Guidance for Esophageal Cancer Patients During Radiation Therapy

This note provides evidence-based guidance for patients with esophageal (food pipe) cancer undergoing radiation therapy. It includes potential side effects, their prevention, do’s and don’ts, home remedies, dietary changes, nutritional supplements, supportive counseling, and medications commonly used by oncologists.

This information is based on international guidelines (such as NCCN, ASTRO) and was kindly provided by Dr. Narendra Rathore (MB Hospital, Udaipur).

1. Common Effects of Radiation Therapy

Radiation therapy for esophageal cancer can affect the esophagus, chest, and surrounding skin.

2. Prevention

Preventive measures can reduce the severity of these side effects:

• Oral and Throat Hygiene: Rinse with warm saline water (1/4 tsp salt per glass) 2–3 times a day to prevent esophagitis and infection.

• Skin Care: Keep the treated area (e.g., chest, neck) clean, dry, and moisturized. Use doctor-recommended moisturizers such as Bepanthen or Aquaphor.

• Hydration: Drink 2–3 liters of water daily to keep the esophagus moist and support digestion.

• Nutrition: Take adequate calories and protein to prevent weight loss.

• Sun Protection: Cover the treated area with loose clothing or prescribed sunscreen.

• Fatigue Management: Engage in light physical activities like walking and ensure proper rest.

3. Do’s and Don’ts

(As per MASCC/ISOO, NCCN guidelines)

✔ Do:

• Oral Care: Rinse 3–4 times a day with saline or baking soda solution.

• Skin Cleaning: Use mild soap (e.g., Dove or Cetaphil) and warm water. Dry gently with a soft towel.

• Stay Hydrated: Drink water, coconut water, or diluted fruit juices.

• Eat Soft Foods: Soups, khichdi, curd-rice, mashed potatoes, thin buttermilk.

• Report Symptoms: Notify the doctor immediately if experiencing difficulty swallowing, fever, or pain.

• Get Rest: Rest properly during fatigue.

✖ Don’t:

• Avoid scented soaps, lotions, or alcohol-based mouthwashes on treated skin.

• Avoid spicy, sour, or hot foods like lemon or tomato.

• Do not smoke or consume alcohol — these worsen esophagitis.

• Avoid hard foods like toast, nuts, or dry snacks.

• Do not hide severe symptoms — inform your doctor promptly.

• Don’t take medicines or home remedies without consulting your doctor.

4. Home Remedies

(Consult your oncologist before use)

For Esophagitis/Burning Sensation:

• Honey: Mix 1 tsp pure honey in warm water and sip slowly.

• Licorice Water: Boil, cool, and gargle.

• Aloe Vera Juice (1:4 ratio): Take with doctor’s advice.

• Chamomile Tea: Drink cold and slowly.

For Skin Burns:

• Use aloe vera gel or coconut oil on external skin (not on open wounds).

For Pain & Inflammation:

• Turmeric Water: Mix 1/4 tsp turmeric in warm water and sip (doctor’s permission required).

• Cold Mint Tea: Can provide throat and stomach relief.

For Nausea:

• Boiled Ginger Water: Drink slowly.

⚠️ Caution: Do not apply any remedy inside the mouth, esophagus, or open wounds without oncologist approval.

5. Dietary Changes & Nutrition

(As per ESPEN guidelines)

Dietary Changes:

• Soft & Liquid Foods: Soups (pumpkin, carrot, bottle gourd), mashed potatoes, thin buttermilk.

• Eat 5–6 small meals to aid digestion.

• High-Calorie, High-Protein Diet: Milkshakes, protein shakes (like KABIPRO), blended nuts in soups.

• Hydration: Drink 8–10 glasses of water, coconut water, or diluted juices.

• Avoid: Fried, spicy, sour, or extremely hot food.

Supplements (only with oncologist’s guidance):

• Protein Powders: e.g., KABIPRO.

• Omega-3 Fatty Acids: Help reduce inflammation.

• Vitamins: B-complex, zinc as needed.

• Glutamine: May help treat esophagitis.

• Probiotics: Support gut health during treatment.

⚠️ Caution: If swallowing is severely impaired, tube feeding (nasogastric or PEG) may be required.

6. Regular Consultations with Your Oncologist

• Attend regular follow-ups to monitor side effects and adjust treatment.

• Keep a symptom diary to track swallowing difficulty, pain, weight loss, and share with your oncologist.

7. Commonly Used Medications

(Prescribed by Oncologists)

For Esophagitis & Pain:

• Paracetamol: 500–1000 mg (as advised).

• Tramadol / Morphine: For severe pain.

• Lidocaine Mouthwash/Gel: For local pain relief.

• Benzydamine Mouthwash: Anti-inflammatory for esophagitis.

For Nausea:

• Ondansetron

• Metoclopramide

For Skin Reactions:

• Hydrocortisone Cream (1%)

• Stronger Steroids (doctor’s advice only)

• Moisturizers: Aquaphor, Bepanthen

For Infections:

• Antibiotics: e.g., Amoxicillin for oral/skin infections.

• Antifungals: e.g., Fluconazole for oral thrush.

For Digestion:

• Loperamide: For diarrhea.

• Lactulose / Isabgol: For constipation.

For Nutrition:

• Enteral Nutrition Formula: e.g., Ensure or Bonutra, when oral feeding is inadequate.

⚠️ Caution: Always take medications under oncologist supervision. Some drugs may interfere with cancer treatment.

🌟 Additional Suggestions

• Stay in contact: Share your symptoms regularly with your oncologist and seek help from family or counselors.

• Monitor symptoms: Track and record issues like swallowing difficulty, pain, or weight loss.

• Mental Wellness: Reduce stress with light meditation or breathing exercises (avoid strenuous activity).

📝 Important Note

Radiation therapy side effects are manageable. With proper care and preventive strategies, treatment remains effective.

Stay in regular contact with your oncologist and physiotherapist, follow their guidance, and be cautious with home remedies.

You are not alone on this journey. ❤️