• 12/15/2005
  • Carolina
  • staff
  • News14Carolina (rdu.news14.com)

Each year, there are nearly 30,000 cases of head and neck cancer. Surgery, chemotherapy and radiation all have their benefits but can leave patients with a difficult time swallowing. Now, doctors are working to improve that.

Allen Clark, M.D., is a plastic surgeon. But two years ago, he became a patient. “I actually had a lymph node come up in my neck,” he says. “Being a physician — a surgeon — knowing what that means, I was pretty sure I had cancer.”

It was throat cancer. Doctors recommended chemotherapy and radiation. But radiation caused Clark’s throat to tighten, and swallowing became excruciatingly painful.

“It’s almost like you’re drinking hot coffee that’s too hot, and you burn your throat, but you do that every day for six or seven weeks,” Bill Carroll, M.D., an otolaryngologist at University of Alabama at Birmingham, tells Ivanhoe.

Dr. Carroll and colleagues noticed patients who continued to swallow during treatment, instead of relying on a feeding tube, did better. Now, patients are taught a series of swallowing exercises they do before and during treatment.

“One of the exercises that we did was we’d hold my tongue between my teeth and swallow,” Clark says. Another is making a high-pitch “E” sound to elevate the larynx. All the exercises work to strengthen the tongue and throat muscles. Patients say the exercises are simple but can be painful.

“But most of them do try,” Dr. Carroll says. “And for the ones that are able to go ahead and do it, there seems to be a benefit.”

Clark still has some trouble with certain foods, but says the exercises have paid off.

Dr. Carroll says the goal of the exercises is to allow patients to have a more functional swallow once chemo and radiation ends. He hopes the exercises will save both time in the hospital and money spent on complications.

Background Information

Head and Neck Cancers:
The American Cancer Society predicts nearly 30,000 new cases of cancer in the oral cavity and pharynx will be diagnosed in 2005. It is more common in men than women — primarily in men over age 50. People who use tobacco products and alcohol heavily are at an increased risk. Signs of oral cancer may include a sore that bleeds easily and doesn’t heal, a lump or a thickening, a red or white patch that doesn’t go away, or difficulties swallowing.

Treatments:
Surgery, radiation, and chemotherapy are all used, depending on many factors. Bill Carroll, M.D., an otolaryngologist at the University of Alabama says, “In the last 10 years or so, a lot more attempts are being made to treat patients non-surgically to avoid the functional and anatomic problems that come from surgery in the head and neck area.” As a result, doctors are using aggressive treatments of chemotherapy and radiation. Dr. Carroll says, “Radiation and chemotherapy are very effective in controlling a lot of these cancers, so the cancer cells die, but there is a price to be paid in the normal tissue.”

Radiation causes a lot of scar tissue, so patients lose not only many of the salivary glands but also the normal flexibility of the tissue. As a result, patients have severe pain while undergoing treatment. Patients have a feeding tube inserted prior to the beginning of treatment so at the height of their pain they can still get nutrients.

New Idea:
Dr. Carroll and his colleagues began to notice that patients who would really push themselves to swallow through treatment had an easier time swallowing after their treatments were completed. Researchers now have a speech pathologist work with patients before and during treatment to teach them exercises to continue to stretch the tissue, to avoid some of the scarring. The exercises themselves, according to Dr. Carroll, are not unique. They are movement and strengthening exercises that most speech and language pathologists use regularly. Patients often have such severe tightening of the tissue that they also have to have them dilated or stretched out with balloons or medical dilators. They have this done the first time while under anesthesia and then after as an outpatient basis.

Future:
Dr. Carroll says so far they have worked with only a small group of patients and hope to study this on a larger scale in the coming year. He adds one of the benefits is that the only cost being added is that of working with a speech pathologist, and in the end, this may prove to lower the overall cost of medical complications during and after treatment.