Cancers and their treatments can cause a sore mouth and throat, this can make chewing and swallowing more difficult. You should speak to your doctor or nurse if you or someone you care for, have difficulty swallowing or problems with your mouth so you can get the help you need.
Some cancers and their treatments can cause a sore mouth and throat, this can make chewing and swallowing difficult. Dysphagia is the medical term for swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids, while others can’t swallow at
all.
Signs of dysphagia include:
- Coughing or choking when eating or drinking
- Bringing food back up, sometimes through the nose
- A sensation that food is stuck in your throat or chest
- Persistent drooling of saliva
- Being unable to chew food properly
- A gurgly, wet-sounding voice when eating or drinking
- Over time, dysphagia can also cause symptoms such as weight loss and repeated chest infections.
You should speak to your doctor or nurse if you or someone you care for, have difficulty swallowing or any other signs of dysphagia, so you can get treatment to help with your symptoms.
Early investigation of dysphagia is also important and can also help to rule out other more serious conditions, such as oesophageal cancer. Your doctor or nurse may refer you for other tests. Read more about diagnosing dysphagia.
There are certain types of cancer that are more likely to cause swallowing problems :
- 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)
- stomach
- lung
Our Head and Neck patients have used their own experiences as they worked along side a member of our Speech and Language Therapy Team and students from the University of Sunderland to create a cookbook.
Treating dysphagia
Treatment usually depends on the cause and type of dysphagia. Many cases of dysphagia
can be improved with careful management, but a cure isn't always possible.
Treatments for dysphagia include:
- Speech and language therapy to help with swallowing recovery with special exercises and techniques
- Changing the consistency of food and liquids to make them safer to swallow
- Other forms of feeding – such as tube feeding through the nose or stomach
- Surgery to widen the oesophagus, by stretching it or inserting a plastic or metal tube (stent)
- Treating a sore mouth or throat with medications
Causes of dysphagia
You may have difficulty swallowing because you have had:
- surgery to your head or neck area, this may affect the muscles in this area which can make chewing and swallowing difficult. How difficult depends on the size and position of the cancer and type of operation that you have had.
- a course of radiotherapy to your head or neck
- a tube (stent) put into your food pipe
- your voice box removed
- a tumour blocking part of your throat, voice box or food pipe (oesophagus)
- a sore mouth or throat due to chemotherapy, targeted cancer drugs or immunotherapy
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 can also affect 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 or discomfort due to teeth or gum problems
- these effects may 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.
Complications of dysphagia
Dysphagia can sometimes lead to further problems. One of the most common problems is coughing or choking, when food goes down the "wrong way" and blocks your airway. This can lead to chest infections, such as aspiration pneumonia, which will require urgent medical treatment. Aspiration pneumonia can also develop after accidentally inhaling something, such as a small piece of food.
Warning signs of aspiration pneumonia include:
- a wet, gurgly voice while eating or drinking
- having a voice that gurgles and sounds 'wet' after you swallow
- the need to clear your throat after each mouthful of food
- coughing while eating or drinking
- pain and dryness when swallowing
- difficulty breathing – breathing may be rapid and shallow
Coming to terms with swallowing or chewing problems
You may avoid eating and drinking due to a fear of choking, which can lead to malnutrition and dehydration. Dysphagia can also affect your quality of life because it may prevent you from enjoying meals and social occasions.
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 this. A soft diet can help to make things easier for you, it may take a while to adjust. This may only be a temporary change for you while you recover from treatment, but for some people this may be permanent. Try to be patient with yourself and give yourself time to get used to new ways of eating.
Dental (oral hygiene)
Many cancer treatments have side effects that affect a person's mouth, teeth, and salivary glands.Your general dentist and other dental health professionals can help with your oral care before, during and after cancer treatment.
