Side Effects of Radiotherapy on Neck Lymph Nodes: Risks and What to Know

Side Effects of Radiotherapy on Neck Lymph Nodes can vary from person to person, but there are some common experiences. The skin in the area being treated, which includes the neck, might become red or darker, and it could feel sore or itchy. Hair loss is also expected in the area where the radiation is directed. Many individuals undergoing radiotherapy to the neck lymph nodes report feeling very tired and weak, and this fatigue can sometimes persist for weeks or even months after the treatment has finished.

What is Radiotherapy for Neck Lymph Nodes?

Radiotherapy is a cancer treatment that uses high-energy beams, such as X-rays or protons, to destroy cancer cells. It works by damaging the genetic material within these cells, making it impossible for them to grow and multiply. In the context of neck lymph nodes, radiotherapy is frequently used to treat cancers that have spread to these nodes from other areas in the head and neck, or when the cancer originates in the lymph nodes themselves, as is common in lymphomas.

The primary type of radiotherapy discussed is external beam radiotherapy (EBRT). In this treatment, a machine located outside the body directs radiation beams precisely at the cancerous lymph nodes in the neck. The beams pass through the skin and other tissues to reach the target area. You won’t see or feel the radiation during the treatment.

Another type of radiotherapy is brachytherapy, also known as internal radiation. In brachytherapy, a radioactive source is placed directly inside the body, close to or within the tumor. One of the texts mentioned brachytherapy involving seed implants in the pelvis, but it did not specifically discuss its use for neck lymph nodes. Generally, for neck lymph nodes, EBRT is the more common approach. Unfortunately, I cannot provide diagrams or visuals in this text-based format.

Why Does Radiotherapy Cause Side Effects?

Radiotherapy, while effective at targeting cancer, causes side effects because the high-energy beams used to destroy cancer cells can also affect normal, healthy cells in the treatment area. This damage to healthy cells is what leads to the various side effects experienced during and after treatment. In the head and neck region, radiation can cause an inflammatory response as the body tries to repair the damaged tissues.

This inflammation, along with the direct damage to cells, can manifest in various ways, such as skin reactions, sore mouth and throat, and fatigue. Additionally, radiation can damage the small blood vessels that supply nutrients to tissues, potentially leading to further complications over time, like the hardening of underlying tissue known as fibrosis. While the texts don’t explicitly detail the immune system’s reaction, it’s understood that the body’s natural defense mechanisms will be involved in responding to the tissue damage caused by radiation.

How Long After Radiotherapy Will I Feel Better?

Generally, you can expect most of the immediate side effects from radiotherapy to start improving within a few weeks to a couple of months after your treatment concludes. However, the exact timeline can vary. Some people might find that their side effects actually feel a bit worse in the first one to three weeks after treatment ends before they begin to get better. Fatigue, for example, is a common side effect that often takes longer to fully resolve, sometimes lingering for several weeks or even months.

Certain side effects might have a longer recovery period. Skin reactions usually heal in a few weeks, but some changes like skin darkening or scarring could be permanent. Hair might take several months to regrow and could have a different texture or color. Late side effects can appear months or years after treatment, and some, especially with high radiation doses, might be permanent. The speed of your recovery depends on factors like the type and dose of radiation, the treated body area, the treatment schedule, and your overall health. Conditions like fibrosis or lymphedema could also be long-lasting.

Common Side Effects of Radiotherapy on Neck Lymph Nodes

Radiotherapy for neck lymph nodes, while targeting cancer cells, can also affect nearby healthy tissues, leading to a range of side effects. Understanding these potential effects can help in managing them throughout your treatment journey.

Oral Mucositis and Mouth Sores

Radiation treatment to the neck area can irritate the lining of the mouth and throat, often leading to soreness and the development of mouth sores. This condition, known as oral mucositis, can make eating, drinking, and even speaking uncomfortable. It’s also possible to develop mouth infections, such as oral thrush, during this time.

Dry Mouth (Xerostomia)

The salivary glands in the neck are quite sensitive to radiation. As a result, many individuals undergoing radiotherapy to this area experience dry mouth, also known as xerostomia. This happens because the radiation can damage the cells in the salivary glands, reducing the amount and quality of saliva produced. Dry mouth can be a persistent issue, sometimes lasting for a long time after treatment ends, and it can lead to difficulties with eating, swallowing, and speaking, as well as increasing the risk of dental problems and oral infections.

