Before treatment for head and neck cancer

Before treatment starts, you will see a dentist. Radiotherapy to the mouth area can make you more likely to get tooth decay. Your dentist can also tell you how to look after your mouth during radiotherapy.

You will also see a dietitian or speech and language therapist (SLT). They can tell you about the effects treatment may have on your swallowing, diet and speech. They can also tell you what can help.

Sometimes radiotherapy causes severe swallowing problems. It can help to put on some weight before treatment starts. If your specialist thinks you may have problems, they may suggest you are fed through a tube for a while. There are different ways of tube feeding.

If you smoke or drink alcohol, your doctor or nurse will give you advice on stopping before treatment starts.

Stopping can help:

  • make treatment more effective
  • reduce the amount of side effects
  • reduce the severity of side effects
  • reduce the risk of another head and neck cancer developing.

Before treatment starts

Before treatment starts, you see a dentist. You also see a dietitian or a speech and language therapist (SLT). If you smoke or drink alcohol, your doctor or nurse will give you advice on stopping.

Dental care

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.

Eating and speech problems

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 lose some 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 put on some 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.

The PEG tube was what I was most scared of, but it really did help. When I couldn’t swallow, it was my only way of eating, drinking or taking medication.



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.

If you smoke and are going to have surgery, your surgeon will discuss the benefits of giving up smoking before your operation. It is best to try to stop 8 weeks before having surgery. Even if you only stop smoking 2 to 3 weeks before the operation and you do not smoke afterwards, this will reduce the risk of complications.

If you stop smoking before having surgery:

  • you are likely to recover more quickly
  • you are more likely have a shorter stay in hospital
  • your wound is likely to heal more quickly.

It can be difficult to stop smoking, especially when you are stressed. You can ask for help and support with stopping smoking at your hospital. NHS Stop Smoking Services can really make a difference to your chances of success. Research shows that people who use it are twice as likely to succeed as people who try to give up on their own. Speak to your doctor or call a stop smoking helpline for more advice and to find out where your local Stop Smoking Service is.

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.


If you drink alcohol, you can help make your treatment more effective by not drinking alcohol. This helps reduce the risk of side effects. Stopping drinking alcohol also reduces the risk of another head and neck cancer developing.

If you would like support to help reduce how much alcohol you drink, your specialist nurse or doctor can arrange this for you.

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