For head and neck cancer patients, treatment creates unique issues.
Jeanette Ferguson, a 29-year-old from Columbus, Ohio, was busy being a newlywed and completing her graduate studies in pathology when she found out she had tongue cancer in June 2002.
“I had none of the risk factors for oral cancer,” says Ferguson, who didn’t smoke and rarely drank. “Basically, I had a sore on my tongue that wouldn ’t go away.”
Ferguson was devastated when she learned it was stage 4 tongue cancer, meaning there was a good chance she would never be able to sing again.
“Singing and music were a huge part of my life,” says Ferguson, who had a tough time choosing between a major in biology or musical theatre when she entered college.
Like Ferguson, many patients with cancers of the head and neck must undergo surgery, chemotherapy, and radiation. Oftentimes reconstructive surgery, speech therapy, and dietary counseling follow treatment.
Speech and swallowing rehabilitation, essential after treatment for patients who have had their larynx removed, includes learning to use a speech aid. The most popular, the electrolarynx, an electronic battery-operated handheld device, produces vibrations transmitted through external tissue or delivered intra-orally by a plastic tube. The downside—and the reason most patients hesitate to use an electrolarynx—is its mechanical-type sound. The benefit, though, is that it can be used immediately after surgery.
Esophageal speech, which sounds more natural, works by rapidly impounding air into the esophagus and expelling it in a controlled manner to produce speech. It sounds more realistic than the mechanical method, but the pitch and intensity is lower than the patient’s normal voice. Unfortunately, it may be necessary to use a speech aid while learning how to master esophageal speech since it usually takes four to six months.
Another option is tracheoesophageal voice restoration. A small opening maintained by a prosthesis that protects the airway during swallowing is created in the tracheoesophageal wall. The movement of the lips, tongue, and mouth shape the sound into words for speech production.
Richard Tyler was looking forward to an active retirement playing golf, gardening, and traveling with his wife Brenda, but those plans were quickly sidelined in 2003 when he discovered a persistent lump in his neck.
After a biopsy and other diagnostic tests, he learned he had stage 4 squamous cell cancer of the base of the tongue that had invaded the lymph nodes on the right side of his neck.
After radiation therapy, chemotherapy, and surgery to remove 20 lymph nodes in his neck, Tyler had rehabilitation therapy.
“Afterwards, I had problems swallowing and tasting food,” Tyler says. “I lost 30 pounds because I couldn’t eat anything but chicken noodle soup and ice cream.”
Resection surgery may change a patient’s ability to chew, swallow, or talk, says Barbara A. Murphy, MD, director of the Head & Neck Oncology Program at Vanderbilt-Ingram Cancer Center in Nashville, Tennessee. This can lead to weight loss and malnutrition due to a number of factors, including difficulty swallowing, lack of appetite, altered taste and metabolic changes associated with tumor and its treatment.
“An important part of our work occurs after a patient completes therapy,” says Murphy. “Patients do not return to normal immediately after treatment. Recovery takes time.”
The patient’s medical team can help patients regain their physical functioning, cope with mood disorders, such as depression and anxiety, and deal with the healing process.
In the past, reconstructive surgery after head and neck cancer involved merely “filling the hole,” but new techniques and the growing awareness of quality of life have provided patients with a better chance at regaining form and function after treatment.
Today, patients talk with a variety of health professionals to plan their treatment and recovery, which may include surgeons, dentists, physical therapists, speech therapists, and prosthodontists.
The goal of reconstructive surgery is to restore as much of the functional and aesthetic quality while also weighing the risk of recurrence, infection, and death. Surgeons attempt to restore facial movement and the ability to swallow, talk, chew, and breathe. Sometimes it is necessary to delay reconstructive surgery to monitor the area of tumor removal.
Ferguson’s oncologist suggested a rigorous treatment schedule that included radiation, chemotherapy, and surgery. After removing more than half of Ferguson’s tongue, surgeons used a muscle graft from her arm to rebuild her tongue. A skin graft from her leg was used to cover everything, and three lymph nodes were removed.
Even when the 14-hour surgery was completed, Ferguson still had a difficult journey ahead of her. She read out loud to herself and worked on pronunciation to get her speech back to what it was before surgery. She attributes her incredible recovery to her background in theatre and singing.
“I’ve kind of impressed my doctors,” Ferguson says. “Because I had a really long history of being in musical theatre, singing, acting, and taking voice lessons, I understood a lot more of the physiology behind speaking and using your tongue.”
Even with her background in speech, Ferguson says it took months. “At first you couldn’t understand a word I was saying, which was very, very frustrating,” she says. “Even today, my tongue will get tired.”
Ferguson has since become active in educating people about head and neck cancer and providing support to those recently diagnosed. One of the ways she has been able to do that is through her singing.
“I pledged to my support group that if I came out of the surgery able to talk and sing, it was my goal in life to sing the national anthem at as many national sporting events as I could to raise awareness for head and neck cancer. ”
When the Cleveland Indians heard about Ferguson’s goal they invited her to sing the national anthem at one of their baseball games.
“It was one of the most incredible experiences of my life,” Ferguson says, which made it even more special since her doctors, nurses, and fellow survivors came from Columbus to hear her sing. “It was the moment that I knew I had beaten cancer.”