Proton Therapy for Head and Neck Cancers

For patients with complex head and neck tumors, proton therapy allows us to treat the tumors effectively while minimizing the radiation dose to vital structures such as the eyes, mouth, and brain. That means a patient’s vision, smell, taste, and swallowing may not be affected by proton therapy. It also means side effects such as nausea, severe dry mouth, difficulty swallowing, loss of taste, and thyroid dysfunction are not as severe with proton therapy.

But some head and neck cancer patients will experience skin irritations, mouth sores, sore throat and painful swallowing due to the tumor and treatment location. 

As nurses at MD Anderson Proton Therapy Center, we get a lot of questions from head and neck cancer patients and caregivers about managing these proton therapy side effects. Here’s how we answer some of the most common ones.

How do I deal with skin irritations from proton therapy?

We recommend that patients wash the affected skin daily with mild moisturizing soap to cleanse. Use an unscented moisturizer starting on the first day of treatment. Do not use anything abrasive on the skin, and avoid wearing shirts with collars. Use an electric razor, and avoid aftershaves or perfumes. Do not apply makeup to the affected area and avoid direct sunlight.

Why is oral care important during proton therapy?

Oral care is important during and after treatment. Mouth sores can become infected, so practice good oral hygiene and tell your care team about any symptoms. Use baking soda and salt rinses four to six times a day. This helps the PH balance and reduces bacteria in your mouth. Brush your teeth with a soft toothbrush after every meal and at bedtime. Avoid commercial mouthwashes that contain a large amount of salt or alcohol.

Also be sure to perform the jaw and neck exercises as instructed by your medical team. These exercises will help with stiffness or tightening of the jaw and neck, mouth opening challenges, and difficulty chewing.

How do I avoid unwanted weight loss?

Many cancer patients lose weight unexpectedly because they struggle with nausea or cannot eat well during treatment. Proper nutrition can help you maintain your weight and hydration, which helps ensure successful treatment results. Good nutrition will also improve your quality of life during and after cancer treatment.

Eating soft, moist foods and avoiding anything that irritates your mouth, such as spicy, rough, acidic, extreme temperatures, or carbonated drinks. If you’re having trouble eating, you may want to try meal replacement drinks like Boost and Ensure. It's also important to talk to your doctor about any vitamins, nutritional or herbal supplements you're taking. 

You should also avoid drinking alcohol or using tobacco products, as these habits can increase treatment side effects.

How can I prevent dry mouth?

Dry mouth can make eating, speaking, and sleeping more difficult. Without saliva, patients also run the risk of increased bacterial growth, bone infection, and nutritional deficiencies.

You can avoid dry mouth by chewing sugar-free gum, over-the-counter saliva substitutes, and staying hydrated. It also helps to swish a baking soda/water solution around your mouth a few times a day. It may be beneficial to sleep with a cool-mist humidifier next to your bed during and after treatment as well.

How can I reduce fatigue?

Fatigue is a normal and often expected side effect of cancer treatment. Try taking naps earlier in the day so that you don’t disrupt your sleep pattern.

Some patients find their fatigue improves with light exercise such as walking. Be sure to check with your care team before starting a new exercise routine.

What can I expect after proton therapy for head and neck cancers?

Side effects from proton therapy may continue or even increase for two to three weeks after treatment for head and neck cancer patients. Be sure to continue the regimen your care team recommends for caring for your mouth, throat, skin, and maintaining proper nutrition. It usually takes four to six weeks for your body to heal after proton therapy.

Remember, your care team is here for you and will provide resources and specific product recommendations for your side effects. Be sure to follow them. The patients that do the best are those who get ahead of their side effects.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

When I first noticed what I thought was a swollen lymph node on the right side of my neck, I thought it was just an infection coming on. It didn’t hurt, but it was swollen.

The swelling went down a few days later and then would swell back up again. It did that for the next few months. By March 2020, it had not gone away, but due to the COVID-19 pandemic, I put off going to the doctor.

In June, I requested an ultrasound from my primary care doctor, followed by a biopsy and PET scan. They all came back negative. My ENT did notice a mass on the CT scan, and suggested that we watch and wait. Instead, I contacted MD Anderson for a second opinion.

Getting answers from MD Anderson’s Suspicion of Cancer Clinic

I chose MD Anderson because it’s ranked No. 1 in the nation in cancer care. We’ve lived all over the country, and every story that I’ve heard about MD Anderson always reiterated this reputation. I love my life and want to keep living it. I knew MD Anderson was the place I needed to be to do that.

I called to make my first appointment. The health information specialists helped me start the appointment process.

I flew to Houston from El Paso, Texas,  and moved into a furnished apartment. I had my first appointment on Sept. 17 with Dr. Gloria Iliescu at MD Anderson’s Mary Ann Weiser Suspicion of Cancer Clinic. Dr. Iliescu was calming and wonderful – exactly what’s needed in a doctor. She went above and beyond to set up my following appointments quickly and kept me updated.

My diagnosis: HPV-related head and neck cancer

After several tests and scans, my head and neck surgeon Dr. Neil Gross explained to me that I had a HPV-related head and neck cancer called oropharyngeal squamous cell carcinoma. Dr. Gross then reassured me he would cure me, not just put me in remission.

Dr. Gross and his physician assistant, Justin Sellers, were amazing. Dr. Gross answered every question I had and encouraged me to ask him anything.

I then met with my medical oncologist, Dr. Charles Lu, who explained everything in a way I could understand. Nurse Rosheer Seymour went out of her way to check on me. My radiation oncologist, Dr. Jay Reddy, was my rock and ended up being the physician I saw the most.

Dr. Gross and the tumor board decided that they could cure me with only chemotherapy and proton therapy. Surgery was not needed. Proton therapy would cause the tumor to disintegrate or, as my 11-year-old son said: “Blow up like the Death Star in Star Wars.”

Proton therapy is well-suited for patients with complicated tumors of the head and neck since it precisely paints the protons onto the tumor layer by layer. The treatment team can confine the tumor-damaging energy to target areas and work to protect normal structures such as the oral cavity and brainstem. This also helps keep side effects to a minimum.

My treatment for oropharyngeal squamous cell carcinoma

My mom flew in from Florida to stay with me at the apartment through treatments. This allowed my husband and son to remain at home in El Paso, so his schooling wasn’t disrupted. My sister also flew in to be with me. Having my family’s support in Houston was exactly what I needed to face cancer treatment in the best possible way.

I began proton therapy on Nov. 9, and my first round of chemotherapy was the following day. I received 33 daily proton therapy treatments and six rounds of weekly chemotherapy. Once they started the Benadryl drip for my chemotherapy, I would fall asleep for three hours. It ended up being my favorite time of the week.

I started to experience side effects from proton therapy around week three, as expected. I had some pain in my throat, tongue and mouth, as well as thick mucus in my throat. But I was able to eat soft solid foods and a lot of soup.

Dr. Reddy and the staff at MD Anderson Proton Therapy Center were very kind and helped me manage my symptoms. Physician assistant Lauren Palmer helped find the pain medication that worked best for me and had many suggestions to help my appetite changes. I would have had a different experience without her support.

I completed treatments on Dec. 22 and was excited to be home in time for Christmas.

Treating cancer as a full-time job

When undergoing my cancer treatments, I reminded myself that this was temporary. Having cancer feels like a full-time job – and it is.

But as I’ve learned, you can do anything for a finite amount of time. You must be positive and focus on the right now. Even though it is very hard, it will pass. So, do what the doctors say and follow directions from your care team to manage side effects, and you’ll get through this.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.