Chemotherapy for head and neck cancer is used in conjunction with supportive care for most patients with metastatic or advanced recurrent head and neck cancer. The choice of specific systemic therapy is influenced by the patient's prior treatment with chemotherapeutic agents and the general approach to preserve the effected organs. Supportive care includes the prevention of infection due to severe bone marrow suppression and the maintenance of adequate nutrition.
Therapeutic options include treatment with a single agent and combination regimens with conventional cytotoxic chemotherapy and/or molecularly targeted agents, combined with optimal supportive care. Chemotherapy is given in cycles, alternating between periods of treatment and rest. Treatment can last several months or even longer.
Enclosed is a link to a site that lists all the chemotherapeutic agents and their side effects.
Chemotherapeutic drugs which are usually given
intravenously, work throughout the whole body by disrupting cancer cells’
growth. Chemotherapy for the treatment of head and neck cancers is usually given at the same time as radiation therapy and is known as chemoradiation. It can be given as adjuvant chemotherapy or as neoadjuvant chemotherapy.
Adjuvant chemotherapy is used for treatment after surgery to reduce the risk of cancer returning, and to kill cells that may have spread.
Neoadjuvant chemotherapy is administered before surgery to shrink the size of the tumor thus making it easier to remove..
Adjuvant chemotherapy is used for treatment after surgery to reduce the risk of cancer returning, and to kill cells that may have spread.
Neoadjuvant chemotherapy is administered before surgery to shrink the size of the tumor thus making it easier to remove..
Chemotherapy drugs
Chemotherapy administered prior to chemoradiation treatment is known as induction chemotherapy.
Side effects of chemotherapy
The kind and type of possible side effects of chemotherapy depend on the individual. Some have few side effects, while others have more. Many individuals do not experience side effects until the end of their treatments; for many individuals, these side effects do not last long.
Chemotherapy can, however, cause several temporary side effects. Although these may be worse with combined radiation therapy, they generally disappear gradually after the treatment has ended.
Chemotherapy can, however, cause several temporary side effects. Although these may be worse with combined radiation therapy, they generally disappear gradually after the treatment has ended.
Side effects depend on the chemotherapeutic agent(s) used. These occur because chemotherapy drugs work by killing all actively growing cells. These include cells of the digestive tract, hair follicles, and bone marrow (which makes red and white blood cells), as well as the cancer cells.
The more common side effects are nausea, vomiting, diarrhea, sores (mucositis) in the mouth (resulting in problems swallowing and sensitivity in the mouth and throat), increased susceptibility to infection, anemia, hair loss, general fatigue, numbness in the hands and feet, hearing loss, kidney damage, bleeding problems, malaise, and balance problem. An oncologist and other medical specialist watch for and treat these side effects.
The more common side effects are nausea, vomiting, diarrhea, sores (mucositis) in the mouth (resulting in problems swallowing and sensitivity in the mouth and throat), increased susceptibility to infection, anemia, hair loss, general fatigue, numbness in the hands and feet, hearing loss, kidney damage, bleeding problems, malaise, and balance problem. An oncologist and other medical specialist watch for and treat these side effects.
The most common side effects include:
Lowered resistance to infection
Chemotherapy can temporarily reduce the production of white blood cells (neutropenia), making the patient more susceptible to infections.
This effect may begin about seven days following treatment and the decline in resistance to infection is maximal usually about 10–14 days after chemotherapy has ended. At that point the blood cells generally begin to increase steadily and return to normal before the next cycle of chemotherapy is administered. Signs of infection include fever above 100.4°F (38°C) and or a sudden feeling of being ill. Prior to resuming chemotherapy blood test are performed to ensure the recovery of the white blood cells has occurred. Further administration of chemotherapy may be delayed until recovery of blood cells has taken place.
Electron microscopy of Staphylococcus aureus
Bruising or bleeding
Chemotherapy can promote bruising or bleeding because the agents given reduce the production of platelets which help the blood clotting. Nosebleeds, blood spots or rashes on the skin, and bleeding gums can be a sign that this has occurred.
Skin bruising
Nose bleeding
Anemia
Chemotherapy can lead to anemia (low number of red blood cells). The patient generally feels tired and breathless. Severe anemia can be treated by blood transfusions or medications that promote red cells production.
Red blood cells
Hair loss
Some chemotherapy agents cause hair loss. The hair almost always grows back over a period of 3-6 months once the chemotherapy has ended. Meanwhile, a wig, bandana, hat or scarf can be worn.
Sore mouth and small mouth ulcers
Some chemotherapy agents cause sore mouth (mucositis) which can interfere with mastication and swallowing, oral bleeding, difficulty in swallowing (dysphagia), dehydration, heartburn, vomiting, nausea, and sensitivity to salty, spicy, and hot/cold foods. These agents can also cause chemotherapy-related oral cavity ulcers (stomatitis) that result in eating difficulty.
Nausea and vomiting can be treated by anti-nausea (anti-emetic) drugs. Regular mouthwashes can also help. These side effects can impact swallowing and nutrition. Accordingly, it is important to supplement one’s diet with nutritious drinks or soups. A dietitian's advice may be helpful to maintain adequate nutrition.
Nausea and vomiting can be treated by anti-nausea (anti-emetic) drugs. Regular mouthwashes can also help. These side effects can impact swallowing and nutrition. Accordingly, it is important to supplement one’s diet with nutritious drinks or soups. A dietitian's advice may be helpful to maintain adequate nutrition.
The cytotoxic agents most often associated with oral, pharyngeal, and esophageal symptoms of swallowing difficulty (dysphagia) are the antimetabolites such as methotrexate and fluorouracil. The radiosensitizer chemotherapies, designed to heighten the effects of radiation therapy, also increase the side effects of the radiation mucositis.
Tiredness (fatigue)
Chemotherapy affects different individuals in different
ways. Some people are able to lead a normal life during their treatment, while
others may find they become very weak and tired (fatigue) and have to take
things more slowly. Any
chemotherapy drug may cause fatigue. It can last for a few days or persists
through and beyond completion of treatment. Drugs such as vincristine, vinblastine,
and cisplatin often cause fatigue.
Factors that contribute to
fatigue are anemia, decrease food and liquid intake, medications,
hypothyroidism, pain, stress, depression, and lack of sleep (insomnia) and
rest.
Rest, energy conservation, and correcting
the above contributing factors may ameliorate the fatigue.
