Many people take the ease with which we speak and eat for granted; however, our ability to speak, eat and swallow relies on a complicated series and interaction of muscles, tissues and nerves. Unfortunately, the effects of head and neck dissection (surgery) and/or radiation to treat cancer in this region can drastically affect these abilities. The purpose of this introductory article is to inform the reader of the possible negative effects of head/neck surgery and/or radiation and ways to manage them. As both a speech pathologist and a head/neck cancer survivor myself, I have dealt with these problems from both sides and can offer valuable guidance.

Being diagnosed with cancer is frightening in itself but the thought of being unable to speak or eat as a result of it or its treatment can truly be devastating. Eating and communicating are core aspects of our daily lives as human beings. Before undergoing head and neck surgery, one must be made aware of possible side effects that will affect daily life.

Some reasons for loss/difficulties of speech after head/neck surgery include:

Complete/partial removal of important structures involved in speech (i.e. tongue, jaw, palate etc.)
Damage/removal of nerves responsible for innervating (making active) muscles used for speaking
Damage/paralysis to vocal folds (depending on site of tumor)
Possible inadequate breath support for speech if tracheostomy (opening in trachea for air exchange) is necessary

Many of these aforementioned reasons also result in swallowing problems because the structures and nerves involved in speech also function during eating. For example, the tongue is responsible for helping to prepare the food and transport it to initiate a swallow.

Another complicating factor is radiotherapy that is typically utilized in conjunction with surgery to treat head/neck/oral cancers.

Radiation can cause the following negative side effects with regard to swallowing:

Xerostomia (lack of saliva which is necessary for breaking down food and keeping the tissues of the mouth moist)
Mucositis (irritation of mucousal membranes like the inside of the mouth)
Oral sensory loss, i.e. change in taste/lack of taste
Decreased range of motion (ability to move) of tongue and jaw

A patient can serve himself or herself best by being informed of these potential side effects. Being familiar with the above will at least allow one to ask his or her doctor to go into explicit detail about potential side effects that may negatively impact quality of life. A patient needs to be his or her own advocate and work as a team with his or her doctor. To do this effectively, you need to be informed!

In conclusion, I would choose to have my surgery and radiation again in order to defeat my cancer. I was fortunate to have a lot of information in this area during my treatment because of my profession. Do not lose hope if you suffer from the difficulties expressed above. Ask your doctor for a referral to a speech and language pathologist. Make sure he or she has experience treating cancer survivors with speech and swallowing disorders. Not everyone in the field has the same experience base and may not be able to treat you effectively.

There is hope! There are prostheses, oral motor exercises, diet modifications with regard to changes in the consistency of food and drinks, swallowing techniques including positioning changes, adapted utensils, diagnostic tests (i.e. modified barium swallow study, fiberoptic endoscopic evaluation of swallowing) and alternative/augmentative communication devices that can help eliminate or manage speech and swallowing problems (referred to medically as dysphagia). Just knowing that help is out there is the first step!

Please feel free to contact me at my email address. Although I cannot give you direct therapy, as it would be unethical for me to assess someone that I have not seen, I can provide information regarding the next step for you to take. I’ll let you know that there are options!!

(In addition to her volunteer work for ACCOI, Mrs. Kerney works at Cerebral Palsy Association of Middlesex County providing speech, language and feeding services. She also provides private speech Early Intervention Services.)