Before treatment starts

Before treatment starts you will see a dentist, a dietitian or a speech therapist. Your doctor or nurse will also give you advice on stopping smoking and drinking.

Dental care

You are more likely to get tooth decay if you have radiotherapy to the mouth area and salivary glands. So you should have a complete dental check-up and have any dental work you need before your treatment begins.

Your cancer doctor may refer you to a dentist with experience in treating people who have head and neck cancers, or you may be asked to see your own dentist. If you’re going to have radiotherapy and some of your teeth are unhealthy, you may need to have these removed before you start treatment.

You may also be referred to an oral hygienist. They can give you advice on how to care for your teeth and gums. Knowing how to care for your mouth is very important because cancer treatment may make it more sensitive and prone to infection, particularly if you have radiotherapy.

We have more information about looking after your mouth and teeth, during and after treatment.

Speech, swallowing and eating

You will be seen by the dietitian and/or the speech and language therapist before having surgery or radiotherapy. They can help with any swallowing, voice, speech or dietary issues you may have before your treatment. They will also tell you about the likely effects that treatment may have on swallowing and speaking, as well as what can be done to help.

Some people with head and neck cancer have difficulty eating and may lose some weight. While you’re waiting for treatment it’s important to eat as well as possible. You can use food supplements if needed. Increasing your calorie intake will help to slow down weight loss and help you cope better with the treatments.

Sometimes radiotherapy can lead to severe difficulty in swallowing, particularly if it’s combined with chemotherapy (chemoradiation). Usually this settles within a few months of completing treatment. It can help to put on a bit of weight before treatment starts.

If your oncologist thinks you may develop swallowing difficulties, they may suggest a small operation to put a tube through the skin of your tummy into your stomach. This is so you can be fed through the tube for a while. It is known as a PEG (percutaneous endoscopic gastrostomy) tube or RIG (radiologically inserted gastrostomy) tube. Once your swallowing improves, and you are able to eat more through your mouth, the tube can usually be removed.

Smoking

If you smoke, stopping smoking will increase the chances of your treatment being effective. Continuing to smoke increases treatment side effects and the risk of the cancer coming back. Smoking also increases your risk of developing a second cancer in your head or neck, and of developing cancer in other parts of your body, such as your lungs.

Smoking can be a difficult habit to break, especially when you’re stressed. There are organisations and self-help groups that can help you. Your doctor or specialist nurse can also give you help. Your GP can give advice and provide nicotine replacement therapies on prescription, such as nicotine patches, gums and inhalers.

Alcohol

Avoiding alcohol will also help make your treatment more effective and reduce the risk of side effects.

If you’d like support to help reduce your alcohol intake, your specialist nurse or doctor can arrange this for you.

I had my four back bottom teeth removed prior to radiotherapy. The rest of my teeth appear to have stood up to the trauma fairly well because I followed the hygiene advice I was given before treatment began.

Gary

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