Changes to eating and drinking

Surgery or radiotherapy for head and neck cancers can change how you eat and drink. Many people find this gets easier after treatment finishes. This is because side effects such as pain, swelling, feeling sick and tiredness start to get better.

Who can help?

If you have eating problems, you will usually be supported by a speech and language therapist (SLT). They can teach you exercises and techniques to help you chew and swallow.

You may also see a dietitian who can advise you on how to increase the nutrients and calories in your diet. They may give you high-calorie supplement drinks if you have lost weight. Supplement drinks are high in sugar and are usually only used for a short period of time. This is to avoid long-term damage to teeth and jaws.

It can take a lot of effort and patience to overcome eating difficulties. If you have found eating difficult for a while, you may no longer associate food with pleasure. Taste changes may reduce your desire for food and affect your appetite.

Talk to your SLT or dietician if you feel this way. They may use different coping techniques, such as mindful eating, to help you enjoy food again. These techniques can help you to feel more relaxed at meal times and find things about eating you can still enjoy.

We have information about what to eat to increase your weight after cancer treatment.

If you have a feeding tube

Some people have a feeding tube put in before, during or after treatment for head and neck cancer. The tube is usually temporary. It may be in for a few weeks or for several months or more after treatment. A small number of people will have a feeding tube in permanently.

A feeding tube may be placed either:

  • directly through the stomach, called a PEG (percutaneous endoscopic gastrostomy) or RIG (radiologically inserted gastrostomy) feeding tube
  • through the nose and into your stomach (nasogastric) and used only for a short while.

A dietitian will provide support while you have the feeding tube in. They can help you with any problems that you may have with it. You may also have a specialist nurse to support you.

You will be encouraged to continue to eat and drink, even if you have a feeding tube in. This is important as it keeps the swallowing muscles working during radiotherapy and while you are recovering. Your SLT will help you to try to eat food again. They will start you on food with a texture that is easier to swallow, and then gradually increase the amount and variety of textures.

You may have days when you cannot eat anything. It is common to have a setback before your eating begins to get better. The feeding tube can normally be taken out when:

  • you have not needed to use it for a few weeks
  • you can get enough calories by eating and drinking normally.

How treatments can affect chewing and swallowing

Mouth stage

Surgery for mouth cancer can affect chewing and the mouth stage of swallowing. If only a small amount of tissue is removed, the effect on chewing may be small. You will probably adjust quite quickly. If a lot of tissue is removed, or if some or all of the tongue or soft palate is removed, you may have longer-lasting changes.

If you had teeth removed, your ability to grind food while chewing may change. This can also happen if you have dentures that no longer fit.

Surgery or radiotherapy can affect the muscles and nerves that control the lips, tongue or other parts of your mouth. This may make it difficult to control food and fluid in your mouth or sense where food is in your mouth.

Jaw stiffness or a dry mouth also cause difficulties with chewing and swallowing.

Throat stage

Surgery to the voicebox (larynx) mainly affects the throat stage of swallowing. Swelling in the throat caused by a build-up of fluid in the tissues (lymphoedema) can also affect swallowing.

Radiotherapy may make muscles and tissues in the throat and gullet weaker and less stretchy. This can make it harder to swallow some foods or cause certain foods to stick in the throat. If nerves that control the muscles in the gullet are affected, they may be less able to move food downwards.

The upper part of the gullet may become narrower after radiotherapy. Any nerve damage may make it harder for you to know whether there is food in the gullet.

Problems with swallowing can cause food or drink to go down the wrong way into the windpipe. This is called aspiration. It can cause choking and may lead to chest infections.

Sometimes swallowing problems develop months or years after radiotherapy. This can happen if scar tissue in the throat makes the swallowing muscles tight and hard. This is called fibrosis.

When to contact your speech and language therapist or dietician

Tell your speech and language therapist (SLT), specialist nurse or doctor if you have difficulty swallowing or if you are experiencing:

  • drooling or dribbling when eating
  • food coming down your nose
  • food getting trapped in one side of your mouth
  • biting your tongue or the inside of your cheeks
  • a feeling that you have too much saliva
  • food sticking in your throat
  • choking or coughing when eating or drinking
  • a wet, or gurgly-sounding voice
  • repeated chest infections
  • weight loss.

Help with chewing

You may be able to have treatment to help with chewing. The type of treatment you have depends on what is causing the problem. Problems could be caused by:

  • a change in the shape of your mouth
  • tooth loss
  • jaw stiffness
  • dry mouth
  • loss of sensation.

