of the wax in your ears if your ears are in, or near, the area being treated.
If you have had chemotherapy, you may have tinnitus (ringing in the ears) or lose the ability to hear some high pitched sounds. Notify your doctor if you notice any loss of hearing or tinnitus.
Hair loss
Radiotherapy will cause hair loss in the treatment area. Hair loss usually occurs after two to three weeks of treatment. The hair usually starts to grow back about three months after treatment. However, hair might not grow back, or be “patchy” in the areas which have had a high dose of radiation. The doctors will advise you about this.
Feeling sick
Feeling sick is unusual during treatment, although some patients, particularly those who are receiving chemotherapy, may feel sick and sometimes be sick. This can be well controlled with anti-sickness medication. If you are experiencing any symptoms, please tell us.
Tiredness
Tiredness is a very common side effect of radiotherapy and proton beam therapy. You may feel more tired than usual and have less energy, both during and after treatment. Do not worry, this is normal. It is usually a combination of travelling to hospital every day, the side effects of treatment, coping with a diagnosis of a tumour and continuing with normal life.
We recommend that you listen to your body. Do as much as you feel you can and rest when you need to. However, gentle exercise has been found to improve fatigue levels in patients and we would recommend walking as a good form of exercise.
Please let someone know if you are finding things difficult, as they will be able to offer practical advice.
At your first treatment appointment the radiographers will discuss the treatment with you and explain any possible side effects you may experience. They will see you every day and ask how you are and how you are feeling. During treatment you will be assessed on a weekly basis by your clinical nurse specialist or specialist radiographer who will monitor your side effects and review your progress.
Late side effects incurred during treatment can appear to develop many months or years after radiotherapy has finished. They are the hardest to accurately predict and, unfortunately, when they do occur they are usually permanent. Your doctor will discuss the possibility of these late side effects with you, at the time you sign your treatment consent form. Possible late side effects may include:
Skin changes
Radiotherapy and proton beam therapy can cause changes of your skin and its underlying structures. Treatment can gradually turn soft, supple skin to skin that is hard and “woody”. It is more likely to happen if you have previously undergone surgery or chemotherapy. Good skin care, the use of water-based moisturisers and avoiding the sun can all help to minimise this.
Loss of taste sensation
Loss of taste can be a very distressing symptom. It can take many months for patients to recover their sense of taste after the end of treatment. However, a small percentage of patients may have a permanent loss of taste or altered taste perception.
Dental decay
Radiation treatment may cause tooth decay and discoloration due to a reduction in blood supply to the teeth. Treatment may also cause gum shrinkage causing further dental problems. If you require dental treatment, be sure to inform your dentist that you have received radiotherapy to the mouth.
Delayed healing
The jaw bone around your teeth may lose the ability to heal especially after trauma including tooth removal. Delayed or no healing of jaw bone is called osteoradionecrosis. The risk is reduced if teeth with poor health are removed from the mouth before treatment.
Dry mouth
Damage to the salivary glands can lead to reduced saliva production. Some patients experience the production of thick saliva/mucus that can be distressing as it can lead to nausea and vomiting. Saliva production usually improves over the months following treatment, but it may not return to normal entirely. There are artificial saliva replacements available from the chemist. Please ask your doctor or GP about their use.
Oral infections
Following treatment you may be more prone to fungal infections, such as thrush, in your mouth due to a lack of saliva. This will be worsened by poor dental hygiene. You may notice white areas on your tongue and/or the inside of your cheeks, and mouth ulcers. Please contact your GP who will prescribe a course of treatment.
Difficulty opening the mouth (trismus)
You may find it difficult to open your mouth wide and comfortably if you have had treatment to your jaw, tongue, or tonsils. This is due to the treatment affecting the large muscles that open the mouth.
The muscles can become stiff (fibrosed) if they are in the treatment area. This is called trismus. This may appear three to six months following radiotherapy. The speech and language therapist will recommend jaw-stretching exercises to help reduce or prevent trismus.
Decreased thyroid function
Radiotherapy to the neck can affect your thyroid gland, leading to an underactive thyroid. This reduces the level of thyroid hormone that regulates the body’s metabolism. It is important to have your thyroid function checked three to six months after your treatment has finished.
Pituitary function
For some patients, it may be necessary for the pituitary gland in the brain to receive a dose of treatment. You may experience changes in your normal hormone levels. This usually occurs a year or more after treatment. There is an increased chance that you may need pituitary hormone replacement therapy in the years following radiotherapy. The doctors will discuss this risk if it relevant to you.
