All first-time diagnosed NPC (nose) cancer patients will be required to undergo radiotherapy (RT) treatment. The cancer tumour responds very well to the RT and almost certainly removes the tumour at the end of the 33 sessions.
However, the RT comes with some heavy side effects during the treatment period. The body absorbs the cumulative rays of the 33 shots causing a bodily reaction. Although these side effects are short term during the course of the treatment, they cause wounds and pain to the head and neck region. It is therefore important to look at preventive and wounds management techniques to manage these side effects as best as possible with the aim of minimising discomfort and suffering to the patient.
There are four major side effects that a typical patient would normally contract during the course of the RT treatment. What I will be sharing is my own personal experience in managing them when I contracted nose cancer in 2003. I have since shared this with close to 200 patients whom I had handheld over the course of the six years that I had helmed the NCCS NPC Support Group. The success rate for the preventive and wounds management is pretty high and I hope this sharing will go some way to helping new cases manage their own. I will also touch on the medication that the doctors provide.
The 4 major side effects of RT during treatment
Before I commence, I would like to state that our bodies are different and what works for one may not necessarily work for another. Therefore, it is also advisable for new patients to consider other options or even experiment on their own to find their own success.
Loss of saliva
Normally within a week to about 10 days of the RT treatment, the patient will lose his saliva due to the RT rays which are directed at the two major salivary glands. This will result in a dry mouth leading to fungus growth due to poor oral hygiene and an uncomfortable feeling, unease in eating “dry” based food like rice, biscuits etc., and other associated problems.
Preventive and wounds management
The loss of saliva is temporary and I will share a little more of its return after the RT treatment in the paragraph below.
But during RT treatment, because the loss of saliva is something that we can never envisage, the physical act of not being able to eat “dry” and other foods that we are used to, can cause emotional trauma.
Unfortunately, there is no solution to getting the saliva back during treatment, nor has anyone so far managed to solve this problem. So we will have to live with the loss of saliva, which affects our food habits. Not easy but no choice. Until the saliva returns after treatment is over, the short term answer is to eat liquid-based food and drink plenty of fluids.
The saliva in the mouth for a normal person contains enzymes etc. to moisturise, manage the good and bad bacteria. With the temporary loss of saliva, this leads to oral hygiene problems. Even though you can brush your teeth after every meal and continue to do so, it will still result in a fungus attack. It is not due to the lack of oral hygiene effort of the patient but due to the loss of saliva. For a temporary stopgap measure, the patient may wish to consider using artificial saliva during the treatment period. There are many brands of artificial saliva found in the pharmacy. For the treatment of mouth fungus, the doctor will usually prescribe a course of medication.
Some percentage of saliva will return after the RT treatment. The amount will depend on the individual, anything from 10 per cent to 70 per cent. The time taken for its return could be weeks to more than a year. At the end of the day, all patients and survivors will suffer a certain amount of loss of saliva which will be life-long. So we will need to learn how to live without saliva, something that many survivors have developed their own technique for, and shared at our monthly NCCS NPC Support Group talk.
Change in taste and loss of taste
With the loss of saliva comes a change, and later complete loss of taste. Again, although this is a temporary loss, it does affect one’s mood and appetite, and even causes emotional anxiety. I believe no one has ever envisaged losing their taste, and that they can continue to eat without any taste. The good news is that the taste will return after treatment is over. When it returns again depends entirely on the rate of recovery. There should not be a drop in the taste once it returns.
Preventive and wounds management
There is really no solution for the temporary loss of taste. The only way to deal with this is a mind over body attitude – Just swallow the food. The body needs to be strong in order to withstand the harsh effects of radiation treatment over the next seven weeks of 33 RT shots.
Although I can empathise with new patients on their change and loss of taste resulting in poor appetite etc, there is no solution to the problem. We need to eat in order that the body can take in nourishment. It is normal for a patient to lose between 6 – 8kg of body weight during the RT treatment. In bad cases, the loss of weight can go as high as between 15 – 25 kg. This will lead to other issues and complications, compounding the problem further.
