Chewing and swallowing involve your lips, teeth, tongue and the muscles in your mouth, jaw and throat working together. Being able to swallow is important for adequate nutrition.
Many people with a head and neck cancer have difficulty swallowing (dysphagia) before, during or after treatment. This may be because of the tumour or the treatments, and difficulty swallowing may be short-term or long-term.
Learn more about:
- Treatments that make swallowing difficult
- Signs that swallowing is difficult
- Swallowing test
- How to manage swallowing difficulties
- Feeding tube
- Weight loss caused by above side effects
Treatments that make swallowing difficult
Surgery to the jaw, mouth or throat areas – This may make swallowing difficult because tissue has been removed or reconstructed or because of a dry mouth.
Removing part of the larynx (partial laryngectomy) – Surgery may cause food to go down the wrong way into the lungs (aspiration). This is because the larynx and epiglottis act like valves and shut off the airway when swallowing so liquid or food don’t go into the lungs. Signs of aspiration include coughing during or after swallowing.
Radiation therapy – This can cause dry mouth, pain, and changes to the strength of the muscles and nerves used in swallowing. These effects could be worse if you also have chemotherapy at the same time as radiation therapy (chemoradiotherapy).
Signs that swallowing is difficult
May include taking longer to chew and swallow; coughing or choking while eating or drinking; or food sticking in your mouth or throat like a ball.
You may have a test before and after treatment to look at what happens when you swallow.
A speech pathologist uses a movie-type x-ray known as a videofluoroscopic swallowing study (VFSS) or modified barium swallow (MBS) to check that foods and liquids are going down the correct way.
If more detail is needed, you may have a fibre-optic endoscopic evaluation of swallowing (FEES) test during a nasendoscopy.
The test results will help plan your treatment.
How to manage swallowing difficulties
- See a speech pathologist for ways to change your swallowing action to help reduce discomfort or food going down the wrong way (aspiration). They can also show you swallowing exercises to complete during treatment. To find a speech pathologist, speak with the health care team at your treating centre or visit Speech Pathology Australia.
- Continue to eat and drink whenever possible during treatment to keep your swallowing muscles moving and working. This will reduce the likelihood of long-term swallowing problems.
- Ask your doctor for medicines to relieve discomfort when swallowing. Some medicines come as mouth rinses.
- Talk to a dietitian or speech pathologist about ways to adjust the consistency of food to make it easier to swallow.
- See the Laryngectomee Association of NSW’s cookbook for recipes, stilltalking.org/#cookbook.
After surgery or during radiation therapy treatment, you may find eating and swallowing uncomfortable and need to have food through a feeding tube (also called enteral feeding) to help you get the nutrition you need while your throat heals. This tube is usually temporary, but is sometimes permanent.
Benefits of a feeding tube
- Help ensure you stay well nourished and hydrated
- Help you maintain or gain weight
- If you can’t swallow medicines, check with your doctor or nurse whether these can also be given through the feeding tube.
Caring for a feeding tube
- Your health care team will show you how to care for the tube to prevent leakages and blockages.
- They’ll also let you know when the tube needs to be replaced.
- If the tube falls out, let your doctor know immediately.
- Washing your hands before using the tube and keeping the tube and your skin dry will help prevent infections.
Having a feeding tube inserted is a significant change, and it is common to have a lot of questions. Adjusting to a feeding tube takes time, but talking to a dietitian or nurse may help.
Types of feeding tube
Temporary feeding tube
A thin tube is put through your nostril, down the throat and oesophagus into the stomach. This is called a nasogastric or NG tube.
It is usually used if you need a feeding tube for less than 4 weeks – for example, for the first few days or weeks after surgery when you’re unable to eat.
The NG tube is usually put in and removed by a doctor or nurse. Specially prepared food will be put down the tube.
Long-term or permanent feeding tube
A tube is inserted through an opening on your abdomen into the stomach. This is called a gastrostomy tube.
If the tube is inserted by endoscope, it is called a PEG (percutaneous endoscopic gastrostomy). If an x-ray is used to guide the tube, this is called a RIG (radiologically inserted
gastrostomy). Sometimes, the feeding tube is placed by surgical incision (surgical gastrostomy).
The above side effects may cause you to lose weight. Even a small drop in your weight (e.g. 3–4kgs) may put you at risk of malnutrition. You may be malnourished even if you are overweight.
Significant weight loss and malnutrition can lead to reduced energy and strength, and lower quality of life. Your response to treatment may be reduced and side effects can become more severe.
Staying nourished after treatment
- Eat small meals frequently.
- Choose foods high in protein.
- Eat and drink nourishing meals or snacks.
- Try walking before meals. Light exercise may help to stimulate your appetite.
- Modify foods to make them easier to chew or swallow.
- Add high energy ingredients to recipes, such as whey powder, full-cream milk, other dairy products (sour cream, butter or cheese), oil, eggs, avocado, or honey.
- Ask your dietitian about nutritional supplement drinks, which may help to prevent weight loss.