What should I do if radiotherapy causes anorexia, nausea and vomiting?
Nausea and vomiting is one of the common side effects of radiotherapy, and most of them are caused by gastrointestinal dysfunction caused by radiotherapy. The prevention and treatment methods are: at this time, patients should pay attention to bed rest and drink more water to facilitate the excretion of metabolites. Food should be carefully prepared, eat less and more meals, eat easily digestible food, do not eat too sweet, spicy and greasy and improper smelling food, eat salty snacks and food. Oral administration of vitamin B6, methotrexate and other drugs can reduce nausea. If vomiting is serious, intramuscular injection of methotrexate and other drugs can be given. The easiest way to help is to press or needle the Neiguan point and the Foot San Li point by hand, which will also help. Anorexia is one of the earliest symptoms and also a side effect of radiotherapy. If the loss of appetite is caused by radiotherapy, vitamin B6 and digestive and appetizing drugs can be taken, and appetizing food such as hawthorn can also be chosen. If the effect of general treatment is not good, you can consider infusion or stop radiotherapy.
How to treat the fever caused by radiotherapy correctly?
Fever during radiotherapy can occur from time to time due to various reasons. The tissue damage caused by radiotherapy itself, especially the necrosis and absorption of tumor tissue, can cause hypothermia; the toxic side effects of radiotherapy can cause the decline of blood picture and immune function, and also easily combined with viral or bacterial infection and cause fever, and the use of chemotherapy or other immune enhancing drugs can also cause fever to increase. Therefore, when fever occurs, the cause should be clarified first so that it can be handled correctly.
The fever can be treated according to different degrees. If the fever is lower than 38℃, it can be tolerated and stabilized to normal without antipyretic drugs, drinking more warm water, paying attention to rest and promoting sweating and urination. If the body temperature exceeds 38℃, causing obvious headache or general discomfort, antipyretic drugs should be used, such as aspirin, antipyretic tablets, etc. Wet towels can also be used to apply cold compresses to the head, and then do the corresponding treatment after further clarification of the cause of fever. For example, apply antibiotics to control bacterial infection, apply antiviral drugs to control viral infection, or adjust the original radiotherapy or chemotherapy program appropriately. If the body temperature continues to rise above 38.5℃, radiotherapy should be suspended, stabilized, supported by intravenous fluids and, if necessary, antibiotics, vitamins and adrenocorticotropic hormones.
What is the effect of radiotherapy on blood picture?
The hematopoietic system is highly sensitive to radiation, and some patients may experience a decrease in peripheral blood picture during radiotherapy. The reason for this is that the division and reproduction of various hematopoietic cells in the bone marrow are inhibited during radiation therapy, resulting in a decrease in the release of mature cells, including white blood cells, red blood cells and platelets, into the peripheral blood. Radiation is equally radiosensitive to the precursor cells that produce these three types of cells, but because leukocytes and platelets are short-lived, counts in the peripheral blood drop quickly, whereas red blood cells are produced over a long period of time and anemia appears later. Therefore, blood picture should be checked once a week during radiotherapy, and radiotherapy should be suspended if the white blood cells are lower than 3.0×109/L.
Radiotherapy alone is generally not easy to cause an obvious decline in blood picture, and the amount of decline is related to the size of the irradiation field, site and whether or not drugs have been applied or applied at the same time, etc. Diet nutrition should be enhanced during radiotherapy to promote hematopoietic function and reduce the damage of radiation on bone marrow. Food should be high in vitamins and protein. For those with obvious decline, drugs that elevate the blood picture should be used, such as leukocyte-raising drugs shark’s liver alcohol, leucovorin, vitamin B4. For those with severe leukocyte decline and risk of infection, granulocyte colony factor, such as Wheal blood, can be applied to bring back the number of leukocytes rapidly. Component transfusion or fresh whole blood transfusion may also be used. Those with a significant decrease in white blood cells have a significantly lower resistance and are prone to combined bacterial and viral infections, so attention should be paid to prevention. Those who have thrombocytopenia should pay attention to the presence of bleeding to prevent various injuries and prevent the occurrence of bleeding. In case of bleeding, hemostatic drugs should be actively applied. For those who have serious decline in blood picture, radiotherapy should be stopped and corrected in time, and antibiotics should be applied to prevent infection.
