Supportive care for pharyngeal cancer

Supportive care helps with the physical, practical, emotional and spiritual challenges of cancer. This important part of cancer care focuses on improving quality of life for people with cancer and their loved ones, especially after treatment has ended.

Adjusting to life after treatment is different for everyone. Your recovery will depend on many different factors, such as where the cancer was in your body, the stage of the cancer, if all or part of the larynx (voice box) was removed, the type of treatment and side effects. If you have been treated for pharyngeal cancer, you may have the following concerns.

Self-esteem is how you feel about yourself. Body image is how you see your own body. They are often closely linked. Pharyngeal cancer and its treatments can affect your self-esteem and body image. Often this is because cancer or cancer treatments change your body in different ways, such as:

• scars
• skin problems
• changes to the shape of your face or neck
• having to use a prosthesis
• changes in body weight
• difficulty chewing, swallowing or speaking
• having an ostomy, such as a tracheostomy or gastrostomy

Some of these changes can be temporary. Others will last for a long time or be permanent.

But treatment can affect your self-esteem or body image even if it doesnʼt affect how you look. Other people may not be able to see changes to your body, but you may still worry about how they now see you. This may affect your confidence, or make you feel angry or upset, afraid to go out or worried that others will reject you.

Find out more about coping with body image and self-esteem worries.

Many people will have dry mouth (xerostomia) during and after treatment for pharyngeal cancer. Dry mouth may be worse with chemoradiation than with radiation therapy alone. Chemoradiation combines radiation therapy with chemotherapy. The 2 treatments are given during the same time period.

Dry mouth can make it hard for you to chew, swallow and talk. When it is very serious, it can affect your nutrition. Your healthcare team will check you for dry mouth and suggest ways you can prevent or manage it. A dietitian can also give you suggestions on how to have good nutrition when dry mouth affects your ability to eat.

Find out more about dry mouth.

Sore mouth and throat can include redness, swelling and painful sores on the tongue, gums, lips or throat. Sore mouth is also called stomatitis or oral mucositis. Chemotherapy drugs and radiation therapy to the head and neck area can damage the cells that line the mouth, pharynx and esophagus and cause you to have a sore mouth. When these treatments are given together as chemoradiation, soreness may be worse than with radiation therapy or chemotherapy alone.

Find out more about sore mouth.

If large parts of the tongue, jawbones, teeth, pharynx or palate are removed during surgery, you may have difficulty chewing and swallowing. Reconstructive surgery and rehabilitation can help you manage if you have difficulty chewing and swallowing.

Find out more about swallowing problems.

Sometimes, during surgery for pharyngeal cancer, parts of the tongue, soft or hard palate, jaw, voice box (larynx) and pharynx are removed. This causes problems with speech. Reconstructive surgery helps reduce problems with speaking. You may not get back to speaking exactly as you did before, but a prosthesis can be used to replace lost tissue and improve your ability to talk.

A speech-language pathologist (also called a speech therapist) can help you deal with changes in your voice and learning to speak again. They can also help you with swallowing problems.

Find out more about speech problems and treatments.

Radiation therapy to the head, neck or mouth may damage the salivary glands and taste buds, which can affect the way some foods taste. Surgery can cause taste changes if parts of the mouth, pharynx or tongue are removed. Chemotherapy drugs can also affect the taste buds.

If you’ve had chemotherapy, your sense of taste will usually return to normal after treatment has finished. But some people who have had surgery or radiation therapy find that their sense of taste is permanently changed.

Find out more about taste changes.

Dental problems such as a dry mouth or cavities can develop after pharyngeal cancer treatment, including surgery, radiation therapy and chemotherapy.

Good mouth care is very important to prevent problems during and after pharyngeal cancer treatment. A dental checkup is often done before treatment starts, while regular visits to the dentist are recommended after surgery, radiation therapy and chemotherapy.

Find out more about dental problems.

Trismus is a condition that makes it hard to open the jaw. It occurs when scar tissue forms in the jaw muscles or joint. Trismus can be caused by either surgery or radiation therapy for pharyngeal cancer. If a person has both surgery and radiation therapy, the risk of developing trismus is higher than if they had just one treatment.

Find out more about trismus.

If you have difficulty chewing and swallowing, as well as changes to your taste, you may lose your appetite. This can lead to poor nutrition and weight loss. You can take steps to help increase your appetite and have good nutrition. A dietitian can help you deal with loss of appetite. Your healthcare team may also recommend nutritional supplements.

You may be given a feeding tube to make sure you have good nutrition during treatment because some treatments for pharyngeal cancer can make it difficult for you to eat or drink.

Find out more about loss of appetite, tube feeding and eating well when you have cancer.

Both radiation therapy and chemotherapy treatments used for pharyngeal cancer can lead to hearing problems. You may have earaches or ringing in your ears. Radiation therapy can harden the wax in your ears, which could block the ear canal.

Let your healthcare team know about any problems or changes to your hearing that you notice during or after treatment for pharyngeal cancer.

Find out more about hearing problems.

The thyroid gland makes hormones that are important in the breakdown of certain nutrients, normal bone formation, regulating the nervous system and maintaining normal body temperature. Hypothyroidism means that the thyroid is not making enough hormones for your body.

Radiation to the neck and some surgeries for pharyngeal cancer can cause hypothyroidism. You will need to have blood tests to see how well your thyroid is working.

Find out more about thyroid problems.

Osteoradionecrosis is the death of bone caused by radiation. People who have had radiation therapy to the head and neck are at risk of developing osteoradionecrosis in the lower jaw. The risk is higher in people who do not have good oral health or who smoke and drink alcohol after treatment.

Find out more about osteoradionecrosis.

Treatment for pharyngeal cancer can cause physical changes to the head and neck, including scars, changes to skin colour, and problems with swallowing and speaking. You may worry that these changes to your body will make you less attractive to people.

Talk to your healthcare team if you have any concerns about sexuality. You may also want to talk to a counsellor if changes to your body image affect your intimate relationships.

Find out more about sex and intimacy when living with cancer.

People with head and neck cancers such as pharyngeal cancer often experience emotional distress. The cancer and its treatment may cause a change in appearance, interrupt their daily activities and lifestyle and prevent them from taking part in their usual interests. This can lead to delays in rehabilitation, which can cause more distress. Symptoms of emotional distress include worry, anxiety, fatigue, depression and changes in mood.

It’s important to tell your healthcare team about your feelings. They may give you medicines and help you find a counsellor who can help you work through your feelings. Talking to someone who has had the same cancer and treatments may also be helpful.

Find out more about talking about cancer and your emotions and cancer.

To make decisions that are right for you, ask your healthcare team questions about supportive care.