My mother is suffering from neck and tongue cancer. Doctor suggested radiation and chemotherapy and we have completed the treatment successfully before six months. But until now, the process of saliva in the mouth is not started yet. Can you prescribe some medicine for it? And we are worried about the future. If possible, can you suggest some medicine, so that we can prevent this in the future? Please suggest.
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As per your information, your mother has undergone chemo-radiotherapy for carcinoma tongue with lymph nodes. So while delivering the radiation dose to cancer, the parotid (salivary gland) gland was also exposed to radiation leading to radiation-induced xerostomia (decreased saliva production post-radiation).
It is a common side effect of head and neck radiation (I do not have information about what radiation dose was delivered to both the parotid gland and which radiation technique (IMRT or 3DCRT) was performed for the treatment).
To stimulate salivary production with some degree of residual salivary parenchyma,
1. Patients need to chew gums or suck pastilles and lozenges.
2. Tablet Cevimeline 30 mg three times a day (TDS) for 12 weeks.
3. Artificial saliva spray is another option if salivary production is not stimulated using tablet Cevimeline. (Tell her to drink the right quantity of water at least 2-2.5 liters/day).
As per the CT (computerized tomography) scan report (dated June 2020), there is soft tissue fullness on the right side of the palate (post-treatment changes or residual disease) for these. You need to consult your primary doctor who has performed the radiotherapy to cross verify the CT finding.
Chemo-radiation induced xerostomia.Investigations to be done:
Salivary flow function using sialometry.Probable diagnosis:
Radiation related xerostomia.Treatment plan:
Chewing gums or sucking pastilles and lozenges. Tablet Cevimeline 30 mg thrice daily (TDS) for 12 weeks. (important: crosscheck for the drug interaction with any other drug that she is taking for another co-morbidity with your treating doctor). Topical application of artificial saliva (salivary substitute). Consult a dentist to perform investigation (sialometry to check for salivary flow) pre and post-treatment after taking tablet Cevimeline.Preventive measures:
Tablet Cevimeline (side effects: sweating, increase in the frequency of urine, nausea, headache). Consult a doctor if you have any of these symptoms. It is contraindicated in asthmatic patient and in glaucoma, and may cause a change in the vision at night. The patient needs to drink at least 2-2.5 liters of water to prevent dehydration.
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