Chemotherapy for head and neck cancer: given with radiotherapy

For most people with head and neck cancer, chemotherapy is given through a drip into a vein at the same time as a course of radiotherapy. This is called chemoradiation. The chemotherapy is usually given once a week or once every three weeks during about six to seven weeks of weekday radiotherapy, so there are several chemotherapy days in total. Each session includes fluids before and after to protect the kidneys, along with anti-sickness medicines, and can take several hours. Less often, a few cycles of chemotherapy are given before chemoradiation or surgery to shrink a large tumour. For cancer that has spread or come back, chemotherapy may be given alone or with immunotherapy in cycles.

Chemotherapy is added to radiotherapy because it makes cancer cells more sensitive to radiation. It is commonly used when the cancer is larger or has spread to glands in the neck, either as the main treatment instead of surgery, or after surgery when the tissue report shows higher-risk features such as cancer at the edge of the removed tissue or spread beyond a gland. For some people, chemoradiation allows the voice box to be kept. Because the combination is intense, your team checks fitness, kidney function, hearing and teeth before starting. For people who cannot have the usual chemotherapy, a different medicine or radiotherapy alone may be recommended instead, after a careful discussion with you and your family.

The most typical effects come from the combination rather than chemotherapy alone. A painful mouth and throat usually builds from the second or third week and often peaks near the end of radiotherapy, making eating and swallowing hard. Many people lose weight, and some need a feeding tube for a period. Dry mouth, thick saliva, taste loss, sore red skin on the neck and deep tiredness are common. The chemotherapy itself can cause feeling sick, low blood counts, strain on the kidneys and changes in hearing, including ringing in the ears. Most mouth and throat effects improve over weeks to months after treatment, though dry mouth and taste changes can last longer.

Usually alongside radiotherapy

Weekly or three-weekly, over six to seven weeks.

It strengthens the radiation

Used as main treatment or after surgery for higher-risk cancer.

The mouth and throat bear the brunt

Pain, weight loss and dry mouth need planning and support.

It cannot tell you whether chemoradiation is right for your cancer. Your scans and tissue report decide that.

It also cannot predict how hard the weeks will be for you. Support makes a real difference.

Dental care before treatment

Radiotherapy to the mouth can make teeth and jaw bone fragile for life. A dental review before starting allows unhealthy teeth to be removed and healed first. Your dentist may advise fluoride care afterwards. Always tell future dentists that you had radiotherapy before any extraction.

Tobacco, gutka and alcohol

Continuing to smoke, chew tobacco or drink alcohol during treatment can worsen mouth soreness and may make treatment less effective. Stopping at any stage helps healing. Ask your team about support to quit, and involve family members who can help remove temptations at home and support you through cravings.

Eating well through treatment

A dietitian should see you before and during treatment. Soft, moist, high-protein foods such as dal, curd rice, khichdi, eggs and milk-based drinks are often easier. Weighing yourself every week helps your team act early if weight starts falling, rather than waiting until you are very weak.

Feeding tubes

A thin tube through the nose or a tube placed directly into the stomach can keep nutrition and medicines going when swallowing is too painful. Needing one is not a sign that treatment is failing. Most tubes are temporary and removed once swallowing recovers after treatment.

Swallowing exercises

A speech and swallowing therapist may teach exercises to keep throat muscles working during treatment. Continuing to swallow small amounts, even with a feeding tube, helps prevent the muscles from stiffening. Ask whether these exercises are part of your plan and practise them daily, even on difficult days.

Mouth care routine

Rinsing several times a day with a mild salt and baking soda solution, brushing gently with a soft brush and avoiding alcohol-based mouthwashes help keep the mouth clean. Avoid very spicy, sour or hard foods. Report white patches, which may be a fungal infection needing treatment.

Hearing checks

Some chemotherapy used in head and neck cancer can affect hearing, especially high-pitched sounds. A hearing test may be done before and during treatment. Report ringing in the ears, muffled hearing or difficulty following conversations, so your team can consider changes to the plan before the next chemotherapy day.

Protecting the kidneys

Painful swallowing makes it hard to drink, and dehydration strains the kidneys, especially with some chemotherapy medicines. Blood tests check kidney function before each chemotherapy day. If drinking becomes difficult, tell your team early, as extra fluids through a drip or a feeding tube may be needed.

Missing radiotherapy days

Unplanned gaps in radiotherapy can make treatment less effective, so try hard to attend every session. If you feel too unwell, contact the team rather than simply staying away. A chemotherapy day may be delayed for low counts while radiotherapy continues, and your team will explain any changes.

Throat cancers linked to a virus

Some throat cancers, particularly of the tonsils and back of the tongue, are linked to a common virus called HPV. These cancers often behave differently from tobacco-related ones. Your tissue report may show this, and your oncologist will explain whether it affects your treatment plan or your follow-up checks.

Longer-term effects

Months or years later, some people develop an underactive thyroid, neck stiffness, lasting dry mouth, swallowing difficulty or hearing loss. Regular follow-up with blood tests, dental checks and swallowing reviews helps catch these early. Neck exercises and good dental care reduce some of these problems.

Costs, travel and accommodation

Chemoradiation needs daily visits for several weeks, so families travelling from districts across Telangana often arrange accommodation nearby. Ask for a written estimate covering radiotherapy, chemotherapy, supportive medicines, feeding supplements and scans, and ask about insurance and government schemes that may help your family through the weeks of treatment.

What to do next

Book a dental review, meet the dietitian before starting, ask whether your chemotherapy is weekly or three-weekly, plan travel for daily visits, and learn which symptoms need a same-day call.