It is important you are assessed by either a surgeon, a restorative dentist or a speech and language therapist (SLT).

Restorative dentistry

Changes to your bite or to the tissues inside your mouth may affect your ability to eat or speak. A restorative dental consultant (restorative dentist) may be able to help.


After surgery to the roof of the mouth (maxilla), some people have an opening between the roof of the mouth and the nose. You may be able to have restorative surgery to help with this.

A restorative dentist can cover the opening with a special type of dental plate called an obturator. This stops food, fluid and air passing between the nose and mouth. Some obturators have a speech bubble at the back to help with speaking.

If you need an obturator, you will usually be fitted with a surgical obturator at the time of your cancer surgery. It is replaced with a temporary obturator a few weeks after your operation. This is because as the tissues in the mouth heal after surgery. They get smaller until they reach their final size and shape. This can take 6 months or longer.

Once your mouth has healed into its final shape, the restorative dentist will make you a longer-term obturator. Your mouth will continue to change shape over the years. Your obturator will need replacing when it starts to feel uncomfortable.

You will have regular appointments to check the obturator fits well and feels comfortable.

It is important to let your restorative dentist know if you have any problems with how well the obturator fits between these appointments. As the tissues in your mouth settle, they may need to adjust the fit from time to time.

Dental rehabilitation

If you had any teeth removed before surgery or radiotherapy, the restorative dental consultant will assess you for follow up dental care. You may need to be managed for gum disease. Or you may need removable dentures, bridges or implants. This will depend on the needs of your mouth and the type of cancer treatment you have had.

Exercises to improve chewing

Your SLT will assess the problems you have with your chewing. They may arrange for you to have tests to help find out the best way to treat any problems.

They may give you exercises to strengthen your lips, tongue and other muscles in your mouth. There are also exercises you can do to help stimulate parts of the mouth that have lost sensation.

Your SLT may give you chewing aids such as Chewy Tubes® to help you practise biting and chewing. Or they may give you spoon-shaped devices such as Ora-Light® to exercise the lips and tongue.

They may also advise you to eat soft, moist foods. Depending on what is causing the chewing difficulties, you may find it easier to chew larger or smaller amounts of food. Your dietician can also give you more advice on this.

Help with swallowing

The type of treatment you have depends on which parts of the the swallowing process you are having problems with. Your speech and language therapist (SLT) will do a clinical assessment of your swallowing. You may need to have a swallowing test to show what happens when you swallow.

There are 2 tests that can be used to assess swallowing. Your SLT will decide which test is best for you. These are:

  • Videofluoroscopy (VF)

    A VF is a special x-ray test which shows:

    • if anything gets stuck in your throat
    • if any food or drink goes down the wrong way when you swallow.

    This helps your SLT see how they can make swallowing safer and easier for you.

    This test is done in the x-ray department by a radiographer and your SLT. It takes about 30 minutes and is painless. The x-rays are recorded on video or DVD.

    They may also ask you to try different techniques to see if they help when you swallow.

    They will ask you to swallow different foods of different textures. This might be:

    • liquid or food with a semi-solid texture, like yoghurt
    • food with a solid texture, like a biscuit.

    A special substance is added to the food to make it show up on the x-ray.

  • Fiberoptic endoscopic evaluation of swallowing (FEES)

    A FEES is another test to show what happens in your mouth and throat when you swallow. Your SLT passes a thin, flexible tube through the nose to look at the back of the throat. The tube contains a small camera which records your swallowing while you eat and drink. The test takes about 10 to 20 minutes.

After having a swallowing test

After your tests, your SLT will meet with you to discuss the results of the tests. The tests help them to recommend exercises and other ways to make swallowing easier for you. They will also advise you eat moister foods, which may be easier to swallow.

It may help to bring a partner, family member or friend with you when you see your SLT. They can learn about exercises and techniques you need to use or changes to food you may need to make.

Your SLT may suggest: 

  • how to position your head and neck when swallowing
  • swallowing techniques
  • exercises to strengthen swallowing muscles
  • eating and drinking thinner or thicker foods or liquids
  • changes to the way you prepare and cook food
  • taking time to eat and swallow
  • coughing to clear your airway after you swallow
  • coping strategies to help you adjust to changes to eating and drinking.

If your SLT gives you swallowing exercises, you will need to do them regularly to get the most benefit. Apps such as iSwallow® can help guide you through swallowing exercises, remind you when to do them and keep track of how often you do them. Always talk to your SLT before using any apps.

