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Head and neck cancer

 

As a speech therapist, I deal with many aspects that result from the cancer itself or complications of treatment. Please note that the information on this page may differ from the information you have been given by your treatment team. This happens because of the complexity of the problem and treatment, and the wide variety of ways that cancer is managed. If need be, please discuss with your team or with me. You might not find sufficient information on this page so consult your team, speak to me if you are my client, or e mail me . The information here describes complications that affect speech or swallowing.

 

Mucositis

Mucositis in an inflammation of the mucous lining of the mouth. The sores are red and burn. Mucositis can be caused by chemotherapy or by radiation, and some people experience it very severely.

Most of the time, mucositis appears about a week after treatment begins, and can last 2 months  or more after treatment ends. It can be made worse if a mouth infection occurs.

Mucositis often leads to pain, a burning sensation in the mouth, discomfort, and sometimes there is bleeding. It can also cause difficulties eating.

Swishing ice chips in the mouth for 30 minutes, beginning 5 minutes before patients receive fluorouracil, may help prevent mucositis.

Patients who receive high-dose chemotherapy and stem cell transplant may be given medicine to help prevent mucositis or keep it from lasting as long.

Treatment of mucositis caused by either radiation therapy or chemotherapy is about the same. Treatment depends on your white blood cell count and how severe the mucositis is.

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The following are ways to treat mucositis during chemotherapy, stem cell transplant, or radiation therapy:

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Cleaning the mouth when you have mucositis

Clean your teeth and mouth every 4 hours and at bedtime. Do this more often if the mucositis becomes worse.

Use a soft-bristle toothbrush.

Use lubricating jelly that is water-soluble, to help keep your mouth moist.

Use mild rinses or plain water. Frequent rinsing removes pieces of food and bacteria from the mouth, prevents crusting of sores, and moistens and soothes sore gums and the lining of the mouth.

If mouth sores begin to crust over, talk to your doctor to ask if you can get a medicated mouth rinse. Salt water rinses can help but you must get advice first.

 

Relieving mucositis pain

Try topical medicines for pain. Rinse your mouth before putting the medicine on the gums or lining of the mouth. Wipe mouth and teeth gently with wet gauze dipped in saltwater to remove pieces of food.

Painkillers may help when topical medicines do not. Ask your doctor if you can use Nonsteroidal anti-inflammatory drugs (NSAIDS, aspirin -type painkillers)  because they increase the risk of bleeding.

Zinc supplements taken during radiation therapy may help treat pain caused by mucositis as well as dermatitis (inflammation of the skin) but you must ask your doctor first!

 

Xerostomia

Xerostomia is a dry mouth, caused by the salivary glands not making enough saliva. Your salivary glands are in your cheeks, under your tongue, and in your tongue.  Often the glands start to function normally again when treatment ends, but sometimes they do not recover fully.  Having a dry mouth may mean that your saliva feels thick. You may have a burning sensation in the mouth, and your lips might crack. Your tongue may feel different, and you might feel like you have crusty lips. Having a dry mouth affects speech and eating, dental health and digestion, and can be most uncomfortable.

Chemo can leave you with xerostomia but it will usually get better; unfortunately, the xerostomia that comes after radiation may not recover well.

Salivary glands may not recover completely after radiation therapy ends.

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Keep mouth and lips moist

Rinse mouth with water frequently (every 2 hrs while awake & when awake during the night). Ask your doctor if you can add salt or baking soda (1/2 to 1 teaspoon in 1 litre of water).

Use saliva substitute (commercially available).  

Products available for treating dry mouth are; mouthwash, toothpaste, as well as, chewing gum that has the pH of saliva.  Moisturizing gel can be applied to the mouth or tongue and acts as a moisturizing coat.

Apply lip moisturizer often (i.e. Lipstick®).

Suck on sour hard sweets (lemon drops)). Watch sugar content with sweets - can produce cavities.

Some people find humidifiers -warm or cold - useful).

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Keep mouth & teeth clean when you have xerostomia

Use soft-bristle toothbrush (can soften even more by placing brush in very warm water), cotton swabs, mouth swabs (sucker stick covered with gauze) to clean teeth after each meal and at bedtime.  (3 or more times a day). 

