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Difficulty swallowing

Some cancers and their treatments can cause a sore mouth and throat. This can make chewing and swallowing difficult.

Cancers likely to cause swallowing problems

The types of cancer most likely to cause swallowing problems are cancers of the:

  • voice box (larynx)
  • thyroid gland
  • mouth and tongue (oral cancer)
  • throat (pharynx)
  • nasal cavity and sinuses
  • melanoma or other skin cancer on the face
  • salivary glands
  • food pipe (oesophagus)

People with these cancers often have problems with chewing or swallowing. Doctors call difficulty swallowing dysphagia.

Overview of the effects of cancer and its treatments

You may have difficulty swallowing because you have:

  • had surgery to your head or neck area
  • had a course of radiotherapy to your head or neck
  • had a tube (stent) put into your food pipe
  • had your voice box removed
  • a tumour blocking part of your throat, voice box or food pipe
  • a sore mouth or throat due to chemotherapy, targeted cancer drugs or immunotherapy

Surgery for cancer of the head or neck may affect the muscles in this area. This can make chewing and swallowing difficult. How difficult it is will depend on the:

  • size and position of the cancer
  • type of operation you are having

The effects of surgery

Food and liquids can be difficult to control after surgery to your mouth (oral surgery). They can leak out of the side or front of your mouth.

Weak throat (pharynx) muscles might make it hard to move food and liquid from your mouth to your food pipe. This can cause coughing and choking at times because food or drink has gone down the wrong way.

After removal of the voice box for cancer of the larynx, inhaling food or drink will not be a problem. This is because your windpipe will no longer open into your mouth. But you may still have difficulty moving food from your mouth down into your food pipe (oesophagus).

Your sense of smell is likely to be poor after the removal of your voice box (laryngectomy). This is because you can no longer breathe air into your nose. This affects your sense of taste. So you may prefer more strongly flavoured food than you used to.

The effects of radiotherapy

Radiotherapy to the head and neck can lead to:

  • soreness in the throat and mouth
  • a dry mouth because less spit (saliva) is made
  • stiffness of the muscles and other tissues around the treatment area
  • loss of taste
  • pain and discomfort from teeth and gum problems

These effects can mean you have difficulty chewing and swallowing, and you might eat less. If you have pain, taking painkillers about an hour before you eat may help.

The effects of chemotherapy, targeted cancer drugs and immunotherapy

Chemotherapy, targeted cancer drugs and immunotherapy may make your mouth and throat very sore. You might need to have a soft diet for a short while.

Talk to your doctor or nurse if your mouth is very painful and you cannot eat. They can suggest several ways to control pain. Taking regular painkillers can reduce the pain so that you may be able to eat and drink.

Your doctor or nurse will also suggest regular mouth care with mouthwashes. This can help to prevent infection and discomfort.

Coming to terms with swallowing or chewing problems

If you have had treatment for a head and neck cancer, you may:

  • need to swallow often to help clear food from your mouth and throat
  • have a voice that gurgles and sounds 'wet' after you swallow
  • cough or choke when you are eating or drinking
  • need to clear your throat after each mouthful of food
  • have pain and dryness when swallowing

All these changes can be tough to come to terms with. Mealtimes may no longer be enjoyable. Some people feel they want to eat alone because they find it embarrassing to eat and drink in front of people.

You may need to switch to food that is easier to chew and swallow for a while. This is called a soft diet. A dietitian will tell you how to manage a soft diet. A soft diet can help to make things easier for you.

It may take a while to adjust to a soft diet. This may only be a temporary change for you, while you recover from treatment. But for some people, it may be permanent. If so, try to be patient with yourself and give yourself time to get used to things.

Last reviewed: 
17 Mar 2020
Next review due: 
17 Mar 2023
  • Quality standard for nutrition support in adults (QS24)

    National Institute for Health and Care Excellence (NICE) guidance, November 2012

  • Radiotherapy in head and neck cancer management: United Kingdom National Multidisciplinary Guidelines

    C Nutting

    Journal of Laryngology and Otology. 2016 May; 130(Supplement 2): S66–S67.

  • Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis

    H Sroussi and others

    Cancer Medicine. 2017 December; 6(12): 2918–2931

  • Treatment of late sequelae after radiotherapy for head and neck cancer

    P Strojan and others

    Cancer Treatment Review. 2017 September; 59: 79–92

  • Best Practice in Systemic Therapy for Head and Neck Squamous Cell Carcinoma

    S Oosting and others

    Frontiers in Oncology. 2019; 9: 815.

  • Overview of treatment for head and neck cancer

    B Brockstein and others

    UpToDate website

    Accessed March 2020

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. If you need additional references for this information please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in.

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