The doctors will usually ask patients to drink milk-based foods like Ensure, Prosure etc., prior to the start of RT treatment to build up the body. Personally, I prefer that one should continue to eat normally, and perhaps eat more than the usual quantity in order to achieve the same outcome. To me nothing beats regular meals. Milk-based foods should only come into the picture when one contracts mouth and throat ulcers which would then diminish the ability of the patient to eat well.
Mouth and throat ulcers
This is the most fearful and painful period for the patient if one contracts mouth and throat ulcers during the course of the RT treatment. The whole mouth and throat is covered with ulcers causing intense physical pain to the person each time he swallows fluid and food. This is definitely the worst one can expect in the RT treatment.
Because of the pain, the patient avoids eating, resulting in an accelerated loss of appetite and weight with bad and foul moods as no one, and nothing he can do, will take away the pain. So I always alert, warn and encourage new patients that they have to be very careful and do their best to avoid the onset of the ulcers.
Preventive and wounds management
The ulcers are caused by the heatiness build-up in our body due to the seven weeks of RT. It has nothing to do with the cancer. To the Chinese, they understand this as “poo juah” – or simply the body is heaty.
Prior to and during the RT treatment period, I always emphasise to patients to drink plenty of cooling fluids. They include but are not limited to “leng yang”, chrysanthemum green bean soup and even Chinese herbs to manage the heatiness. This is the first but very important step to prevent the ulcers from coming on.
Secondly, I have during my treatment time in 2003 discovered that manuka honey can also help to prevent the ulcers from coming on, including healing early stage ulcers. More details are available in my other article (see the link below) which is posted in our support group website. So far, more than 60 per cent of patients that I have handheld have benefitted from it.
The doctors will usually prescribe Panadol tablets to numb the mouth area and provide the window of opportunity for the patient to eat. In more severe cases of ulcers, the doctor will change it to a morphine patch to improve the numbness. These are just short-term pain management measures and do not do anything to heal the ulcers.
Therefore, it is in the interest of all patients to do their utmost to prevent the ulcers from coming on. Without the ulcers, the pain of the RT treatment is significantly removed allowing one to go through it with minimal discomfort.
The cumulative doses of RT can cause neck burn. The first sign usually comes after about a week when some redness appears on the neck area where the RT rays are directed. Within the next few days, the skin of the neck will tear, exposing an open flesh. This will lead to infection with yellow pus and much discomfort. When the skin has dried, it will turn dark brown/black, somewhat similar to a burnt BBQ.
Preventive and wounds management
Neck burn is highly preventable. During the course of my own treatment in 2003, I found that applying a liberal amount of aloe vera daily over the neck area will prevent the neck burn. The natural plant of the aloe vera contains properties to prevent and heal burns and cuts. Whilst I often encourage new patients to purchase the American aloe vera for its gel, some have also used the commercial aloe vera products. More details again in the same web article (see link below). So far, more than 90 per cent of patients that I have handled have benefitted from it.
The doctors will usually prescribe QV cream or something similar to treat the neck burn. But this is usually offered after the burn has appeared which is too late. Therefore it is best to prevent it from happening at the outset.
Other side effects and Issues
Other side effects include temporary hair loss and a droning sound in the ear. Other issues relating to the treatment include emotional stress of the patient and family members, in particular the female spouse and caregiver.
Should you need further clarification on the subject or wish to speak or meet with me to find out more about the side effects and their management, please do email me at
firstname.lastname@example.org. I will be glad to meet with you and your family members to share my own experience, and the collective experiences of the Support Group.
Contributed by:-Teo Thiam Chye (TC)
NPC Survivor since 2003
About the Author
Calling himself a Nose Cancer Ambassador, Thiam Chye (TC) aims to de-mystify nose cancer by encouraging all survivors to share their personal experiences in their fight against cancer to enable new patients to undergo their treatment with courage and minimal pain, and to lead a better quality of life on recovery. Should you wish to join the support group in its activities or need guidance on this article, please email him at
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