Preparing for head and neck cancer treatment
You will see different specialists before head and neck treatment. They help prepare you for the effects of treatment and give you advice.
You are more likely to get tooth decay if you have radiotherapy to the mouth area and salivary glands. If you have time before your treatment begins, you should have a complete dental check-up and have any dental work you may need.
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 are going to have radiotherapy and some of your teeth are unhealthy, you may need to have these removed before you start treatment.
Your doctor may also refer you to an oral hygienist. They can give you advice on how to look after your teeth and gums. Knowing how to look after your mouth is very important. This is because cancer treatment may make it more sensitive and likely to get infections, particularly if you have radiotherapy.
Before having surgery or radiotherapy, you see a dietitian or speech and language therapist (SLT), or both. They can help with any swallowing, dietary, voice or speech problems you may have before treatment. They can also tell you about the effects treatment may have on swallowing and speaking, as well as what can be done to help.
Some people with a head and neck cancer have difficulty eating and may changes in weight. While you are waiting for treatment, it is important to eat as well as possible. You can use food supplements if needed. Increasing how much food you eat will help slow down weight loss and help you cope better with the treatments.
Sometimes radiotherapy can lead to severe difficulty in swallowing, particularly if it is combined with chemotherapy (chemoradiation). Usually this settles within a few months of finishing treatment. It can help to changes in weight before treatment starts.
If your cancer specialist thinks you may develop swallowing difficulties, they may suggest you need to be fed through a tube for a while, to ensure you have enough calories to maintain or gain weight.
There are different ways you can be fed by a tube:
- Nasogastric (NG) feeding – a thin tube is passed up the nose and down into the stomach. It is used for shorter periods of time, for example less than 4 weeks.
- Gastrostomy feeding – a tube is passed through the skin and muscle of the tummy (abdomen) into the stomach. This is called a percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) tube, depending on how it is put into the stomach. This is usually used if tube feeding is needed for a longer period of time.
If you have swallowing problems and need tube feeding, your oncologist will explain which type is best for you. Once your swallowing improves, and you are able to eat more through your mouth, the tube can usually be removed.
You may need to go home with a feeding tube. If this happens, your dietitian, SLT or a nurse in hospital can teach you and your family members or friends to use and look after it safely. You can also have daily home visits from community nutritional care nurses, who can help with feeding tube care and setting up the feeds.
We have more information about nutritional support and artificial feeding.
If you smoke, there are lots of benefits of stopping smoking before treatment. Stopping smoking:
- increases the chances of your treatment being effective
- means you are likely to have fewer side effects from cancer treatment
- means the side effects of treatment may be less severe
- may reduce the risk of cancer coming back after treatment
- reduces your risk of developing a second cancer in the head or neck, and of developing cancer in other parts of the body, such as the lungs.
Your GP can also give advice. They can provide nicotine replacement therapies on prescription, such as nicotine patches, gums and inhalers.
We have more information about giving up smoking that you may find helpful.
Below is a sample of the sources used in our head and neck cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
British Association of Head and Neck Oncologists. Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines. 2016. Available from: https://www.bahno.org.uk/_userfiles/pages/files/ukheadandcancerguidelines2016.pdf (accessed September 2018).
Brockstein BE, Stenson KM, Song S. Overview of treatment for head and neck cancer. UpToDate https://www.uptodate.com/contents/overview-of-treatment-for-head-and-neck-cancer (accessed Spetember 2018).
National Institute for Health and Care Excellence (NICE). Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. 2016. Available from: https://www.nice.org.uk/guidance/ng36 (accessed September 2018).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.
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