Skin Reactions in the Treated Area

The skin in the area of the neck receiving radiation is also prone to reactions. You might notice redness, feeling warm or itchy, and the skin may become dry. It’s also common for the skin to change color, appearing pink, red, darker, or even tanned. Hair loss is also expected in the specific area where the radiation beams are directed. These skin reactions usually start within the first few weeks of treatment and generally improve after treatment finishes, although some changes like skin darkening or scarring can be permanent.

Fatigue During and After Treatment

Feeling extremely tired, or fatigued, is one of the most common side effects reported by individuals undergoing radiation therapy, including treatment to the neck lymph nodes. This fatigue can develop after a few weeks of treatment and might get worse as the treatment continues. It’s believed to be caused by the body using more energy to heal itself during this time. This feeling of tiredness usually goes away gradually after the treatment has ended, but for some people, it can persist for several weeks or even months.

Rare but Severe Side Effects of Radiotherapy

While many side effects of radiotherapy to the neck lymph nodes are common and manageable, there are some less frequent but more serious complications that can occur. These include damage to blood vessels and nerves, as well as the development of significant tissue fibrosis.

Radiation-Induced Fibrosis and Tissue Scarring

Radiotherapy can sometimes lead to the development of fibrosis, which is the thickening or scarring of tissue. This can happen in the skin, muscles, or other organs in the treated area of the neck. Fibrosis generally starts to develop a few months after the start of radiation therapy and can be a long-term issue. In the neck, this might cause a woody texture and limit the range of motion. It can also contribute to tightness in the neck and shoulder muscles.

Risk factors for more severe fibrosis can include higher radiation doses and potentially surgery or re-radiation in the same area. To minimize the risk of neck tightness, maintaining flexibility through regular stretching exercises is important. Myofascial release therapy might also be beneficial after fibrosis has developed.

Lymphedema in the Neck

Lymphedema is another potential but serious side effect that can occur after radiation therapy to the neck. It involves the swelling of tissues due to a buildup of lymph fluid when the lymphatic system is damaged. Radiation can cause scarring that interferes with the function of the lymphatics in the neck, leading to a slow and progressive swelling. Lymphedema can start weeks or months after the initiation of radiation and can be a lifelong issue.

It can cause sensations of heaviness and achiness in the neck and may even lead to skin changes. In more severe cases, lymphedema in the neck can cause difficulties with breathing, congestion, and problems with speech and swallowing. While the lymphatics can sometimes find new ways to drain over time, leading to a reduction in swelling, specialized treatments like manual lymph drainage and compression therapy can help manage the condition and prevent permanent swelling and fibrosis. Sleeping with the upper body elevated can also aid in lymph fluid drainage.

source: www.medpagetoday.com

When Do Side Effects Typically Occur?

The timing of side effects from radiotherapy to the neck lymph nodes can vary. Generally, they can be categorized by when they tend to appear.

Immediate Side Effects (First Few Weeks)

Many individuals start to notice some side effects relatively soon after beginning their radiation therapy, often within the first few weeks. These can include feeling very tired or fatigued, and the skin in the treated area might become red, sore, or itchy. Some people may develop soreness in their mouth, and their sense of taste could change. It’s also possible to experience nausea or a decrease in appetite during this initial period. Dry mouth and thicker saliva can also start to become noticeable early in the treatment course, and some individuals might begin to have difficulty swallowing.

Delayed Side Effects (Months Post-Treatment)

While some of the immediate side effects will gradually improve in the weeks following the completion of radiotherapy, other effects might take more time to appear or resolve. For instance, skin reactions usually get better within a few weeks after treatment ends, but fatigue can sometimes last for several weeks or months. Hair in the treated area typically starts to grow back a few months after treatment.

Some longer-term effects, such as the development of fibrosis (tissue hardening) or lymphedema (swelling), can begin to show up a couple of months after treatment starts and might persist for a long time. Other potential issues, like osteoradionecrosis or thyroid problems, might even occur months or years later. It’s important to remember that some side effects can be long-lasting or even permanent. Unfortunately, I cannot provide a visual timeline in this format.

How Long Do Side Effects of Radiotherapy Last?

The length of time that side effects from radiotherapy to the neck lymph nodes last can differ greatly depending on the specific side effect experienced. Some issues are temporary and will get better as time passes, while others might persist for a long time or even become permanent.

