Head and Neck Cancer FAQs

Treatment Effects

Head and neck cancer treatments can affect everyday activities such as eating, swallowing, and speaking. These changes are common, and most people experience at least some of them during treatment. You might notice difficulties with eating or swallowing, changes to your speech, reduced mouth opening (trismus), a dry mouth, taste changes, mouth ulcers, an increased risk of tooth decay, or—more rarely—problems with the jawbone (osteoradionecrosis or ORN).

It’s important to know that you won’t be facing these challenges alone. Many of these effects can be managed, improved, or prevented with the right support. These Frequently Asked Questions have been created to guide you through what to expect and to introduce the specialist teams who will be with you throughout your treatment and recovery.

Many people want to keep working during cancer treatment, but head and neck radiotherapy and chemotherapy can be physically and emotionally demanding. Everyone’s experience is different, but it is important to plan and be flexible.

Will I be able to work during treatment?

Some people continue working, especially early on or if their job is less physically demanding. However, most people find that they need to reduce their hours or stop working for a period.

Radiotherapy is given daily (Monday-Friday) on average of 6-weeks, and chemotherapy may be given alongside it. The side effects tend to build up over time, meaning you may feel progressively more tired or unwell.

Common side effects that can affect work

Treatment to the head and neck often causes specific side effects that can make working difficult:

• Fatigue (extreme tiredness) – very common and can be overwhelming
• Sore mouth and through – can make speaking, eating and, and drinking difficult
• Changes to voice – hoarseness or difficulty speaking clearly
• Difficulty swallowing – may affect eating at work
• Dry mouth or thick saliva
• Skin reactions – soreness or redness in the treated area
• Taste changes and reduced appetite
• Increased risk of infection (especially with chemotherapy)

These side effects often worsen during treatment and for a couple of weeks afterwards before gradually improving.

Practical considerations for work that you may want to think about:

• Flexible working – shorter days, working from home, or adjusted duties
• Time off for treatment – daily hospital visits can be tiring
• Communication needs – of your job involves talking, side effects may make this difficult
• Physical demands – manual or active jobs may become too difficult due to infection risk – avoiding environments if your immunity is low

It can help to talk early with your employer or HR department about what adjustments might be possible.

Planning time off

Many people need to take sick leave at some point during treatment. This is normal.

You might consider:

• Taking planned leave for the later weeks of treatment
• Keeping plans flexible, as it’s hard to predict exactly how you’ll feel
• Phased return to work after treatment
• Recovery can take several weeks or months, especially for energy levels and eating/swallowing. We usually advise at least 3-months.
• Financial and workplace support that you may be entitled to such as:
  • Sick pay (from your employer or statutory)
  • Benefits or financial support
  • Workplace adjustments under disability legislation

A healthcare professional, support worker, or organisations like Macmillan Improving the Cancer Journey team or Maggie’s can provide guidance.

Looking after yourself

• Listen to your body and rest when needed
• Focus on nutrition and hydration
• Accept help from family, friends, or colleagues
• Keep in touch with your healthcare team about side effects

When to seek help

Contact your treatment team if you have:

• Severe pain or difficulty swallowing
• Signs of infections (e.g. fever)
• Inability to eat or drink
• Side effects that are affecting your daily life or work

Final thoughts

It’s okay if you’re not able to work during treatment. Your focus should be on getting through treatment safely and recovering well. Many people return to work gradually once treatment is complete.

Why Have I Been Referred to SLT?

Speech and Language Therapists assess and support swallowing, speech, and voice.
Early SLT involvement helps prepare you for treatment side effects and promotes long‑term swallow function.

What Types of Therapy Are Offered?

Therapy is tailored to your individual needs and may include:

• Voice therapy
• Swallowing exercises
• Mouth opening (trismus) exercises
• Techniques for safer eating, drinking, and communication

Why Do I Have Swallowing Exercises If I Have No Swallowing Concerns?

Exercises help:

• Keep swallowing muscles strong
• Maintain muscle function during treatment
• Reduce long-term swallowing difficulties

Are There Foods I Should Avoid?

Most people can continue with their usual foods.
Only a minority require changing the texture of food and drink so they are easier to swallow.
Your SLT will advise individually.

Do I Need a Blender?

No — unless specifically advised.
Eating normal foods helps keep swallowing muscles active.

When Will I Eat Normally Again?

Recovery varies from person to person.
Most people temporarily adjust textures for several weeks after treatment.
Dry mouth and texture difficulties may continue longer term.
Your SLT and clinical team will guide you.

Why Do I Need a Dental Appointment Before Treatment?

Cancer treatment may affect the teeth, gums, saliva, and jawbone.
Healthy teeth help reduce complications during treatment.

What Happens at the First Dental Appointment?

The dental team will:

• Check your mouth and teeth
• Take X‑rays
• Discuss whether treatment is required
• Create a personalised dental plan
• Explain expected side effects and management

Possible Dental Treatments

You may need:

• Professional cleaning
• Brushing support
• Denture adjustments
• Fillings or repairs
• Tooth extractions
• Moulds for fluoride trays

How Long Will the Dental Team See Me?

• From referral until cancer treatment is complete
• Until your mouth is stable
• Then you return to your regular dentist

Mouth Care During Treatment

You may be advised to use:

• A soft toothbrush
• Sodium bicarbonate mouth rinse
• Difflam® mouthwash
• High-strength fluoride toothpaste (Duraphat)

Duraphat instructions:
Use a pea-sized amount, twice daily, and spit but do not rinse.