Stretching the gullet (oesophagus)

Radiotherapy to the head and neck area can cause the top of your gullet to narrow. This may be shown on a videofluoroscopy (VF). You may be offered a quick procedure to make swallowing easier. A doctor puts a tube down into the gullet to stretch it. This makes more space for food and fluid to pass through. You can have this done as an outpatient.

You usually have a local anaesthetic for this procedure. But it is sometimes done under general anaesthetic. Your doctor can tell you what the possible benefits and risks are.

Taste changes

Radiotherapy to your mouth can affect your sense of taste. A lack of saliva can also affect your taste buds. Some treatments can change your sense of smell, which can affect taste.

Most foods may taste the same or you may dislike the taste of certain foods. Some people can taste the first few bites of food and then find the taste gets weaker. These changes can lower your desire for food and affect your appetite.

Usually, your sense of taste gradually improves after treatment ends. But sometimes it can take a year or more. If you have taste changes, tell your doctor, dietitian or specialist nurse. They can offer advice and support.

Read more about our tips for coping with taste changes.

Acid reflux

Acid reflux (indigestion) is caused by acid in the stomach coming back up into the throat or gullet. It is quite common after surgery or radiotherapy for head and neck cancers. Acid reflux can cause symptoms such as:

  • heartburn
  • coughing
  • a sore throat
  • the sensation of having something in the throat
  • a hoarse voice.

You should always tell your doctor if you have any of these symptoms.

Saliva helps to neutralise stomach acids. So acid reflux may be more noticeable if your mouth is dry. It can usually be treated with drugs to reduce or neutralise acid in the stomach.

Reflux is often worse when you are lying down. If you notice this, try not to eat or drink anything. You should not have caffeine for 3 hours before you go to bed. It may also help to raise your head with an extra pillow so that you are not lying flat.

Eating smaller meals often can also help reduce acid reflux. If you are having food through a tube, having it at a slower rate can help.

Eating and socialising

Many social activities involve eating and drinking. If you have difficulty chewing or swallowing, you may feel anxious or unsure about eating in front of other people.

  • If you feel self-conscious

    If you feel self-conscious about eating in front of others, it may help to get used to eating at home with people you know first. When you feel ready to try eating away from home, do something simple to start with, such as going for ice cream. You can start to go out to eat other things as your confidence grows.

  • If you take a long time to eat

    If you take a long time to eat, try eating smaller portions but increasing the number of times you eat each day. Eating small portions means you need to concentrate on eating for a shorter amount of time, so you are less likely to get tired when eating.

  • Keeping people waiting

    If you are worried about keeping family or friends waiting while you eat, talk to them about this. They can reassure you that they do not mind you taking longer. You will probably find they are more relaxed about it than you think.

  • Eating at a friend's house

    If you go to someone’s house for a meal, try not to worry about telling them about your dietary needs. People often adapt meals for guests, for example if someone does not eat meat or cannot eat gluten. Tell your host in advance if you need food of a certain texture or thickness or if you cannot eat spicy food. This helps them to prepare food that suits you. Or you can ask if you can bring your own food to be heated up.

  • Going out to eat

    If you are going out to eat in a restaurant, try to look at the menu before you go. You can find out if they offer meals that suit you or that can be adapted for you. Try contacting them in advance to ask if they can make changes to a dish. For example, you could ask them to add extra gravy, mayonnaise or butter, leave out certain spices or blend your food.

  • Using liquid supplements

    If part of your meal is a liquid supplement, ask the restaurant if they can provide you with a cup. This means you can take a liquid supplement meal with you and still order something from the menu.

  • People you do not know

    People you do not know may ask about your eating difficulties when they first have a meal with you. You may find it helpful to think about what you want to say beforehand. Or you might decide you do not want to explain it at all. You could ask the people you know to tell other guests in advance and add that you would prefer not to talk about it. Do whatever makes you feel comfortable.

For more support and advice, you can visit our head and neck cancer forum to talk with people who have been affected by head and neck cancer, share your experience, and ask an expert your questions.

About our information

  • References

    Below is a sample of the sources used in our late effects of head and neck cancer treatment information. If you would like more information about the sources we use, please contact us at

    Nilsen M L, Belsky MA et al. Late and long term treatment-related effects and survivorship for head and neck cancer patients. Current treatment options in oncology. 2020. Volume 21. Issue 12.

    Machiels J.-P, Leemans C. R. et al. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx. EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020. Volume 31, Issue 11, Pages 1462-1475.

  • Reviewers

    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.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

Date reviewed

Reviewed: 01 April 2022
Next review: 01 April 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

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