Need help -- excess foamy saliva production when eating

Dear Diana

As usual, those of us who read this site, are always sad to see another person post about their new diagnosis of Esophageal Cancer.  Having read this site for quite some time now because my own husband is a survivor of EC Stage III (T3N1M0), it really is distressing when we see the cancer diagnosed as Stage IV.  Having spent more than an hour trying to find some answer for you, I must tell you that I have read many complaints from Esophageal Cancer patients relative to this white foamy substance.  I can tell you that even EC patients that have had the surgery have this problem from time to time but not on a “regular” basis.  Post-op patients still have problems with acid reflux and sometimes aspiration. 

So far, I have not read of a solution to this problem.  It is definitely related to having Esophageal Cancer, and patients write about it from time to time.  Below my name is an old post from this site where several are writing about the same problem.  They are all Stage IVs.  Years have passed but I remember this discussion when it was written, and really there were NO definitive concrete answers.  So I will put that link down for your information.

If I could offer any advice, it would be that if my husband had a recurrence, he would then be diagnosed as Stage IV.  Thankfully, this is a hypothetical presently. But, if it did happen, and if he had difficulty with food intake, I would ask the doctors to insert a J-tube.  Hydration would be very important as well.

As for the “J-tube”, my husband had one put in place during his surgery.  He kept it in for 3 weeks after his surgery, because one’s food intake is greatly diminished.  I remember 2 Tablespoons full of Cream of Wheat was his “first meal.”  The J-tube was there for that reason.  It is inserted into the second section of the small intestine known as the Jejunum.  From there all the nutrients are distributed throughout the body and the patient can have proper nutrition from the supplements.  This is a surgical procedure performed by a doctor in the OR. 

A patient may have a G-tube put in place, but this is more cumbersome, plus it puts the food directly into the stomach instead of the small intestine.  (My opinion)  And has been the case, some with G-tubes have experienced problems with the stomach not emptying properly, and that in turn caused other problems.  Understand that I am not a doctor, and all that I say should be discussed with your doctor.  But we are allowed to relate our personal experiences which can be greatly beneficial for new patients.  

Diana, I am sorry on two counts—one that your husband has been diagnosed as Stage IV, and two—that I can’t really help you with a definitive answer, which is always my desire here. 

Sincerely,

Loretta Marshall

P.S.  A few links here that will let you know that this is often a problem with Esophageal Cancer patients.   So far I haven’t read about a “slam-dunk solution.”

1.  http://www.buzzle.com/articles/coughing-up-white-mucus.html

“…Most of the time, this condition is related to GERD.   Gastroesophageal Reflux Disease relates to a condition where the fluids from the stomach flow backwards to the esophagus which is the tube connecting the stomach to the mouth. This irritates the throat and causes white phlegm along with other symptoms like chest pain, sore throat, sensation of lump in the throat, etc…”

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2.  https://csn.cancer.org/node/224856

This particular discussion was on “increased mucus” and they are all Stage IV patients or caregivers.  None of these people are currently posting on this site. 

Here is one comment from “Rose20” whom I happen to have corresponded with in the past but she no longer posts here.  She writes:

“…My brother has stage 4 cancer and he had the phlegm so very bad...this is finally what helped him, mucinex and muguard and getting hydration twice a week and also lowering his chemo…And since they lowered the dosage of chemo he seems to be doing much better.  And the hydration has done wonders…”

“Cher76” shares the experience with her Stage IV husband…

“…My husband’s doctor prescribed a medication called glycopyrrolate to help keep down the mucous secretions. This has worked fairly well. I also think sleeping elevated at night helps too…”

3.  http://www.ncbi.nlm.nih.gov/pubmed/15681902

Sialorrhea: a review of a vexing, often unrecognized sign of oropharyngeal and esophageal disease.

Boyce HW¹, Bakheet MR. Author information ¹Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida College of Medicine, Tampa, FL 33612, USA. wboyce@hsc.usf.edu

“Abstract - …On the other hand, sialorrhea or ptyalism, the condition of increased salivary flow, is rarely discussed in the clinical literature.

Sialorrhea can occur with various neurologic disorders, infections, the secretory phase of the menstrual cycle, heavy metal poisoning, Wilson disease, Angelman syndrome, as well as a relatively unknown condition called idiopathic paroxysmal sialorrhea. Normal salivation may be altered by drugs (such as clozapine, risperidone, nitrazepam, lithium, and bethanecol) that have a cholinergic effect that induces sialorrhea.

This report focuses on sialorrhea as it relates to disorders of the oropharynx and esophagus. The patient typically recognizes a problem with excessive "foamy mucus" but does not understand its origin.

Infections and obstruction are the most common oropharyngeal causes. Increased salivary flow occurs as a typically subtle manifestation of gastroesophageal reflux disease. This occurrence is referred to as water brash. Idiopathic achalasia and megaesophagus due to the parasite Trypanosoma cruzi are regularly associated with sialorrhea.

Esophageal obstruction (foreign body, cancer, or stricture formation), infection, and nasogastric intubation are the more common conditions associated with the symptomatic sequelae of sialorrhea.

Sialorrhea-related respiratory and pulmonary complications are greatest in those with a diminished sensation of salivary flow and hypopharyngeal retention. Extremes of age, the chronically debilitated, or those in chronic care facilities, especially associated with cerebrovascular accidents and esophageal cancer, typically comprise this population…” -

4.  http://www.healthpages.org/anatomy-function/anatomy-function-digestive-system/

“Anatomy and Function of the Digestive System

The digestive system is an essential to the human body. It helps break down the foods we eat into smaller components that can be absorbed by the cells in our body for energy. This process is known as digestion. The process of digestion involves grinding of the food, moving food through the digestive tract, breaking down large molecules, absorption of nutrients into the blood and removing waste from the body. The digestive system is made up of the digestive tract and the digestive organs—a group of organs that each has its own job in the digestive process. The digestive tract is one long tube that starts at your mouth and ends at the anus. In a fully grown adult, the digestive tract is about 23 feet long.

This one long tube of the digestive system—the digestive tract—includes the esophagus, stomach, small intestine and large intestine along with accessory organs like the liver, gallbladder, pancreas, and salivary glands. The digestive tract of a normal adult human being is about 30 feet long. The accessory organs make enzymes and chemicals that help digest food. It takes several days for food to pass all the way through the digestive tract…

Jejunum Function - The second (middle) section of the small intestine is a coiled tube which is thicker and more vascular than the ileum. It lies in the belly button area of the abdomen. There are small fingerlike projections in the wall of the jejunum called villi. These villi are covered with smaller projections called microvilli. The villi increase the surface area of the jejunum and allows much more absorption of nutrients in this part of the small intestine—most of the food absorption is done in this part of the digestive tract. Simple sugars, water soluble vitamins (except vitamin C and some Bs) and amino acids made from the food is passed from the villi into the blood stream while the fat is passed into the lymph capillaries. The rest of the food passes into the ileum…”

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