Swallowing Problems after Head and Neck Cancer

Treatment for head and neck cancer can cause swallowing problems, called dysphagia. Head and neck cancer includes laryngeal and oral cancer. Problems you may have depends on the type of cancer, the type of surgery, and other treatments that you may need, like radiation or chemotherapy.

The following problems may occur after treatment for head and neck cancer:

• needing to swallow many times to clear food from your mouth and throat  
• having a gurgly, wet-sounding voice after swallowing
• coughing or choking
• throat clearing while eating
• pain when swallowing
• dry mouth or throat

Surgery may be needed to treat cancer in the mouth, throat, or voice box, called the larynx. You may need radiation therapy before or after surgery. Each type of treatment can cause swallowing problems.  

Oral, or mouth, surgery can cause food or drinks to spill out of your mouth. You may have trouble chewing. It may be hard to control food and liquid in your mouth. 

Throat surgery can make it hard for food and liquid to move from your mouth to your esophagus. The esophagus is the tube that goes from the back of your throat to your stomach. Your airway is next to your esophagus. After surgery, food or liquid might go into your airway instead of into your esophagus. This is aspiration, and it can make you cough or choke.

A laryngectomy is surgery to remove part or all of your voice box. It can make it hard to move food and liquid from your mouth to your esophagus.

Radiation therapy can make your mouth or throat sore. You may eat less because of the pain. You may have a dry mouth or less saliva. It may be hard to move your mouth, tongue, or throat. It may be harder to chew and move food from your mouth and throat. 

Speech-language pathologists (SLP) have experience in rehabilitation of speech and voice after treatment for head and neck cancers. The muscles we use for swallowing may become weak during radiation and scarring after radiation may limit their ability to move freely. These problems can lead to symptoms like food sticking in your throat, things going down the wrong pipe, and things going up your nose when you swallow. Such problems can lead to health problems like pneumonia which can be quite serious. Fortunately, there are treatments that can help prevent these problems from occurring. 

Active use of the swallowing muscles during radiation has been shown to protect them from weakening and scarring. There are two activities you can do to use these muscles. The first important activity is to continue eating and drinking with your mouth. Though you may need to alter your diet due to dry mouth and taste changes, you are encouraged to eat and drink as normally as possible. The second activity that is important for protecting your swallowing muscles is swallowing therapy. The speech-language pathologist can provide you with the appropriate exercises.

In addition to swallowing, some patients may have problems with speech, voice, or jaw stiffness during and after radiation. The SLP can provide exercises and strategies to minimize these problems as well.

The Speech-Language Institute (SLI) of Salus University has a Laryngectomee/Throat Cancer Club for those who have undergone laryngectomy surgery and those suffering with throat cancer. Led by professional speech-language pathologist, Amy Lustig, PhD, CCC-SLP, the group aims to provide a supportive environment to share information, personal stories and ideas for living well. Those who have undergone a laryngectomy surgery or have/have had throat cancer both experience similar difficulties, such as trouble speaking, swallowing, and breathing. The club’s focus is to provide a supportive community to share personal stories, gain expert insight, and allow members to socialize.

If you or a loved one has difficulty swallowing, contact the Speech-Language Institute today at 215.780.3150.