by Sarah Barts, MA, RD, CSO, LD and Ann E. Smith, M.S. CCC

April is Head and Neck Cancer Awareness Month.

Head and neck cancers account for nearly 4 percent of all cancers in the United States, according to the National Cancer Institute. Head and neck cancers are more than twice as common among men as they are among women and are diagnosed more often among people over age 50.

Head and Neck Cancer includes cancers of nasal cavity, sinuses, lips, mouth, thyroid glands, salivary glands, throat and voice box. Most head and neck cancers can be prevented, and many are curable if caught early.   Including a Registered Dietitian for nutrition intervention and Speech and Language Pathologist as part of your treatment team has been shown to lead to more positive outcomes related to treatment. Below you will find information regarding the typical signs that may indicated a Head and Neck Cancer malignancy, risk factors, possible treatment options and how both the Registered Dietitian and Speech and Language Pathologist can provide support to improve outcomes.

What are the symptoms of Head and Neck Cancer?

• Swallowing difficulties – including difficulties swallowing solid food and sometimes liquids
• Changes to voice – Noticeable voice changes for > 2 weeks
• Persistent earaches – Can be constant pain or associated with swallowing
• Changes to skin – usually appears in sun-exposed areas of face, neck, ears or forehead
• Growth in mouth that doesn’t go away. Sometimes these growths can be painless.
• Lump in neck area lasting more than 2 weeks

If you present with symptoms that are concerning, they should be brought to your physician’s attention as soon as possible.

What are the risk factors for Head and Neck Cancer?

• Tobacco and Alcohol – Tobacco is the most significant risk factor for head and neck cancer, which multiples when combined with alcohol.
• HPV – The human papilloma virus (HPV) is a factor in some cases of throat cancer, such as tonsil cancer and hypopharyngeal cancer.
• Workplace Exposures – Lengthy exposure to certain chemicals used in metalworking, plastics and textile industries, wood dust and paint fumes.

What are the treatment types?

Treatment options are dependent on the stage, type and location of tumor as well as the patient’s health prior to starting treatment.

• Surgery – May include surgically resecting the tongue, pharynx, larynx or jaw. This also may include removal of lymph nodes of the neck.
• Radiation Therapy – Radiation can be used as stand-alone, after surgery, or with chemotherapy. The goal of radiation therapy includes the concentration of radiation beams to the tumor while minimizing damage to surrounding healthy cells.
• Chemotherapy – This treatment plan destroys the cancer cells through the bloodstream using one drug or a combination of more than one drug.
• Immunotherapy – This type of treatment uses the body’s immune system to help fight cancer cells.

Nutrition and Head and Neck Cancer

The Role of Nutrition:

• Dietitians at MN Oncology are Board Certified in Oncology Nutrition and have experience working with patients who may have this diagnosis. Nutrition Interventions provided as soon as possible after diagnosis of Head and Neck Cancer has shown to improve health outcomes by decreasing weight loss, improving physical function, and improving overall quality of life.
• Up to 60% of patients with Head and Neck Cancer are malnourished before they are even diagnosed.
• Malnutrition is directly associated with worsening outcomes related to treatment for this type of cancer.
• As little as 6% of weight loss during treatment for Head and Neck Cancer can lead to malnutrition and is associated with worsened outcomes related to treatment.
• Malnutrition causes a decreased response to therapy, decreased immunity, increased risk for infections, increased post-operative complications and decreased survival rates.

Goals of Nutrition Intervention:

• Meet calorie and protein needs to help prevent weight loss and minimize muscle loss
• Provide guidance on food choices when chewing or swallowing can be difficult
• Assist with side effects from treatment when it impacts appetite, swallowing, and digestion.
• Manage options that may be used to support nutrition intake and maintain weight including consumption of oral nutrition drinks or tube feeding (enteral nutrition).

Speech Therapy and Head and Neck Cancer

What is a Speech Pathologist?

A speech pathologist is a health care professional who can evaluate your swallowing function, identify areas of weakness, and causes of swallowing difficulties (dysphagia). They can provide exercises and techniques to improve swallowing function and evaluate speech problems associated with the treatment of head and neck cancers.

What are some of the swallowing problems after treatment for head and neck cancer?

• Difficulty chewing or moving food to the back of the mouth
• Food getting stuck in the throat or going into the airway (aspiration)
• Food sticking in the mouth or liquids spilling from the mouth

Many of these problems are a result of surgical removal of cancer tumors in the mouth or throat. Swallowing problems can also be from muscle loss (atrophy) in the head and neck from lack of use or damage from treatment Tissue damage from radiation can develop years after treatment.

What are the treatments for swallowing problems?

• Performing swallowing exercises before surgery and chemo-radiation can lessen loss of swallowing muscles and improve swallowing function
• Use it or lose it!

What are the possible speech changes after treatments for head and neck cancer?

• Changes in tongue and lip movement and strength resulting in imprecise speech
• Voice sounds hoarse, strained, or weak

What are treatments for speech changes?

• Your speech pathologist can introduce exercises and techniques to work on specific speech changes that you are experiencing
• In some cases, you may benefit from using tools to help you better communicate. These tools include text to speech apps, electronic speech-generating devices, electrolarynx, and prosthesis.

When should I see a speech pathologist?

• You may see a speech pathologist for evaluation soon after head and neck cancer diagnosis. You may also have an evaluation at any time before or after treatment begins. The sooner the better!
• If there has been a change in speech or swallowing function after treatment has been completed.

Common swallowing concerns include:

• You are dependent on a feeding tube
• You have a history of aspiration pneumonia
• You have a gurgly or wet sounding voice after eating
• You can’t eat certain consistencies or types of foods
• Food gets stuck in your throat

Ask your MN Oncology Provider for a referral to see Registered Dietitian and Speech and Language Pathologist:

Registered Dietitians at Minnesota Oncology and Hemotology:

• Sarah Barts, MA, RD, CSO, LD
• Angela Stephens, RD, CSO, LD
• Tracie Swearingen, RD, CSO LD

Speech and Language Pathologist at Midwest Ears, Nose and Throat Specialists