During head and neck cancer treatment, a time comes when eating by mouth suddenly becomes hard. The throat and mouth that radiation has passed through are raw, saliva dries up, and every swallow stings as if cut by a knife. When the medical team suggests, at such a time, passing a thin tube through the nose or the abdomen, most people are flustered. It is natural for the first thought to be, "Will I never be able to eat by mouth again?" Yet a feeding tube is usually closer to a temporary bridge for getting over the hurdle that is treatment. If weight drops and strength fails, you cannot properly finish chemotherapy or radiation in the first place — so the tube is essentially a supporting device that helps you endure that period.
Tubes are broadly divided into two kinds. A nasogastric tube (L-tube), passed through the nose down to the stomach, is chosen for relatively short-term use, while a gastrostomy tube (PEG), which makes a small opening in the abdomen and connects directly to the stomach, is recommended when it looks like it will be needed for several weeks or longer. Either way, the core is the same: steadily delivering, in liquid form, the calories, protein, and fluids that cannot be swallowed by mouth. One person said it felt miserable at first to "live by tube," but about two months later, once radiation ended and appetite returned, they began spooning up porridge again, one bite at a time. So there is no need to look too far ahead and be frightened.
The nutrition that goes through the tube cannot be just anything blended up. Commercially sold enteral formula (a commercialized balanced nutrition diet) has a consistent concentration and viscosity, so there is less risk of the tube clogging, and the ratios of calories, protein, and electrolytes are also balanced. If you are blending food at home, you must set the concentration in consultation with a dietitian, and it is important to make a habit of straining it through a fine sieve so no lumps remain. The infusion rate must not be ignored either. If it all goes in at once, the belly swells tight and diarrhea or nausea easily follows, so you adjust it by going slowly at first and increasing the amount little by little as the body adapts. Flushing the inside of the tube by running 30 to 50 cc of lukewarm water through it before and after feeding can considerably reduce clogging.
When you actually handle it at home, you get stuck on the small things. When giving medicine, dissolve the powder thoroughly and, if possible, switch it to a syrup or liquid form to be safe. During infusion, it is good to keep the upper body raised to about 30 to 45 degrees in a seated posture. If you feed while lying down, there is a risk of reflux carrying it over into the lungs. Even after the feeding ends, do not lie flat right away for about 30 minutes. If you have a PEG, make a habit of checking the abdominal skin where the tube enters every day for redness, sores, or oozing. For those using a nasal tube, gently shifting the position of the tape-fixed skin on the bridge of the nose once a day also helps keep it from getting raw.
And what must not be forgotten is that getting nutrition through a tube does not mean you can let go of mouth care. If you do not eat by mouth, saliva secretion drops further, the mouth dries out, and fungal inflammation easily develops. Rinse frequently with lukewarm saline or a prescribed gargle, and keep your lips moisturized. If you keep up the practice of swallowing even a sip of water or a spoonful of ice cream by mouth, within the range your doctor permits, your swallowing muscles will be less stiff later when the tube comes out. Recovery is not a straight line but a jagged curve, so on some days it goes in well and on others nausea rises. That is not failure but part of the process.
If your weight keeps dropping by 1 to 2 kg a week, if you vomit severely every time you feed and the diarrhea will not stop, or if the area around the tube swells and runs a fever, do not endure it alone — tell the medical team right away. What is written here is for reference in grasping the broad flow; the actual type of formula, amount, and rate are set by your attending medical team and dietitian to match your condition.
This article is intended to convey general medical information in an accessible way and does not replace individual diagnosis or treatment. Please be sure to consult your own physician for any specific decisions.