Head and neck cancer usually starts in the lining of the mouth, throat, or voice box. Less common types can form from sinuses or salivary glands.
Men over the age of 50 are up to three times more likely to get a head and neck cancer diagnosis than women. About 900,000 cases become known worldwide each year. In the U.S., head and neck cancers account for approximately 3% and 4% of all cancer diagnoses.
Impaired speech and swallowing often follow head cancer diagnosis and treatment. A speech-language pathologist (SLP) intervention can help improve or keep up your quality of life. But what can you expect from this treatment?
Why Would I Need Speech-Language Pathology Services?
If you’ve recently gotten diagnosed with head and neck cancer, you may need to undergo speech or swallowing therapy. This may make up part of your rehabilitation treatment.
This intervention usually starts at the onset of diagnosis and continues throughout treatment. Sometimes, it also continues afterward. The level of difficulty you have swallowing or communicating can result from different factors, such as:
- Factors such as advanced age, tracheostomy, and other medical conditions such as stroke, COPD, and neurological disease.
- The surgery’s extent and the treatment’s side effects.
- The location and size of the tumor.
- Prior treatment for head and neck cancer with or without chemotherapy/radiation.
How Can a Speech-Language Pathologist Help with Swallowing and Communication Difficulties?
Swallowing issues
Although many may consider swallowing a simple action that takes little thought, it’s a very complex process. It involves at least six cranial nerves and over 20 muscles of the mouth, throat, and esophagus. They all work together to transport food or water from the mouth and through the throat to the stomach.
Difficulty swallowing, also known as dysphagia, is common for patients diagnosed with head and neck cancer. If left untreated, it can cause dehydration, weight loss, and aspiration pneumonia, which can lead to death.
Dysphagia and throat cancer often go hand in hand.
Head and neck cancer treatment can change how a person moves food through their body. Eating may require more time and effort, and certain textures may become difficult to swallow.
A test will check for swallowing safety (whether food and/or liquid enters the airway). It’ll also check for swallowing efficiency (how easy or difficult swallowing food and liquid is).
Swallowing difficulties can include:
- Coughing or choking.
- Developing a wet, gurgling vocal after eating or drinking.
- Food or liquid coming back up from the esophagus or out of the nose.
- Pain when swallowing, also known as odynophagia.
- Recurrent aspiration pneumonia.
- The sense that the food is sticking in the throat.
- Taking a longer time to eat.
- Weight loss.
Verbal communication challenges
Tumor location, treatment, and side effects can result in changes in communication (speech and voicing). Some of these changes may prove temporary, while others are permanent.
Patients who undergo surgery of the lips, tongue, or jaw, may have an impaired ability to pronounce words clearly. These changes can result from swelling and pain immediately following surgery.
They often improve as the symptoms decrease. Extensive surgery (removing 50% or more of certain structures) may make speech difficult to understand.
If surgery involves the larynx (voice box), a partial laryngectomy may cause the voice to sound breathy or hoarse. A total laryngectomy, or complete removal of the voice box, results in no voice (aphonia).
Head and neck cancer patients who undergo radiation may experience side effects that cause scarring of the tissues. This leads to limited movement of the structures related to speech and swallowing.
If the voice box has had contact with radiation, the voice may sound hoarse. Additionally, chemotherapy may increase the side effects of radiation.
How Can a Speech-Language Pathologist Help?
A speech-language pathologist (SLP) is part of a cancer care team. They’re experts in managing the communication and swallowing disorders associated with the disease.
An SLP evaluates a patient’s current speech and swallowing function, educates the patient on potential changes, and develops a therapy plan.
Swallowing therapy
The goal of swallowing therapy is to improve quality of life by helping patients safely maintain an oral diet. In fact, studies have shown that early intervention results in better outcomes and reduces the need for feeding tube dependency.
Swallowing therapy may include swallowing strategies to improve safety and efficiency when eating and drinking, including:
- Breath-hold techniques to protect the airway.
- Diet texture changes.
- Head rotations.
- Varying delivery methods to transfer food.
Swallowing exercises target specific muscles to improve strength and range of motion. To obtain the best results, patients often benefit from both strategies and exercises.
Speech and voice therapy
An SLP will teach techniques for how to improve speech so others can understand it better.
Techniques can include:
- Overexaggerating the word pronounced.
- Reducing background noise.
- Slowing the rate of speech.
- Speaking louder.
Range of motion exercises often facilitate better movement of the tongue, lips, and jaw. If structures are increasingly stiff from radiation treatment, myofascial release, a form of deep tissue massage, may benefit the patient.
At UPMC, a physical therapist (PT) who’s an expert in treating the head and neck, offers myofascial release.
For patients who had a total laryngectomy, the surgical removal of the voice box, an SLP can introduce the different forms of communication. These may include:
- Communication devices (augmentative and alternative communication, or AAC).
- Electrolaryngeal speech.
- Esophageal speech.
- Tracheoesophageal (TE) voicing.
If a patient has a tracheoesophageal puncture, an SLP can place a voice prosthesis. The SLP will train the patient on how to use and care for the device. Because these devices wear out over time, a trained SLP must later replace them.
Changes in communication and swallowing aren’t the same for every patient. Sometimes, speech therapy after cancer is a long and sometimes physically and mentally taxing process.
Counseling with an SLP is the first step to understanding what to expect and how to prepare, regardless of the treatment plan.
Reach out to your doctor to learn more about treatment options and resources.