Clean dentures and/or bridge after eating. Leave out dentures if experiencing any discomfort caused by xerostomia.

Floss gently with unwaxed floss (if platelet count not too low).

May use Water-Pik®

Avoid mouthwashes with alcohol base.  Use non-alcohol based mouthwashes. 

Avoid lemon glycerin swabs  - contribute to dryness.

Drink plenty of liquids unless advised not to by your doctor.  This helps to thin and loosen mucous.

Carry a glass (not plastic)water bottle with you and sip frequently during the day to help alleviate dry mouth. 

Limit coffee, tea and alcohol.  These contribute to dry mouth.  Caffeine products as coffee, tea and colas act as diuretics.

Try non caffeine drinks as a substitute for tea and coffee. Rooibos tea or flavoured teas, especially if kept cold, can be wonderful.

 

Diet

If you cannot eat, ask your doctor to advise you about the insertion of a gastronomy, a pipe that goes directly to your stomach.

Eat a soft, high protein moist diet

Substitute moist fish, eggs, cheese for red meat if you cant cope with meat

Eat food lukewarm, hot food can burn mouth.

Avoid dry foods (bread, dry meat, pastries, toast and crackers, snack foods that are dry and salty).

Soak bread and or rolls in milk or sauces.

Eat moistened casseroles and meats with gravies, sauces, soups, stews.

Use sour cream as a sauce or in sauces if you need calories

Avoid citric foods, juices such as tomato, orange, grapefruit based products and sauces.

Blend food and drink.

Blend Yoghurt, fresh fruit, powdered milk to make delicious thick drinks

Fruit slushies - but don't underestimate the amount of acid in the fruit

Milk shakes with or without fresh fruit.

Avoid colddrinks  that are fizzy.  May try letting the soda go flat and then drink.

Milk is high in protein but may produce thick saliva.  If this is true for you try soy or rice milk. Almond milk is popular and easily available but take care if you can't eat nuts.

 
Medications that may be prescribed by your health care provider for treating dry mouth

If you are dehydrated, you probably need intravenous fluids. Go to your doctor immediately if you are nauseous, vomiting or have diarrhea. If you have a high temperature (38C), or if you can't drink or eat, and if you feel dizzy - you could be dehydrated.

If dry mouth is due to infection, medications for treating the infection may be prescribed such as: 

  • Antifungals

  • Antibacterials

  • Antivirals

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Peripheral neuropathy

The nerves that provide our muscles with feeling or which tell our muscles how to move can be affected by chemo and radiation. People who have peripheral neuropathy before cancer treatment (e.g. caused by diabetes or previous chemo) can be affected too.

You may feel tingling, burning, or numbness in your face, tongue, palate, cheeks or other parts of the head and neck. Some people report feeling numb, strange, having altered sensation or a feeling of being uncertain about where their body parts are … “It feels like my lips are not there”, one of my clients said to me.

These sensory changes can start during treatment, and can get better or worse during treatment. They can appear after chemo too…it is very variable. Once treatment stops, the odd feelings can disappear or get less uncomfortable. But it generally takes time for the sensation to return to a comfortable, unnoticeable level. Sometimes, these sensations don’t recover all that well.

You do need to protect your head and neck because you may not be aware of things like food that is too hot; ice that is too cold, and you may find that you prick yourself with a fork or cut your mouth with a knife (so don’t put knives near your mouth however tempting it is to lick the gravy off!)

Some clients report that doing exercise helps.

Speech therapists work with clients to try breathing exercises and oral motor therapy to try to alter sensation and we work with your team to try to help you to be able to deal with the pain that is associated with neuropathy.

Always remember to  chat to your team if you start to experience sensations that cause you discomfort, that are strange or painful.

 

Dental complications

Dental problems can affect your speech. Teeth can be affected by radiation and chemo, from caries (holes) to disintegration of roots as well as changes to the jaw bone.  Speech therapists advise clients about the effects on speech and will help you to work with your team (including dentists, prosthodontists, orthodontists) to help you to manage your dental issues.This site belonging to a dentist (click here) has some detailed info about your teeth and radiation… I don’t know him and don’t know if everything on his page is valid - although I think it is and that is why I have put it here -  so please consult your dentist if you have any questions.

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