Short-Term vs. Long-Term Side Effects

Many of the side effects that appear during or shortly after radiotherapy are temporary. For example, skin redness and soreness usually subside within a few weeks after treatment ends. Fatigue, while it can last for a few months, typically improves gradually. Soreness in the mouth and throat also tends to get better over time as the tissues heal. Hair will usually grow back within several months.

On the other hand, some side effects can be long-term. Dry mouth is a common issue that can persist for many months or even years after treatment, and in some cases, it might be permanent. Swallowing difficulties can also be long-term for some individuals. Conditions like fibrosis and lymphedema, which involve tissue changes, can also be ongoing issues requiring long-term management.

Permanent Side Effects: Understanding the Risks

While many side effects improve, there are some that have the potential to be permanent. Permanent loss of saliva is a known risk due to irreversible damage to the salivary glands. Significant fibrosis in the neck can also lead to permanent limitations in movement. In some instances, skin changes like darkening or scarring might be permanent. Other potential permanent side effects include hearing loss if the ears were in the treatment field, and in rare cases, nerve damage.

Hypothyroidism, a condition where the thyroid gland doesn’t produce enough hormones, often requires lifelong medication. Osteoradionecrosis, a serious condition affecting the bone, is also a lifelong risk for those who have received high-dose radiation. It’s important to discuss the potential for both temporary and permanent side effects with your healthcare team before starting treatment to understand what to expect.

Long-Term Side Effects of Head and Neck Radiation

Head and neck radiation can sometimes result in long-lasting complications that may continue to affect individuals for months or even years after the completion of treatment. These can include persistent issues like progressive fibrosis, chronic pain, and functional limitations that can impact daily activities. Consistent medical follow-ups are vital for monitoring and addressing these potential long-term consequences.

Dental Problems and Tooth Decay

Radiation can significantly impact oral health in the long term. The reduction in saliva production, often a persistent issue after neck radiation, increases the risk of dental problems such as tooth decay and cavities. The altered saliva can also affect the mouth’s pH balance and the levels of protective proteins, making teeth more vulnerable. Radiation can also directly damage the blood supply to the jawbone, potentially leading to a severe condition called osteoradionecrosis, although this is less common. Maintaining excellent oral hygiene, using fluoride treatments, and having regular dental check-ups are essential for managing these long-term risks.

Swallowing Difficulties (Dysphagia)

Problems with swallowing can also persist long after radiation therapy to the neck. The radiation can cause scarring and stiffening of the muscles and tissues involved in swallowing, leading to ongoing difficulties in moving food and liquids from the mouth to the stomach. This can sometimes require long-term dietary changes, swallowing exercises guided by a speech-language pathologist, or even procedures to help open up any narrowed areas in the throat or esophagus that might develop over time.

Changes in Taste and Appetite

While taste changes often occur during and shortly after radiation, some individuals may experience long-lasting alterations in their sense of taste. This can affect their enjoyment of food and consequently their appetite. Persistent dry mouth can also make eating less appealing. These long-term changes in taste and appetite can sometimes lead to nutritional deficiencies or weight loss, highlighting the importance of ongoing nutritional support and guidance.

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Managing Persistent Side Effects of Radiotherapy

Managing the long-term side effects of radiotherapy often involves a combination of approaches tailored to the specific symptoms experienced. Here is a guide based on the information provided.

Managing Chronic Pain After Radiotherapy

For persistent pain that may develop after radiotherapy, several options can be considered. These include specific injection therapies aimed at trigger points, alongside other pain management medications. Muscle relaxants and certain types of antidepressant medications, known as tricyclic medications, might also be helpful in managing chronic pain.

Treating Radiation-Induced Dry Mouth (Xerostomia)

Coping with long-term dry mouth involves diligent oral care. Regularly rinsing your mouth with a solution of baking soda and salt in water can help keep it moist and clean. Staying well-hydrated by drinking plenty of fluids is also important. If dry mouth continues to be a significant issue, there are also saliva substitutes and other products that can provide relief.

A 2016 systematic review by Gil-Montoya et al., published in Medicina Oral, Patología Oral y Cirugía Bucal, found that pilocarpine remains the most effective drug for dry mouth caused by head and neck cancer radiation or Sjogren’s Syndrome. For dry mouth solely due to medication, malic acid showed some promise. Oral lubrication generally provides short-term relief of symptoms.