Does radiation therapy have any effect on the body’s immunity?
The radiation currently used in clinical practice, while killing tumor cells, inevitably affects normal tissues and diminishes the immune function of the body. Some patients need to do certain regional lymphatic system irradiation and high dose irradiation to certain immune organs (such as thymus) adjacent to the tumor during the treatment, and some need to do whole body irradiation, hemibody irradiation or whole lymphatic system irradiation, which makes the patient’s white blood cells drop and immunoglobulin level decrease, thus affecting the immune function.
How can patients protect the skin in the radiation area during radiation therapy?
In order to protect the skin in the radiation area during radiation therapy, tumor patients should wear loose and soft underwear, preferably cotton absorbent underwear, to reduce the stimulation of local skin such as friction and moisture. Keep the irradiated area clean and dry, and mark the irradiated field clearly and visibly; if it is blurred, it should be re-marked by the doctor. Do not apply adhesive tape, red mercury, iodine or other irritating drugs in the irradiated field, do not wash the area with alkaline substances such as soap, do not expose to the sun, etc. Avoid stimulation by all physical and chemical factors. Patients should pay attention to protect the skin in the radiation area to ensure its integrity for successful completion of radiotherapy.
What should I do if the skin in the radiotherapy area is itchy?
Radiation skin damage is a frequently encountered problem during and after radiotherapy, and it occurs in the neck, axillae and groin where the skin is thin, tender and multi-folded. The occurrence of radiation skin lesions is not only related to the anatomical structure of the local skin, but also to the total dose, split dose, total treatment time, type of radiation, external climatic conditions and the patient’s self-protection. In case of erythema, burning and itching sensation on the irradiated skin, gently pat the local skin with the palm of your hand. Apply 0.2% ice starch or sterile and dry talcum powder. During this period, the patient should expose, breathe and keep dry the skin in the radiation field, and avoid using petroleum jelly ointment or wet compresses. Minimize soap application and rubbing of the skin in the radiation field. Do not scratch with your hands to avoid aggravating the local skin damage.
What should I do if the skin at the radiation treatment site is peeling, erosion or oozing?
The physician should regularly check the skin reaction in the radiation field during the radiotherapy period. Once the skin becomes red, swollen or dry peeling, the radiation can be stopped for 2 to 3 days to avoid further development of skin damage and wet peeling. If the skin in the irradiated area becomes congested, edematous or even oozing and erosion, radiotherapy should be suspended. To keep the affected area clean and prevent infection, use ointment containing antibiotics and dexamethasone, such as chlorodi cream topical or wet compress with boric acid solution to make the lesion heal as soon as possible to resume treatment, available gentamicin, rehabilitation new wet compress after exposure therapy, can play a role in anti-infection, eliminate inflammation, edema, accelerate the repair of lesion tissue. Also can apply comfrey oil, prohibit the use of alcohol wipe. Wet burn cream is also very effective for skin damage caused by radiotherapy. For bacterial infections combined with skin breakdown, if it is light and limited, topical anti-inflammatory creams such as erythromycin and chloramphenicol ointment can be used; when the infection is heavy, anti-inflammatory drugs can be injected intramuscularly or ordered quietly. All in all, skin breakdown in the irradiated area is a normal reaction to radiotherapy, which can be cured as long as the patient cooperates with the doctor and is treated reasonably.
What are the issues that patients with head and neck tumors should pay attention to when undergoing radiation therapy?
Head and neck is a good site for tumor, and the occurrence of various tumors accounts for about 20% of the whole body tumors. Most of the malignant tumors in the head and neck area need radiotherapy at different stages of the treatment process. What should patients with head and neck tumors pay attention to when receiving radiotherapy?
Before radiotherapy, patients should consciously quit smoking, alcohol and other bad habits. On one hand, this can reduce the damage to normal tissues caused by radiation during radiotherapy, such as throat erosion and mouth ulcers. In addition, it can avoid the recurrence of tumor or the development of second primary tumor caused by the stimulation of smoking and alcohol. If the scope of radiotherapy includes the oral cavity, a dentist should be requested to conduct a comprehensive examination before radiotherapy to treat the lesions in the oral cavity, if necessary, in order to control the infection foci in the oral cavity, remove the residual tooth roots and repair dental caries. In case of oral surgery such as tooth extraction, radiotherapy should be considered at least 2 weeks after surgery.
