Paul,

Here are a few areas the radiation oncologist should cover (and you should ask about in any event):

1. Dental issues -- Since radiation tends to make your teeth and gums more vulnerable down the road, your doctors may want to deal with any existing dental problems now to get them out of the way. However, if anyone suggests pulling a number of teeth as a "preventive" measure, I'd be skeptical and get another opinion. FYI -- 16 years after radiation, I still have all my original teeth.

2. Nutrition -- The effects of radiation can creep up on you (frequently somewhere around the midpoint of treatment, if not sooner). Dry mouth and increasing soreness in the lining of your mouth can making eating very difficult. You should have a nutrition consultant readily available to help with any specific issues you may encounter, and if you need a PEG tube to help with feeding, your doctors should be prepared to give it to you. In the meantime, I'd suggest "bulking up" a bit in anticipation of this. There are many suggestions on this site for a variety of foods that are easy to swallow (and fairly high in calories) to help you get through the radiation phase.

3. Saliva issues -- For the long term, you want to preserve as much of your salivary function as possible to help with eating, speaking and overall dental health. As Marica mentioned, it's possible that your doctor can use IMRT, which is a form of radiation that can lessen the permanent effect of radiation on salivary glands. However, even if you find that IMRT isn't an option for you, there are various medications that can help to counteract the dryness problem. I had a number of salivary glands removed during surgery, and IMRT wasn't even available when I had radiation, but over time I've been able to get back a reasonable amount of saliva with medication.

4. Fatigue -- It's impossible to know in advance how your system will respond to radiation. Some people find that they can continue to work (at least part-time), while others find it really disabling for some period of time. Ask your doctors about what they've seen with patients in situations similar to yours, and try to have a plan in place, in case you need it, with friends/family who can help with errands, etc. during your treatment.

This list isn't all-inclusive, but it's indicative of some of the issues you should plan to discuss. Please keep us posted on how your consultation goes, and what your doctors are recommending for you.

Cathy