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Head and Neck Cancer: Swallowing Basics

People who receive treatment for head and neck cancer can have difficulty swallowing at different points in time of their cancer treatment. The causes of swallowing difficulty can be complex and related to multiple factors: tumor growth resulting in injury to normal tissue, surgery-induced damage to the oral and/or pharyngeal (throat) muscles, and/or excessive scarring from radiation.

BEFORE beginning cancer treatment

Get to know your health care team and ask your questions: physicians, oncologists, otolaryngologists, speech-language pathologists, etc.

It may be beneficial to meet with a speech-language pathologist (SLP) before beginning treatment to discuss swallowing expectations and recommendations.

Knowing the oral and pharyngeal swallowing exercises before beginning treatment can reduce the burden of learning new information when you begin to experience changes caused by the treatment

Other specialists to meet with before beginning treatment may include:

  • Dietitian: to discuss ways of maintaining adequate nutrition and hydration during your treatment.
  • Dentist: to determine if any pre-treatment dental work is needed. In some cases, dentists may recommend extraction of some teeth


Swallowing difficulty DURING cancer treatment

Many people develop difficulty swallowing during the course of their radiation or chemotherapy treatment due to some of the side-effects from these cancer treatments.

Complications of radiation therapy may include the following:

  • Mucositis- inflammation of oral tissue resulting in ulcerations or sores
  • Dermatitis- inflammation of the skin
  • Xerostomia- dry mouth
  • Nausea and/or pain (resulting in decreased desire to eat)
  • Altered taste and sensation (resulting in decreased desire to eat)


What can you do?

Maintain good oral hygiene- keep the mouth as clean as possible to minimize oral bacteria and the severity of mouth sores.

  • Try to avoid carbonated beverages, citrus flavored juices, punches, tea, or any liquid containing sugar
  • Try to avoid using any liquid with an acidic pH as an oral moistener
  • Brush your teeth with a soft toothbrush at least 2-3 times a day
  • Use fluoridated toothpaste
  • Floss at least twice a day
  • Use a topical fluoride rinse or gel daily

Preventative oral and pharyngeal exercises- research shows that doing exercises during cancer treatment can help minimize swallowing difficulty later (Carnaby-Mann et al 2012, Duarte et al 2013). Contact your speech-language pathologist to learn more about recommended exercises.

Keep swallowing sips of water throughout the treatment. It helps hydrate the tissue in your mouth and most importantly keeps the muscles in your mouth and throat moving so they don’t become weak.

If possible, try to consume a ½ cup of food or drink a day during your treatment. Swallowing is the best exercise for swallowing.

Meet with a speech pathologist (SLP) periodically during treatment. An SLP can suggest strategies and make food suggestions to assist with swallowing.


Swallowing difficulty AFTER cancer treatment

Some people can develop difficulty swallowing months or years after cancer treatment due to delayed effects of radiation therapy called late radiation-associated dysphagia (RAD).   This can result in the following:

  • Xerostomia- dry mouth
  • Trismus- reduced opening of the jaw/mouth
  • Hoarseness
  • Stiffness (fibrosis)
  • Strictures- areas of tightness that form inside the throat or esophagus


What can you do?

Many over the counter products, such as mouth rinses or toothpaste specifically for dry mouth, are available that can offer some relief from xerostomia.

A speech pathologist can provide you with exercises and stretches to help with reduced mouth opening and stiffness.   An SLP can also give you suggestions to help with eating and drinking.

An SLP or ear, nose and throat doctor (ENT) can evaluate your vocal cord functioning and may be able to treat hoarseness.

An ENT and/or a gastroenterologist (GI doctor) may be able to stretch any strictures that have formed in your throat or esophagus.

A dietitian can make dietary recommendations to help maintain your nutritional needs


This is more voice than swallowing related, but newer radiation treatment equipment (e.g., Intensity-Modulated Radiation Therapy (IMRT)) has the advantage of targeting the radiation on the tissue which is to be radiated while sparing tissue near it where radiation is not warranted. If the radiation that you are receiving is near your voice box, talk to your radiologist about ways to protect your vocal cords from unnecessary radiation damage. This simple discussion could literally save your voice.