During and after radiotherapy, the function of salivary gland is often reduced due to radiation, saliva secretion is decreased, and self-protection function of teeth is reduced, so besides dry mouth, patients are prone to infection in the oral cavity and radioactive caries. Therefore, patients should pay more attention to oral hygiene, rinse and brush their teeth after meals, and choose some fluoride toothpaste for toothpaste. Within 2 years after radiotherapy, oral surgery such as tooth extraction should be avoided as much as possible to avoid the occurrence of radioactive osteonecrosis caused by surgical trauma. If surgery is necessary, you can go to a specialist hospital for consultation. During and after radiotherapy, it is important to maintain regularity of life and improve physical fitness to avoid upper respiratory tract infections as much as possible, so as to avoid dilatation of submucosal capillaries and hemorrhage in the nasopharynx and nasal cavity due to upper respiratory tract infections. In the dry season of spring and autumn, peppermint and paraffin oil can be used in the nasal cavity to protect the local mucosa. After radiotherapy for nasopharyngeal cancer patients, the anti-infection ability of nasopharyngeal mucosa decreases and local mucositis is easy to occur, and the secretion increases sometimes with odor, so nasopharyngeal rinsing can be used under the guidance of physicians to relieve the symptoms. Some patients with healed nasopharyngeal cancer may develop temporomandibular joint ankylosis and surrounding muscle contracture, difficulty in opening mouth and other late radiation injuries. Therefore, after the radiotherapy course, patients can usually do some functional training to open and close their mouths.
What is the therapeutic significance of teeth cleaning for head and neck radiotherapy patients?
Oral reactions in patients undergoing head and neck radiotherapy are a common side effect due to the irradiation site and scope. When people eat or consume other foods, some food residues and bacteria inevitably remain in the teeth. When the radiation therapy reaches a certain amount, the salivary glands, blood vessels in the dental bed and dental pulp are damaged, causing local resistance to decrease and leading to infection, manifesting dry mouth, toothache, pulpitis, oral mucosal edema and oral ulcers. Therefore, it is very important to keep the oral cavity and teeth clean during radiotherapy to ensure the smooth implementation of radiotherapy.
Why should nasopharyngeal cancer patients practice mouth opening and closing exercises during radiotherapy?
Mouth opening restriction is a long-term radiotherapy reaction of nasopharyngeal carcinoma patients, and there is no special treatment. Patients should frequently do mouth opening exercises during and after radiotherapy to prevent fibrosis of masticatory muscles and surrounding tissues. Once mouth opening restriction occurs, patients should be instructed to perform functional exercises and pay attention to oral hygiene.
How to deal with oral and throat pain during radiotherapy of nasopharyngeal cancer patients?
Pain in the oral cavity and throat is the most common side effect of radiotherapy for nasopharyngeal carcinoma patients, which often starts to occur around 2 weeks after radiotherapy. In the early stage, the oral mucosa is congested and edematous, and there are dots and flakes of white film, and the patient shows dry throat, sore throat and difficulty in swallowing. To reduce the reaction, drink more water, keep the mouth moist, and rinse the mouth with oral Tai or Dobelle’s solution, and take oral Shuahe 25 mg 3 times a day. In case of severe mucosal reactions, such as oral ulcers, erosions, and interfering with eating, radiotherapy can be suspended and oropharyngeal spraying with Rehabin 20 ml, Gentamicin 240,000 U, and Lidocaine 100 mg three times a day half an hour before meals can be given. Antibiotics should be given intravenously if necessary, and oral hygiene should be observed.
What are the commonly used nasal rinse solutions?
Nasopharyngeal rinsing can remove secretions and shed necrotic tissues, prevent local infection, prevent mucosal damage, and enhance the penetration of radiation. Generally, the rinsing solution is saline, 2.5%-3% sodium borate solution or 2% hydrogen peroxide solution twice a day. Rinse once before each radiotherapy. For severe local inflammation, antibiotic rinses, such as gentamicin and butalbital kanamycin, can be added appropriately. For those with severe nasal congestion, ephedrine nasal drops can be used first followed by rinsing.
