Ask CancerCare

A. Depending on exactly where you receive radiation, a number of side effects can occur either on a temporary, long-term, or delayed basis. They include changes in sensation (the ability to feel), secretions (dry mouth), taste, and range of motion (when tissue hardening restricts movement and posture). These side effects can then affect key physical functions associated with the mouth and throat, such as speech and, especially after radiation, swallowing.

Whether these side effects turn into a chronic condition (or lead to other problems) often depends on how soon they are recognized and treated. Certain measures such as dental care can be taken before treatment begins to reduce—if not outright prevent—long-term side effects. A publication from the National Cancer Institute, Oral Complications of Chemotherapy and Head/Neck Radiation, provides an overview of possible treatment side effects and how to manage them.

Other helpful resources include these CancerCare podcasts:

• Medical Update on Head and Neck Cancer
• Dental Health During Cancer Treatments
• Coping with Cancer Pain: What You Need to Know

For more on how to cope with the side effects of treatment, please read on.

A. There are a number of changes after treatment similar to what you've described, some of which can be permanent. Rehabilitation, however, can ease the side effects of treatment, and there are ways to cope with these effects over the long term.

Given the complexities of treating head and neck cancer, a team approach which utilizes a variety of different specialists is essential to minimizing the complications and maximizing the chances for recovery. In addition to the treating physicians—an oral or ear, nose and throat surgeon, a medical and/or radiation oncologist, a plastic surgeon, prosthodontist, and a dentist among them—a number of other health care professionals can assist with your recovery. These other team members include dietitians, social workers, nurses, physical therapists, and speech-language therapists.

Check with your surgeon regarding the loss of feeling on the side of neck. While nerves may have been cut in the area during the node dissection, you should not rule out at least some sensation returning over time. Have your taste and swallowing problems evaluated using tests such as the modified barium swallow (a kind of x-ray) or fiberoptic endoscopy. A speech-language pathologist can provide advice and guide you with therapeutic exercises to improve swallowing ability. There are also medications (both prescription and over the counter) that can help with saliva problems and dietary changes (such as avoiding foods that are made up of small particles) to ensure you continue to obtain sufficient nutrition.

CancerCare provides helpful tips for coping with dry mouth and swallowing problems in our booklet, Advances in the Treatment of Dry Mouth . Consider joining a peer support group at your local medical center or through a national advocacy organization such as Support for People with Oral and Head and Neck Cancer (SPOHNC), which also offers a variety of publications related to oral and head and neck cancer survivorship.

A. With any symptoms, it is necessary to check with your doctor in order to properly diagnose a medical condition, of cancer or any other condition. Normally, cancers that start in the neck are grouped with cancers of the head (primarily the mouth, nose, and throat). The warning signs of head and neck cancer include:

• Painless white patch or red patch in the mouth
• Hoarseness or change in voice
• Sore throat
• Painless lump in the mouth or neck
• Difficulty chewing, swallowing or breathing
• Frequent nosebleed, particularly on one side of the nose
• Hearing loss or ear pain, particularly in one ear
• Blood in saliva or phlegm
• Weight loss or fatigue

This list of symptoms worrisome for head and neck cancer is drawn from the CancerCare booklet, A Team Approach to Treating Head and Neck Cancer . This booklet also contains information about the risk factors associated with head and neck cancers, particularly tobacco and alcohol use. Each year, more than 35,000 people develop head and neck cancer in the United States. However, only through physical examination and by performing various diagnostic tests, including tissue analysis, are doctors able to confirm a diagnosis of cancer with certainty.

As with many cancers, the earlier it is diagnosed, the better the chances for successful treatment. While your neck and shoulder pain may not fall under the usual warning signs of head and neck cancer, you should see your doctor for a full examination and to rule out any major illness.

A. I am sorry that your brother has to wait for more definitive information about what may be an advanced head and neck cancer. As difficult as waiting may be, however, it is essential that the medical team have as full a picture of his cancer as possible, to help them — and more importantly, your brother — understand what the treatment options are. There are different types of oral, head, and neck cancers: cancers of the oral cavity (including the lips, gums, and hard palate), the nasal cavity and sinuses, the salivary glands, the larynx (or voice box), and the pharynx and hypopharynx (different parts of the throat).

For a number of these cancers, treatments have improved, resulting in better quality of life and survival rates. Some of these improved treatments are summarized in our Connect booklet, Head & Neck Cancer: Your Guide to the Latest Research and Treatments (Highlights from ASCO 2008) . Besides treatments specific to certain types of head and neck cancers, there is a whole new class of treatments called targeted treatments that are now being applied to head and neck cancers with promising results. For more about these investigational treatments, and access to them through clinical trials, see the CancerCare booklet, A Team Approach to Treating Head and Neck Cancer .

At 51, your brother is on the younger side for people with head and neck cancer, a factor which could work in his favor when estimating his ability to tolerate treatment and the likelihood of a successful outcome. But statistics provide only a limited view of what the future may hold in store for your brother. It will be important for his medical team to review his very individual cancer situation and medical history before they, or anyone else, can predict how all this will turn out.

As you and your brother work with his doctors to have this conversation, it may be helpful to review our publications with tips on facilitating communication with the healthcare team, such as "Doctor, Can We Talk? Tips for Communicating with Your Health Care Team" . You can also prepare by reading some basic information pertaining to head and neck cancer (how it is diagnosed and treated) to help you create a list of questions to ask the doctors:

• The National Cancer Institute's "Head and Neck Cancer: Questions and Answers"
• The American Society of Clinical Oncology's "Head and Neck Cancer"