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

During your treatment for laryngeal 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 laryngeal 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 that 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 enough oxygen, you may feel tired. Decreased red blood cell counts can be caused by small amounts of blood loss due to bleeding, by chemotherapy or 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. There are medications that can improve your red blood count.

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.

• You may decide to get counseling to help you deal with these feelings.

Appetite loss

Eating well during cancer treatment can help you maintain your strength, stay active, and lower your chance of infection. When you're being treated for cancer, a diet high in calories and protein is best. Side effects of treatment can change the way food tastes to you or reduce your appetite. In addition, treatments to your throat may make it difficult 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 your body 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 and set up a daily menu for you. A nutritionist can also advise how to add extra calories to foods that you already eat and enjoy.

• 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. Supplements can also help get more calories into your body.

• 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 your fluid intake: gelatin, pudding, soups, Popsicles, and ice cream.

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

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

• Keep snacks handy to eat when you are hungry and even if you are not hungry.

• Eat with friends or play your favorite music at mealtime to boost your appetite. Small amounts of spices can boost your appetite and caloric intake.

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

• If you can, increase your activity level. Light exercise is best. 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.

Bleeding

If you have problems with bleeding that won't stop or bloody noses, see Thrombocytopenia below.

Bloating and swelling

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

• Ask your health care team for suggestions on ways to ease facial swelling.

• Elevate the area that is swollen for temporary relief. Sleep with your head higher with more pillows to reduce facial swelling. Keep your legs up to reduce leg swelling. Compression stockings can sometimes help. Ask your doctor or nurse if they can help you.

• Some people find massage and physical therapy helpful for swelling. Ask your doctor if this may 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 cut through your neck and into your trachea (windpipe) to help you breathe. This procedure is known as a tracheostomy. The hole (which is called a stoma) 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 your stoma, if you have one. He or she can also give you suggestions for how to keep the airway open and clean.

Chewing, swallowing, or talking difficulties

The tumor itself, the surgery to remove the tumor, and chemotherapy or radiation therapy may all 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 laryngeal cancer.

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

• Work with your health care 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 (percutaneous endoscopic gastrostomy) tube, that can be used for food, water, and medicines if you have serious trouble eating and drinking. Feeding tubes are usually temporary, 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 an esophageal stricture. Special tests, such as an evaluation by a speech and swallow therapist or a video swallow study, or both, can help identify this problem. If identified, an esophageal stricture can often be corrected by a dilation procedure to help widen the narrowed area.

Constipation

Constipation leads to difficult or infrequent bowel movements. It can range from mildly uncomfortable to painful. Taking pain medications can lead to constipation, so it's wise to take these preventive 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.

Diarrhea

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

• Avoid milk and milk products.

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

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

• Tell your doctor if you are having more than three loose bowel movements per day.

• 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 that 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.

• Some doctors advocate an ice-filled cap during chemotherapy. This decreases the amount of chemotherapy reaching your scalp and may decrease hair loss. Speak to your doctor about whether this is a good idea in your situation.

Increased infections

If you are having more infections than usual, you may have a lowered white blood cell count. See Neutropenia below.

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 bedroom only for sleeping, not for 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.

• Occasionally, sleep medicines may help but they should be taken only under medical supervision.

Mouth dryness (xerostomia)

Radiation to your larynx can cause changes in your saliva and in the amount of saliva you produce. Because saliva protects your teeth, tooth decay and chronic dry mouth can be a problem after treatment. 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 the 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 the mouth fresh and help protect your teeth from decay.

• Use a fluoride toothpaste, a fluoride rinse, or both to reduce your risk for 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 and radiation. These sores may hurt and make eating an unpleasant experience.

To prevent sores in your mouth, take these actions:

• Brush your teeth after meals and before bedtime.

• Rinse your mouth with lukewarm water plus salt, hydrogen peroxide solution, 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 and can make your cancer more difficult to treat.

• Ask your doctor about topical mouth medications. Your doctor or nurse may suggest a special rinse to numb your mouth and reduce discomfort.

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

• Call your doctor or nurse if your temperature reaches 100.5 degrees 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. This occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be five to six hours after treatment, and the symptoms end within the first 24 hours.

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

• Anticipatory nausea and vomiting. These 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. This occurs despite treatment to prevent it. It requires additional treatment.

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

Your doctor will prescribe medication for nausea. Most nausea can now be prevented or successfully treated with medication.

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.

• 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 had the flu or were nauseated from stress. These may be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

• 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)

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 blood 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 or higher, severe chills, a cough, pain, a burning sensation during urination, or any sores or redness.

• There are medications that can prevent or treat low white cell counts. Speak to your doctor about them.

Pain

Pain may be from the tumor, from the surgery, from radiation, 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 though, 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 (such as yoga or meditation), or guided imagery exercises. Ask your doctor or nurse where you can learn more about these.

Sexuality and reproductive issues

Chemotherapy and the stress of dealing with cancer can affect 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 with 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. Good skin care is important at this time. Your doctor or nurse will show you how to keep the area clean. Also, follow these tips for protecting your skin:

• Leave your skin open to the air, but covered from the sun.

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

• Only use lotion or cream with advice from your doctor or nurse. Ask what kind of lotion you can safely use to moisturize and soothe your skin. Don't use any lotion, soap, deodorant, sunblock, cologne, cosmetics, or powder on your skin within two hours after treatment because they may cause irritation.

• Wear loose, soft clothing over the treated area. Don't wear clothes that rub the 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.

• During radiation, hair usually does not grow in the treated area; if it does, men should not shave.

• Keep your nails well trimmed and clean so that you don't unintentionally harm your skin.

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 doctor's visits with you--an extra person along for the visit can help remember detailed information you receive.

If you have trouble remembering information, such as names, directions, and task sequences, be certain to let your medical provider know, and ask what can be done to help improve your cognitive health. Cognitive interventions may be especially important after treatment ends. 

Thrombocytopenia (low platelet 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 platelet levels. Many types of chemotherapy can cause low platelet levels, as can the cancer itself. Low platelet levels is called thrombocytopenia. Without enough platelets, your blood may not be able to clot properly.

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.

• Use a soft toothbrush to prevent bleeding gums.

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

• Call your doctor if you develop a rash or bleeding, or you bruise easily.

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

Tiredness

Tiredness is a very common symptom and 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. Resting is important, but doctors usually tell people to try to stay as active as they can. Finding a balance between rest and exercise is a good idea:

• Take action to treat a poor appetite because eating improperly can make you even more 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 the tips under Anemia above.

• Rarely, your doctor may prescribe a stimulant or other medication that can help with fatigue.