Swallowing Disorders Frequently Asked Questions

There are immediate and long-term effects of radiation therapy for the treatment of head and neck cancer.

The immediate side effects may include:

• Dry mouth
• Burning sensations
• Sore throat, tongue, or lips
• Ulcers
• Problems with denture retention
• Abnormal taste and smell

Whether you get cavities in your teeth will depend on your oral hygiene. A build-up of plaque on your teeth can occur due to the altered flow of saliva. Doctors suggest fluoride treatments to prevent tooth decay.

The long-term effects of radiation may include:

• Limited ability to open the mouth (trismus)
• Fibrosis (excess tissue formation)
• Dead tissue (soft-tissue necrosis)
• Swelling

These side effects can alter swallowing function, depending on what area receives the radiation and how much therapy you have. People tend to have the most issues during treatment and need to make changes in their diet to prevent swallowing discomfort.

After radiation therapy, patients tend to have more interest in trying to eat different kinds of foods again.

It is very helpful to have swallowing tests before and after radiation therapy to note any changes that have occurred. These tests will help your doctor decide on the most fitting treatment plan to help you achieve your swallowing and nutrition goals.

A fiberoptic endoscopic evaluation of swallowing (FEES) is a swallow test that involves the use of a small camera to view the structures of the throat during swallowing. Having this test before you begin radiation will allow your doctor to compare the changes that occur after treatment and determine what kinds of foods and liquids are the safest and most manageable for you during treatment.

After your initial evaluation at the UPMC Swallowing Disorders Center, your doctor will give you swallowing exercises. It's important to exercise the muscles you use to swallow both during and after radiation treatment to prevent scar tissue from developing.

One to two weeks into your radiation treatment, you may start to notice that your mouth is dry. By the third week, you may find that certain foods are harder to swallow.

Most people need to change the types of foods they eat because of ulcers in the mouth. These ulcerations can cause burning sensations, especially when they come in contact with spicy or acidic foods and drinks.

As a result of radiation therapy, saliva production may decrease and the consistency of the saliva in your mouth may change. Saliva protects your teeth from bacteria, so these changes may make your teeth more prone to bacterial attack.

You also may be eating more foods that have a higher sugar content to maintain your weight. Because the excess sugar will attract bacteria that can cause tooth decay, it's crucial that you clean your mouth well — especially before and after you eat. You may also want to use an alcohol-free mouthwash, such as Biotene®.

If your mouth is the area receiving radiation, you should see your dentist regularly, even if you wear dentures. Do not wear your dentures while undergoing therapy.

A sore throat is the main side effect of radiation therapy for head and neck cancers, but each patient will react differently depending on the dose of radiation they receive.

To help reduce sore throat discomfort, gargle with the following mixture:

• 1 teaspoon of salt
• 1 one teaspoon of baking soda (sodium bicarbonate)
• 1 quart of water

Do this six to eight times a day and before and after each meal.

Drink small amounts of water, juice, or a high-calorie supplement — such as Boost or Ensure — often. Keep a glass of water or juice at your bedside to drink during the night. There is no limit to how much liquid you can consume during radiation therapy.

Chew ice chips or sugarless gum, drink ginger ale, or use an artificial saliva formula to increase moisture in your mouth, especially right before eating.

Artificial saliva substitutes may relieve the dryness, but be sure to check with your doctor. Some saliva substitutes have side effects such as excessive sweating and diarrhea.

If your saliva is thick, try sipping pure papaya juice. Papaya contains natural substances that will help thin the thick saliva.

Include more moist foods in your meals such as gravies, sauces, sour cream, and macaroni and cheese. Add extra butter to help lubricate your mouth and increase your calories.

This is normal because you may have more swelling some days than others. Increased swelling will make it harder to swallow.

If you consistently notice that it is more difficult to swallow, call your doctor.

Continue to use the muscles involved in swallowing as much as possible during radiation treatment.

If you are able to swallow water safely, then it's good to continue. Water may help relieve some of the dryness in your mouth and throat.

If you do nothing at all, those muscles may tighten more and cause swallowing to be even more difficult when you complete radiation therapy.