Coping with Swallowing Difficulties (Dysphagia)

If you experience ongoing difficulties with swallowing, consulting with a speech pathologist is recommended. They can provide specific exercises to strengthen the muscles involved in swallowing and suggest changes to your diet to make it easier to eat. In some cases, especially if there is a narrowing in the throat or esophagus, medical procedures to stretch or open these areas might be necessary.

Addressing Lymphedema and Tissue Fibrosis

For managing lymphedema, which can cause persistent swelling, a range of therapies can be beneficial. These include manual lymph drainage, which is a specialized type of massage, the use of compression bandages and garments, and devices like tactile lymphatic pumps. Specific exercises designed to encourage lymphatic drainage, along with careful skin care, and the use of elastic therapeutic tape can also be helpful. For tissue fibrosis, which can lead to stiffness and reduced movement, stretching exercises are key. Myofascial release, a hands-on therapy that involves massaging and stretching connective tissues, can also help to increase range of motion and reduce pain.

A 2008 retrospective case series by Stubblefield et al., published in Archives of Physical Medicine and Rehabilitation, explored botulinum toxin type A (BTX-A) for radiation fibrosis syndrome (RFS). The study of 23 patients found BTX-A injections were indicated for issues like cervical dystonia, neuralgia, trismus, and migraine, with 87% of patients reporting benefit. The authors concluded that initial experience is encouraging but further prospective studies are needed.

Preventing and Managing Radiation Fibrosis Syndrome

To minimize the risk and impact of fibrosis, especially in the neck, it’s important to maintain flexibility through regular stretching exercises that target the neck muscles. These exercises should ideally be continued throughout life. If fibrosis does develop, myofascial release can be a helpful method for improving flexibility and reducing pain. Early intervention is generally more effective.

Alternative and Complementary Therapies

Some alternative therapies might also offer relief for certain long-term side effects. For example, acupuncture has been reported to be beneficial in improving peripheral neuropathy, a type of nerve damage that can occur after radiation. Additionally, oncology rehabilitation programs can provide comprehensive support for managing conditions like lymphedema.

A 2017 systematic review by Dimitrova et al., published in The Journal of Alternative and Complementary Medicine, assessed acupuncture’s efficacy for neuropathy. Analyzing 15 studies, the review found that most RCTs showed benefit for acupuncture in treating diabetic neuropathy, Bell’s palsy, and carpal tunnel syndrome. Meta-analyses of diabetic neuropathy and Bell’s palsy data (680 subjects) favored acupuncture over control (OR 4.23, p < 0.001). Acupuncture also appeared to improve nerve conduction parameters.

Do Side Effects Mean That Treatment is Working?

Experiencing side effects during radiotherapy does not necessarily mean that the treatment is effectively destroying cancer cells. Radiotherapy works by damaging the DNA of cancer cells, making it difficult for them to multiply and spread. However, the radiation beams also pass through and can affect normal, healthy cells in the treatment area, and this damage to healthy tissue is what causes the various side effects that individuals may experience.

The severity and type of side effects are often related to the dose of radiation, the specific location being treated, the size of the treatment area, and whether other treatments like chemotherapy are being used concurrently. While the presence of side effects indicates that the body is responding to the radiation, it doesn’t directly correlate with the treatment’s success in targeting and eliminating cancer cells. The effectiveness of the radiotherapy is monitored through imaging scans and other assessments by your medical team, rather than by the presence or intensity of side effects alone.

Radiotherapy vs. Chemotherapy Side Effects: A Comparison

Radiotherapy and chemotherapy are both powerful cancer treatments, but their side effects can differ in several ways regarding severity, duration, and the types of symptoms experienced. Radiotherapy tends to cause side effects that are more localized to the area of the body being treated. For instance, when radiation is directed at the neck lymph nodes, individuals might experience skin reactions in that specific area, as well as a sore mouth, dry mouth, and difficulties with swallowing. Fatigue is also common with radiotherapy and can last for some time. Some of these side effects, like dry mouth or tissue fibrosis, can be long-term or even permanent.

In contrast, chemotherapy often has more systemic side effects, affecting the whole body. Common side effects of chemotherapy can include nausea and vomiting, hair loss all over the body, fatigue, and a decrease in blood cell counts, which can lead to increased risk of infections, bleeding, and anemia. While some chemotherapy side effects are temporary, others, like nerve damage (neuropathy), can also be long-lasting. Both treatments can cause mouth sores, but the other common symptoms often differ based on how each treatment works in the body. Unfortunately, I am unable to create a side-by-side comparison table in this format.

Written by Aren Karapetyan, MD