Lymphoedema (swelling)
Swelling of the neck, especially under the chin, may persist for several weeks or even months after your treatment. Lymphoedema can be caused by surgery and radiotherapy/ proton beam therapy (which can damage the lymphatic drainage vessels). The swelling is often worse in the morning and feels like a lump under the chin. This condition is known as “dewlap oedema” and is a recognised side effect of treatment. Although “dewlap oedema” rarely causes any problems, many patients are worried that the swelling might represent a recurrence. If you are anxious, contact your specialist nurse or doctor. This condition usually resolves six months to a year after treatment.
Cataracts
The development of mistiness of the lenses of the eye can occur because of unavoidable radiation to the eye. This will be discussed with you before your treatment starts if your eye is near the area being treated. Cataracts usually develop five to six years after treatment. In many cases this will not have an effect on your vision. However, in a small number of cases, some people may require surgery to remove the cataract in later years. Fortunately, cataract surgery today is very straightforward and successful.
L’hermitte’s Syndrome
L’hermitte’s Syndrome, also called transient radiation myelopathy, can occur if your spinal cord is in or near the area being treated. The radiation can cause a temporary inflammation of the membrane surrounding the spinal cord. Within four to six weeks after the end of treatment you may experience tingling or “pins and needles” in your hands and feet. Very occasionally, L’hermitte’s Syndrome can cause jerking of your limbs. This is not a sign of serious nerve damage and recovers without treatment. These symptoms can take four to six months to settle.
Second malignancy
Very rarely, people who have received treatment for one particular tumour may develop another type of tumour in the treated area some years later. The radiotherapy doctors will discuss this risk if it is relevant to you.
Post-radiotherapy/proton beam therapy dental care
Following radiotherapy to your mouth, especially if your saliva production has been reduced, keeping your teeth and gums healthy is difficult. It is essential that you clean your teeth and gums carefully and regularly, particularly after food and drink. You should clean your teeth using fluoride toothpaste four times a day, and floss between your teeth daily. You should visit your dentist every six months and we would recommend seeing a dental hygienist between your dental appointments. You should inform your dentist, if they do not already know, that you have had radiotherapy to the mouth area. This is important if you ever need teeth removed.
This booklet deals with the physical aspects of your treatment, but your emotional wellbeing and that of your family is just as important.
Having treatment can be deeply distressing for some patients. Within the radiotherapy department there will be access and support from your specialist nurse, the specialist radiographer, the radiotherapy review team, the treatment radiographers and the Macmillan information and support team. However, if you feel you require further medical or emotional support you can be referred to a variety of health professionals who can help with any worries or difficulties you may be having.
All the staff are here to make sure your treatment goes as smoothly as possible and to support you through this difficult period. We will try to help you with any questions or problems you may have.
The side effects you may have experienced will continue after radiotherapy treatment has finished. It is common to experience a worsening of the skin reactions for about ten to fourteen days after radiotherapy. Some patients will continue to be seen in the Thursday on-treat clinic for two to three weeks post-treatment to manage your symptoms. They will then be discharged and seen as an outpatient in the Macmillan Centre. Some patients will be discharged back to their local referring centres for follow-up. A letter will be sent to your local district nurse and GP telling them what treatment you have received, what medication you are receiving on and what dressings, if appropriate, are needed.
Please feel free to contact your specialist nurse, your specialist radiographer or the radiotherapy or proton beam therapy department if you are worried about your treatment side effects.
My Oncologist is:
My Clinical Nurse Specialist (CNS) is:
CNS contact number:
Head and Neck Specialist Radiographer
t: 077909 14033
Proton Beam Therapy Reception
Proton Beam Therapy Review Team (via Proton Beam Therapy Reception)
Radiotherapy Reception
Radiotherapy Review Team (via Radiotherapy Reception)
Macmillan Information and Support Radiographer:
Out of hours oncology advice number (available 24 hours)
t: 07947 959020
If you have any concerns that you would like to discuss in confidence, please contact our PALS (Patient Advice and Liaison Service) for information and advice.
NHS Smoking Help Line
Head and Neck Cancer UK (HANCUK)
Changing Faces
Let’s Face It
Young Lives vs Cancer (formerly CLIC Sargent)
w: www.
Shine Cancer Support
t: 07804 479413
Macmillan Cancer Support
e: cancerline
Cancer Research UK
Carers UK
NHS Choices
w: www.
UCLH cannot accept responsibility for information provided by other organisations.
Page last updated: 03 July 2024
Review due: 01 June 2026