What is Chemotherapy?

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. This treatment is often given at the same time as radiotherapy or before radiotherapy is started. Chemotherapy drugs are used to treat a number of situations particular to head and neck cancer, including:

  • Treating cancer of the larynx (voicebox), oropharynx and hypopharynx where the aim is to preserve the anatomical function as much as possible
  • Treating head and neck cancers that have spread to multiple lymph nodes
  • Treating head and neck cancers that have spread to nearby nerve fibres in the head and neck region
  • Making sure that residual cancer cells are destroyed after surgery
  • Shrinking incurable tumors to prevent them from pressing up against normal tissues and causing pain or other complications

Types of Chemotherapy

There are many different types of drugs used for chemotherapy.  Some of them work by killing cancer cells that are rapidly growing.  Other drugs,  called angiogenesis inhibitors, work by stopping the flow of blood to tumors, essentially starving them of nutrients and preventing their growth. There are also chemotherapy drugs that are referred to as immune therapies because they employ special antibodies that can latch onto cancer cells and target them for destruction by the immune system.
Chemotherapy drugs can be delivered to patients via the blood (using drips, catheters, or pumps), via an oral route (pills or liquids), via injections (into muscles in arm, thigh, hip or fatty tissue of the arm, leg or belly) or topically (creams on the skin).

The type of chemotherapy drug used to treat your head and neck cancer will depend on the stage of the cancer, whether it has spread to nearby lymph nodes, nerves or other areas in the body, and your general health.  Your multidisciplinary treatment team will consult with you to explain which drug or combination of drugs will work best to treat your type of head and neck cancer.

Side Effects of Chemotherapy

Chemotherapy drugs kill cancer cells but they can also do not kill normal cells in the body that are dividing rapidly, especially those in the mouth and digestive system. The bystander damage to normal tissues that results can lead to a number of unwanted side effects, such as:

  • Mouth sores and ulcers
  • Changes in sense of taste
  • Tiredness
  • Loss of appetite
  • Hair loss
  • Nausea and vomiting
  • Infections
  • Loss of sensation in hands and feet
  • Ringing in the ears (tinnitus)
  • Skin damage (dryness and discolouration)
  • Infertility

Most of the side effects of chemotherapy are temporary and will disappear once the treatment is over, but the feeling of tiredness may take up to six months or longer to go away.

Preparation for Chemotherapy

Because chemotherapy tends to kill rapidly dividing cells in the mouth and digestive tract, it is very important to make sure that both these regions are in good health prior to receiving your treatment.

  • Seeing a dentist at least two weeks before chemotherapy will help with preparing your mouth and ensuring that it has time to heal after any dental work is completed.
  • Consulting with your physician about ongoing digestive problems (such as parasitic infections or chronic intestinal Candida) will help prepare your digestive tract for treatment.
  • Getting plenty of rest and mental preparation will help to put you in the best possible frame of mind before your treatment.

During Chemotherapy

The treatment schedule for chemotherapy will depend on many factors, including:

  • the stage of the cancer
  • the goals of the treatment
  • the type of chemotherapy drug used
  • how well your body responds to the treatment.

Typically, chemotherapy is given in cycles that are followed by longer periods of rest so that the body can recuperate and prepare for the next cycle of treatment. For example, a one-week cycle of treatment may be followed by a three-week period of rest.

Follow-Up Care

You will need to see your radiation oncologist and head and neck specialist about 3-6 weeks after you finish your chemotherapy treatment.  At that visit, they will let you know the outcome of the chemotherapy and discuss the long-term considerations.

Patients who have had chemotherapy treatments, alone or in combination with radiation or surgery, will need to be closely monitored for the rest of their lives. During regular check-ups your physician will evaluate your general health and assess whether the cancer treatments were effective. It may be necessary to have repeat blood tests and/or diagnostic tests to check for the recurrence of head and neck cancer. Your dentist will also monitor the oral cavity during regular dental check-ups.

Remember to monitor how your body feels so that you can let your physicians know during the regular check-ups about any changes that are worrisome, such as:

  • constant pains
  • unexplained weight loss
  • lumps, rashes, bruises, swellings, bleeding
  • fever, cough, or persistent hoarseness

Depending on the treatments needed, patients may also have to undergo a period of rehabilitation to help restore bodily functions. Various members of the multidisciplinary treatment team, such as physiotherapists or speech therapists, may be involved in your ongoing rehabilitation. These professionals will help you with swallowing or speech problems, and will also make referrals for community support upon your return home.