Why Nutrition Matters

Eating may become harder due to pain, swallowing difficulties, dry mouth, taste changes, or fatigue.
Good nutrition supports strength and recovery.

Eating Little and Often

Eat every 2–3 hours to maintain intake.
Increase calories by adding:

• Butter, cream, cheese, oils
• Full-fat milk or milk powder
• Nut butters

Choose soft, high-energy foods such as yoghurts, puddings, and creamy soups.

Increasing Protein

Protein supports healing.

Soft, protein-rich options include:

• Scrambled eggs
• Minced meat or fish with sauce
• Soft fish in white or cheese sauce
• Yoghurt, fromage frais, custard
• Crustless quiche

Your advice will be tailored to the food texture safe for you.

Oral Nutritional Supplement (ONS) Drinks

ONS drinks are used when:

• Eating is difficult
• Intake is too low
• Extra calories or protein are needed

They come in milk-based, juice-based, fibre-containing, and compact high-energy forms.
They are usually taken between meals.

Enteral Feeding

Can I Breathe in the Mask?

Yes, you can breathe and swallow normally.
You can signal staff if you need help.

Can I Have Treatment Without the Mask?

No — the mask ensures accurate, safe treatment.

Shaving, Haircuts, and Hair Dye

Avoid during radiotherapy:

• Wet shaving
• Hair dye
• Major hair or beard changes
• Waxing or hair removal creams

Use an electric shaver prior to Mould Room appointment and during radiotherapy as you may be required to be clean shaven throughout.

Mouthwash During Radiotherapy

Use only products recommended by your clinical team.
Many patients are advised to use bicarbonate of soda rinses.

Vaccines During Radiotherapy

Ask your oncology or radiotherapy team for individual guidance.

If You Become Unwell

Do not miss sessions unless necessary. Contact:

• Cancer Treatment Helpline: 0800 917 7711
• 999 in emergencies

Will I See a Doctor?

Yes — you will be reviewed weekly.
You will have post-treatment scans around three months after finishing radiotherapy.

Changing Appointments

Speak to radiographers.
Flexibility may vary depending on clinic capacity.

Hair Loss

Hair loss occurs only in the treated area.

Makeup and Lip Balm

Avoid using products on the treatment area unless approved.

What is lymphoedema?

Swelling caused by a build-up of lymph fluid after surgery or radiotherapy to the head and neck.

What symptoms should I look for?

Swelling in the face or neck, tightness, heaviness, dry or thickened skin, or trouble swallowing/speaking.

Can it be treated?

It can’t be cured, but swelling can be managed with skin care, gentle exercises, and specialist lymphatic massage.

Discuss this with your clinical team, who can refer you to a specialist physiotherapist or lymphoedema service if required.

What can I do to help myself?

Protect your skin, avoid tight clothing, do gentle neck/shoulder exercises.

When should I seek medical help?

If the area becomes red, hot, more swollen, or you feel unwell (possible infection).

Can I be intimate during treatment?

Yes—if you feel well enough. Fatigue, pain, or dryness (including dry mouth or vaginal dryness) can make intimacy harder. Go at your own pace and listen to your body.

What about during chemotherapy?

Chemotherapy can cause tiredness, nausea, low mood, and temporarily weaken your immune system. Intimacy is usually safe, but:

• Avoid sex if you have infections, open sores, or feel unwell
• Take extra care if your blood counts are very low (your team will tell you if this applies)
• Some chemotherapy drugs can be present in bodily fluids for a short time after treatment, so your clinical team may recommend using protection (e.g., condoms) for a few days after each cycle

Will my desire change?

Yes—libido often drops due to fatigue, stress, and side effects. This is very common and often improves after treatment.

Is it normal to feel self-conscious?

Yes. Changes in appearance, speech, saliva, or swallowing can affect confidence. Open, gentle communication with your partner can help reduce pressure.

Can treatment side effects affect comfort?

Yes—dryness, stiffness, fatigue, or discomfort can make intimacy challenging. Slower pace, different positions, or focusing on non-sexual touch can help.

Does my partner need special protection?

Generally no—but:

• Use protection if advised after chemotherapy (see above)
• Avoid contact with any treated skin areas if you’ve had radiotherapy and the skin is sore
• Don’t have sex if it causes pain or irritation

How can we stay close if intimacy is difficult?

Cuddling, holding hands, massage, and quiet time together are all meaningful ways to stay connected.

Who can help if intimacy remains difficult? Your clinical team, specialist nurses, or a counsellor/sex therapist can offer support and practical strategies.

For more information on Sexual Intimacy During & After Treatment you may find the link below helpful https://www.cancerresearchuk.org/about-cancer/treatment/chemotherapy/sex-and-chemotherapy

Why have I been told my cancer is HPV‑related?

Your clinical team may have identified HPV-related changes in your tumour.
This information can help guide treatment and provide a better understanding of how the cancer developed.

For information on HPV you may find the following resources helpful:
Macmillan Cancer Support – HPV and cancer
https://www.macmillan.org.uk/cancer-information-and-support/worried-about-cancer/causes-and-risk-factors/hpv

“Let’s talk about HPV: 6 common questions answered”
https://news.cancerresearchuk.org/2021/06/16/lets-talk-about-hpv-6-common-questions-answered/