Mouth and neck radiation - discharge

Two weeks after radiation treatment starts, you might notice changes in your skin. Most of these symptoms go away after your treatments have stopped.

• Your skin and mouth may turn red.
• Your skin might start to peel or get dark.
• Your skin may itch.
• The skin under your chin may get droopy.

You may also notice changes in your mouth. You may have:

• Dry mouth
• Thicker saliva
• Mouth pain
• Nausea
• Difficulty swallowing
• Pain on swallowing
• Lost sense of taste
• No appetite
• Stiff jaw
• Trouble opening your mouth very wide
• Dentures may no longer fit well, and may cause sores in your mouth

Your body hair will fall out 2 to 3 weeks after radiation treatment starts, but only in the area being treated. Some of the hair loss may be permanent. Sometimes if the hair does grow back, it may be different than before.

When you have radiation treatment, color markings are drawn on your skin. Do not remove them. These show where to aim the radiation. If they come off, do not redraw them. Tell your provider instead.

To care for the treatment area:

• Wash gently with lukewarm water only. Don't scrub your skin.
• Use a mild soap that doesn't dry out your skin.
• Pat dry instead of rubbing dry.
• Don't use lotions, ointments, makeup, perfumed powders, or other perfumed products on this area. Ask your provider what is OK to use.
• Use only an electric razor to shave.
• Don't scratch or rub your skin.
• Don't put heating pads or ice bags on the treatment area.
• Wear loose-fitting clothing around your neck.

Tell your provider if you have any breaks or openings in your skin.

Keep the area that is being treated out of direct sunlight. Wear clothing that protects you from the sun, such as a hat with a broad brim and a shirt with long sleeves. Use sunscreen.

Take good care of your mouth during cancer treatment. Not doing so can lead to an increase in bacteria in your mouth. The bacteria can cause infection in your mouth, which can spread to other parts of your body.

• Brush your teeth and gums 2 or 3 times a day for 2 to 3 minutes each time.
• Use a toothbrush with soft bristles.
• Let your toothbrush air dry between brushings.
• If toothpaste makes your mouth sore, brush with a solution of 1 teaspoon (tsp) or 5 grams (g) of salt mixed with 4 cups (c) or 1 liter (L) of water. Pour a small amount into a clean cup to dip your toothbrush into each time you brush.
• Floss gently once a day.

Rinse your mouth 5 or 6 times a day for 1 to 2 minutes each time. Use one of the following solutions when you rinse:

• One tsp (5 g) of salt in 4 c (1 L) of water
• One tsp (5 g) of baking soda in 8 ounces (oz) or 240 milliliters (ml) of water
• One tsp (5 g) of salt and 1 tsp (5 g) of baking soda in 4 c (1 L) of water

Do not use rinses that have alcohol in them. You may use an antibacterial rinse 2 to 4 times a day for gum disease.

To further take care of your mouth:

• Don't eat foods or drink beverages that have a lot of sugar in them. They may cause tooth decay.
• Don't drink alcoholic beverages or eat spicy foods, acidic foods, or foods that are very hot or cold. These will bother your mouth and throat.
• Use lip care products to keep your lips from drying out and cracking.
• Sip water to ease mouth dryness.
• Eat sugar-free candy or chew sugar-free gum to keep your mouth moist.

Your provider may prescribe mouth rinses to keep away bacteria, and special fluoride treatments to prevent tooth decay.

If you use dentures, wear them as infrequently as possible. Stop wearing your dentures if you get sores on your gums.

Ask your provider or dentist about medicine to help with mouth dryness or pain.

You need to eat enough protein and calories to keep your weight up. Ask your provider about liquid food supplements that can help.

Tips to make eating easier:

• Choose foods that you like.
• Try foods with gravy, broths, or sauces. They will be easier to chew and swallow.
• Eat small meals, and eat more often during the day.
• Cut your food into small pieces.
• Ask your provider or dentist if artificial saliva might be helpful for you.

Drink at least 8 to 12 c or 2 to 3 L of liquid each day, not including coffee, tea, or other drinks that have caffeine in them.

If pills are hard to swallow, try crushing them and mixing them with ice cream or another soft food. Ask your provider or pharmacist before crushing your medicines. Some medicines do not work when crushed.

You may feel tired after a few days. If you feel tired:

• Don't try to do too much in a day. You probably will not be able to do everything you are used to doing.
• Try to get more sleep at night. Rest during the day when you can.
• Take a few weeks off work, or work less.

Your provider may check your blood counts regularly, especially if the radiation treatment area on your body is large.

You may be instructed to visit your dentist more often. See your dentist as often as recommended.

Radiation - mouth and neck - discharge; Head and neck cancer - radiation; Squamous cell cancer - mouth and neck radiation; Mouth and neck radiation - dry mouth; Oral cancer

Doroshow JH. Approach to the patient with cancer. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 164.

Majithia N, Hallemeier CL, Loprinzi CL. Oral complications. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 40.

National Cancer Institute website. Radiation therapy and you: support for people with cancer. www.cancer.gov/publications/patient-education/radiation-therapy-and-you.pdf. Updated April 2021. Accessed June 3, 2024.

Updated by: David Herold, MD, Radiation Oncologist in Jupiter, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.