After head and neck cancer treatment

Head and neck cancer treatment affects the functions people use constantly — eating, speaking, tasting, swallowing, breathing. Survivorship here is unusually practical, and the difference between coping and struggling often comes down to whether someone was referred to the right therapist and dentist early enough.

• See a dentist experienced with head and neck cancer patients, on the schedule your team recommends — often more frequently than the general population.
• High-fluoride toothpaste or fluoride trays are commonly prescribed after radiotherapy, because reduced saliva dramatically increases decay.
• Tell any dentist that you have had radiotherapy to the head or neck BEFORE any extraction. Extractions in irradiated bone carry a risk of osteoradionecrosis and need specialist planning.
• Report jaw pain, exposed bone, non-healing sockets or loose teeth promptly.
• Trismus (difficulty opening the mouth) responds to jaw exercises — ask for them early rather than after it sets in.

• Dry mouth may be partially permanent. Frequent sips, saliva substitutes, sugar-free gum and moist foods all help; some medications can stimulate saliva — ask.
• Taste changes often improve over months to a couple of years, but may not fully return.
• Swallowing difficulty needs speech and language therapy. Exercises maintain and often improve function, and stopping using the swallow makes it worse.
• Report coughing while eating or drinking, food sticking, or recurrent chest infections — possible aspiration, which needs assessment.
• A dietitian should be involved if weight is falling or if eating has become restricted.

• Neck stiffness and fibrosis after radiotherapy respond to physiotherapy and stretching — keep it up long-term.
• Shoulder weakness or pain after neck dissection is common and physiotherapy helps significantly.
• Head and neck lymphoedema — swelling under the chin or in the face — is treatable by a lymphoedema therapist, and is under-recognised.
• Thyroid function should be checked at least annually after neck radiotherapy; underactivity develops in a significant proportion of people and is easily treated.
• Report any new neck lump promptly.

• Frequent clinical examination — often every one to three months in the first year or two, reducing over time — with imaging as indicated.
• Stopping smoking and reducing alcohol substantially reduce the risk of a second head and neck cancer; support with medication roughly doubles success rates.
• HPV-related oropharyngeal cancers generally have a better prognosis; this does not change the need for follow-up.
• Ask about a survivorship plan covering dental, swallowing, thyroid and physiotherapy needs together.