How to rinse the nasal cavity of nasopharyngeal cancer patients?
Put the front end of the nasopharyngeal irrigator with solution into one nostril gently, and the patient should breathe with open mouth and gently squeeze the nasopharyngeal irrigator with hands to make the irrigation solution flow into the nasopharynx slowly and out from the other nostril, alternating between the two sides. During the rinsing process, attention should be paid to.
(1) Nasopharyngeal irrigation should be performed once or twice a day.
(2) The pressure should not be too high when flushing to avoid complications.
(3) Do not talk while flushing to avoid choking and coughing.
(4) After rinsing, advise the patient not to blow the nose forcefully to avoid bleeding in the nasopharynx.
What should be done when cancer patients have oropharyngeal pain?
(1) Ask the patient to drink more water and eat warm soft food to reduce food irritation, and if necessary, use 0.2% procaine solution to gargle before meals to achieve surface anesthesia and facilitate eating.
(2) Gentamicin 240,000 U, dexamethasone 5 mg, saline 20 ml nebulized inhalation, twice a day.
(3) For those who have severe pain and cannot eat, intravenous fluid should be supplemented to ensure the nutrient supply of the organism.
Why will head and neck tumor patients have dry mouth after radiotherapy and how to prevent and treat it?
The saliva of normal people is secreted by parotid gland, submandibular gland, sublingual gland and especially parotid gland to keep the mouth moist and help digestion of food, while patients suffering from malignant tumor of head and neck are mostly in the radiation field when receiving radiation therapy. After receiving high dose of radiotherapy, the gland cells of normal glands cannot secrete enough saliva and the saliva becomes less and sticky, so the patient will feel dry mouth. This condition starts during radiotherapy and may last for the rest of the patient’s life. Although there is no good way to restore salivary function to normal, the following can reduce the symptoms.
(i) When planning treatment, physicians should use a variety of treatments to avoid irradiating glands such as the parotid gland or its high exposure if they can be avoided, especially if one side of the tongue, gingival and buccal mucosa cancers are present.
②Use various treatment plans, such as radiotherapy plus surgery, external radiotherapy plus inter-tissue insertion or intracavitary therapy, to control the dose of large area radiotherapy and enhance the local dose. Even if the damage of the gland is reduced. and the tumor can be well controlled.
③Patients drink water in small amount and many times during the treatment, and eat more vitamin-rich foods and fruits, such as vegetables, pears, watermelon, strawberries, etc.
④ Less spicy food and “tonic” (such as ginseng, etc.), avoid smoking and alcohol.
⑤ Pay attention to oral hygiene and rinse your mouth more often.
⑤ Cooperate with Chinese herbal medicine treatment to produce fluid and remove fire, such as fat sea, maitong, chrysanthemum, green tea brewing.
How to deal with the white film and rupture of oral mucosa during head and neck radiotherapy?
Patients suffering from head and neck tumors are not only treated in the tumor area, but also in the corresponding preventive treatment area, usually the oral cavity and pharynx are within the radiation treatment field, so the normal tissue area is larger. When the radiation therapy reaches 20-30 goreys, due to acute congestion and edema of oropharyngeal mucosa, patients will feel dry mouth and sore throat, especially when swallowing things, and many patients say “even swallowing saliva is difficult”. With the increase of radiation therapy dose, some mucous membranes break down to form ulcers, and some necrotic material is deposited there, forming a white film, which we call “white film”, and when the doctor examines, he will find congestion, erosion, ulcers and white film in the oropharynx, usually in the soft palate, buccal mucosa and other parts. At this time, the patient’s reaction is very heavy, and some patients do not even drip. At this time, for the patient should contain more rinses, keep the mouth clean, eat more light food, like milk, egg custard, rice porridge, pear water, watermelon juice, etc., avoid spicy food and tobacco and alcohol. For doctors, patients can be given large doses of vitamin B, C, E, etc. They can also take oral dicaine sugar cubes half an hour before meals to reduce pain in the lower throat to facilitate eating, and can also be treated with Chinese herbs such as fatty sea, chrysanthemum, maitake, etc. After the above treatment, most of the patients will gradually reduce their symptoms and can adhere to the treatment with the narrowing of radiotherapy field, only a few patients have very serious reactions due to various reasons to suspend radiotherapy. In this case, patients may have fever and localized septicemia, which can be treated with fluids and systemic anti-inflammatory treatment. Severe reactions are usually seen in patients with poor nutrition, weak constitution, high single dose of radiotherapy, rapid radiotherapy or combined chemotherapy.