You may be experiencing some of the late effects of radiation treatment. This may include a tightening sensation due to swelling and a narrowing of the passageway where food travels (esophagus).

You should consult your doctor for further recommendations. Sometimes, doctors can stretch this area of the throat using a procedure called dilatation.

Nutrition during radiation therapy should help you feel better and recover as quickly as possible.

Proper nutrition will also help you:

• Retain your strength and energy.
• Maintain your normal weight and the body’s nutrition stores.
• Decrease the risk of infection.
• Tolerate treatment-related side effects.

Most likely, yes. A sore throat is the main side effect of radiation therapy for head and neck cancers. If your sore throat is severe, you may be unable to take in enough food and liquids by mouth to maintain your weight or avoid dehydration.

Your doctor will place a feeding tube temporarily into your stomach (a gastrostomy tube). This will allow you to maintain adequate nutrition without having to swallow all of the food that you need.

It's vital to continue swallowing even with a gastrostomy tube in place. Otherwise, your swallowing muscles may atrophy. This can cause permanent swallowing problems and make it difficult to stop using the gastrostomy tube, even after you've completed radiation treatment.

Try keeping a food record of everything you eat and drink. The time period varies greatly from one patient to the next. In addition to safety and nutrition factors, your medical status plays a huge role.

The main goal of swallowing therapy is to have every patient fed orally. Feedings by mouth should be safe and adequate to maintain nutrition and hydration.

It will depend on the:

• Area of the head and/or neck that is receiving radiation treatment.
• The amount of radiation you are receiving.
• The frequency of treatment.

In most cases, the side effects of radiation prevent people from eating a regular diet. Most people seem to drink more liquids and eat less solid food during radiation therapy.

If you are undergoing chemotherapy along with radiation therapy, you may experience a loss of appetite.

We suggest having an evaluation by a registered dietitian. A dietitian will often suggest a bland diet during head and neck cancer treatment.

Your taste buds also are radiated since they are in the treatment area. They become inactive during this period, so your taste may change and you won’t recognize some flavors.

In about three months after treatment, you should start regaining some taste. In the mean time, you might want to marinate meats in fruits, sauces, or soy sauce to add flavor.

It is very normal for appetite to decrease during treatment. Your regular routine of daily living has changed and there are many new things to get used to, including your taste for food and ability to eat. You may also feel tired, which can decrease your desire to eat and enjoy food.

Make an effort to keep mealtime pleasant. Try to “eat with your eyes.”

At mealtime, stimulate your appetite with:

• A nice table setting
• Pleasant colors
• Favorite aromas
• A peaceful atmosphere

Remember that eating well is one of your most vital medicines.

The following tips also may help to stimulate your appetite:

• Walk or engage in another light activity.
• Eat small, frequent meals and snacks.
• Make meal preparation an easy task by choosing foods that are easy to prepare and eat.
• Select high-protein and high-calorie snacks.
• Drink a nutritional supplement to provide additional calories, protein, and other nutrients. A registered dietitian can recommend a good brand to meet your needs.
• Avoid beverages with no nutritional value, such as black coffee and tea.
• Plan meals to include your favorite foods.
• Make eating a pleasurable experience, not a chore. Liven up your meals by playing background music.
• Try not to eat alone. Invite a guest to share your meal or go out to dinner.
• Use your imagination to increase the variety of food you're eating.
• Use colorful garnishes — such as parsley and red or yellow peppers — to make food look more appealing and appetizing.

Emotions, pain medication, and the lack of bulk in your diet — any or all of these may cause constipation.

Your lower intestine needs bulk in order to function properly. If you have not been eating or drinking enough during radiation treatment, it is possible that stool will not form in your lower intestine for two or three days. This is normal.

The following tips may help:

• Try to relax.
• Engage in light daily exercise. Even a brisk walk is helpful for normal bowel function.
• Eat meals regularly and slowly, and chew your food well.
• Eat cooked carrots, bananas, and other fruits and vegetables.
• Drink plenty of fluids.
• Before breakfast, drink juices (prune juice) or a glass of warm water with a teaspoon of lemon juice added.