Radiation Therapy Side Effects: Esophagitis and Mucositis
Will radiation therapy make my mouth or throat hurt?
The lining of your esophagus (food pipe) is sensitive to radiation and may become inflamed and sore during treatments (a condition called esophagitis). You may feel a burning sensation in your throat or chest or you may feel as if you have a "lump" in your throat. You may also feel pain when swallowing.
The lining of your mouth, throat, and gums is called the oral mucosa. This lining is sensitive to radiation and may become inflamed or sore during treatments (a condition called mucositis). You may have a dry mouth with thick, sticky saliva. You also may have mouth sores or discomfort when chewing or swallowing. Some patients receiving radiation treatments to the mouth may be referred to a dentist, but most patients will be referred to a registered dietitian.
The symptoms of esophagitis and mucositis may occur during the second or third week of radiation therapy. The symptoms are common and temporary - they will subside gradually within two or three weeks of completing treatment.
What should I do if I have a sore mouth or feel pain when swallowing?
To reduce the discomfort caused by esophagitis or mucositis, follow these guidelines:
- Sit upright at a 90-degree angle and lean your head slightly forward.
- Eat slowly. Cut your food into small pieces and chew it completely.
- Eat small, frequent meals throughout the day instead of three large meals.
- Eat foods that are warm or are at room temperature. Avoid hot foods and drinks. Also avoid crunchy foods, such as potato chips and nuts.
- Eat soft foods. Puree or finely chop cooked meats, fruits and vegetables. You may want to try commercial baby foods, which are nutritious, convenient and easy-to-swallow. High-protein milkshakes are also nutritious and easy to swallow.
- Drink liquids through a straw to make swallowing easier.
- If you are experiencing a burning sensation when eating or drinking, try taking an antacid before your meals.
- If swallowing is painful, try rinsing your mouth with a local anesthetic or taking a pain medication prescribed by your health care provider before you eat.
- Do not talk with food in your mouth.
- Remain sitting or standing upright for 15 to 20 minutes after eating a meal.
- Avoid eating spicy foods.
- Avoid eating or drinking acidic foods and beverages such as tomatoes, oranges, grapefruits and their juices. Instead, try nectars and imitation fruit drinks with vitamin C.
- Avoid alcohol and tobacco.
What should I do if I am having difficulty swallowing my medications?
If you are having difficulty swallowing your medications, ask you pharmacist which medications can be crushed. If your pharmacist tells you it is safe to crush your medications, mix them with soft foods such as applesauce or pudding. It is important to ask your pharmacist for his/her recommendations on which pills should not be crushed.
How can I relieve the discomfort of a dry mouth?
- Rinse your mouth with water before meals.
- Chew your food completely. Sip liquids frequently while eating to keep food moist and help with swallowing.
- Drink six to eight 8-ounce glasses of fluid per day. You may want to carry a small bottle of water with you.
- Chew sugarless gum or suck on hard candies or mints (preferably sugarless).
- Gargle with club soda or drink fluids with lemon or lime to help "cut" thick saliva.
- Run a cold air humidifier in your main living area during the day and in your bedroom at night. If you do not own a humidifier or vaporizer, boil a pan of water and carefully inhale the steam.
- Ask your health care provider about artificial saliva. This may be prescribed if your mouth dryness is severe.
- Avoid tobacco and alcohol.
What are some oral hygiene tips?
Good mouth care may not prevent side effects to your mouth, but it helps prevent infection and the spread of infection. Good mouth care also helps reduce the risk of further reaction on tissue. Lastly, good oral hygiene prevents bad breath, leaves a fresh feeling in your mouth, and improves your appetite.
Here are some tips:
- Examine your mouth and gums daily. Your health care provider may recommend that you see your dentist before your radiation treatments begin.
- Brush your teeth after each meal with a small, soft toothbrush and fluoride toothpaste. Use foam sticks instead of a toothbrush if your gums are especially sore. Keep dentures clean and fitting properly.
- Use dental floss daily.
- Avoid commercial mouthwashes or lozenges that contain a high concentration of alcohol -- they may irritate or dry your mouth.
- Prepare a gargle by dissolving one teaspoon each of salt and baking soda in a quart of warm water. (A smaller portion of this can be made by stirring 1/4 teaspoon each of salt and baking soda into eight ounces of warm water.) Rinse your mouth and gargle with this solution at least four to six times a day, especially after meals and before going to bed.
Will I still be able to wear my dentures if I'm receiving radiation to the mouth?
If your gums become inflamed or sore during your radiation treatment, you may have difficulty wearing dentures. Often, dentures may have to be removed during treatment and refitted 3 to 6 months after your treatment is complete.
Will radiation therapy change my sense of taste?
Your sense of taste may change during radiation treatments. Different foods may seem to taste the same, have a slightly bitter taste or not have any taste at all. Despite changes in your sense of taste, it is very important to continue eating well-balanced meals and avoid losing weight.
Foods that are slightly chilled (flavored gelatin, pudding, and applesauce) may be tolerated better.
Meat commonly becomes distasteful after several weeks of treatment. If you are unable to eat meat because it is distasteful, be sure that you have another protein source in your diet. Try eating more fish, poultry, eggs, cheese and milk.
Adding protein supplements to your meal plan usually becomes necessary when your sense of taste changes. A registered dietitian can recommend a supplement brand to meet your nutritional needs.
Is there anyone available to address my individual nutritional concerns?
Yes. Registered dietitians can help you with any nutritional concerns you may have. Dietitians are available to help you modify your diet and advise you on recipes and nutritional supplements to provide additional calories, protein, and other nutrients.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/15/2007...#4532