Why do patients lose their hair during head and neck radiotherapy and will it grow back?
The high-energy radiation used in radiotherapy is very penetrating, and the size of the human head is limited, so the radiation can completely penetrate. As long as there is hair in the irradiated field of the head and neck or hair in the path of the rays, the rays will have an effect on the growth of hair follicles and will cause hair loss after a certain dose is reached. Hair will grow back after radiation therapy causes hair loss, but the time it takes for hair to grow back varies from person to person.
Why do patients with chest irradiation have pain in their throat when they eat?
Patients receiving radiotherapy to the chest, when the radiotherapy to 20 Gorey later, patients will have pain in the lower throat or discomfort behind the sternum, especially when eating buns, rice, this is because in the radiation field of the esophagus received radiotherapy, mucosal congestion, edema, this is generally a temporary phenomenon, through into the soft, light food, radiotherapy field changes, the above symptoms will be reduced or adapt, patients should not be anxious. If the symptoms worsen, radiation esophagitis, the patient can not eat, through the infusion, oral local anesthetic drugs, or even suspend radiotherapy and other methods to relieve the symptoms.
What systemic reactions will the patient have during radiotherapy. How to deal with them?
The common systemic reactions during radiotherapy include nausea and vomiting, loss of appetite, fatigue, etc. They are usually not very serious and are mostly caused by gastrointestinal dysfunction after radiotherapy, but also because the brainstem is irradiated or the radiotherapy field is too large, plus the patient’s mental tension, anxiety, pain, etc. can aggravate these reactions. You can take some gastrointestinal drugs, such as vitamin B6, gastrofacial or morpholine, pepsin, etc., to promote gastrointestinal peristalsis and digestion. In addition, we should establish the confidence to overcome the disease, strengthen the courage to fight with the disease, treat eating well as the first treatment, and make the diet with good color, aroma and taste, various kinds, easy to digest, no special smell, and make some exercises after meals. If the reaction is very serious, it can be solved by combining with infusion, static antiemetic drugs, or even temporary suspension of treatment. In addition, the decrease of white blood cells and platelets is also one of the systemic reactions, which can be treated with blood-supplementing foods such as pork liver, pig’s feet, blood-raising drugs and Chinese medicine, and if necessary, transfusion of component blood and suspension of radiotherapy.
To what extent should the white blood cells and platelets drop to stop radiotherapy?
When patients receive radiotherapy, especially when irradiating large areas of flat bone, bone marrow, spleen and large areas, such as whole lung radiotherapy, whole pelvis radiotherapy and whole abdomen radiotherapy. The hematopoietic system is affected resulting in a decline in whole blood cells, such as white blood cells and platelets. The decrease of leukocytes and platelets to a certain degree will affect the human body and have certain harmful effects, such as the patient feels general weakness, which can easily lead to serious infections or even sepsis, and has a tendency to bleed, resulting in internal organs and intracranial bleeding leading to death. Therefore, when the white blood cell is less than 3 × 109/liter and platelet is less than 70 × 109/liter, radiotherapy should be suspended, and the blood is raised for symptomatic treatment, and the treatment can be started after the blood picture recovers. However, when the radiation field is small, such as radiotherapy for pituitary tumors, or when the radiation field does not include the hematopoietic system, such as radiotherapy for the neck and radiotherapy for soft tissues of the extremities, if the white blood cells are less than 3 × 109/liter but more than 2 × 109/liter and platelets are less than 70 × 109/liter but more than 50 × 109/liter, radiotherapy can still be continued, but the changes of blood cells should be closely monitored, and if there is a gradual decline, radiotherapy should be stopped immediately. If the trend is gradually decreasing, then radiotherapy should be stopped immediately and blood raising therapy should be strengthened.