Head and neck cancer patients can sometimes experience voice or swallowing disorders.
Dr. Apoorva Ramaswamy is here to tell us more.
Dr. Ramaswamy what are head and neck cancers?
So as you would expect, they’re cancers of the head and neck that can occur
basically anywhere along the tract, either
on the skin or inside the nose,
the mouth, the throat, all the way down to the upper esophagus.
So those are all considered head and neck cancers.
Indeed, yes.
What are the symptoms? Well, it really depends.
But for a lot of the most common cancers, it can be something
subtle like pain in the throat,
sometimes difficulty swallowing, sometimes changes in the voice.
Other times, it's really no symptoms at all.
And we really have to be very careful when doing exams.
Say when you go to the dentist in being watchful.
What kind of treatment can these folks expect?
It really depends based upon where the cancer is,
but it can take any form of combination of surgery, chemotherapy and radiation.
What about age as a risk factor?
In the olden days, we thought of head neck cancer primarily
being in older patients, mostly male, who had a history of smoking and alcohol.
But actually, that's all changing now with the rise of HPV,
human papillomavirus related cancers, where much younger people,
healthier people and women are also having increased risks of cancer.
What are the results of treatment?
So thankfully, with patients who have HPV
related cancer, the treatment is very effective.
It's more effective, in fact, than with patients who have
a history of smoking and with alcohol.
But really, that's why where I come in is ensuring quality of life afterwards.
Can you give me examples of what you mean by that?
So a lot of these treatments, while wonderful in curing cancer,
do result in long term consequences in terms of voice and swallowing
issues as well as other things that can arise later.
How do you treat these disorders?
It really depends on where the issue is.
You can imagine we swallow and speak with everything from our lips
down to our esophagus and stomach.
So depending on the issue, we can do a combination of therapy,
swallow therapy, physical therapy, surgery, or medication to address it.
Tell us about the expertise at The James.
I think at The James, we are blessed by having a very big team
all here for both the treatment of cancer
and in ensuring the quality of life of our patients afterwards.
So we have swallow therapists, we have physical therapists,
we have dieticians, we have social workers,
and of course myself as a throat surgeon to help with this.
So this sounds like a collaborative approach.
It is indeed.
We are very lucky and everyone is here for the same purpose in terms
of helping our patients get the best outcome.
Are there any breakthroughs in this that you can share?
We're very lucky because of how many patients we've treated at the James.
I've been able to do research with our group and we've already changed
how we treat our patients with swallowing problems.
So it's research is an integral part of how we do what we do.
How our treatment is being improved for these folks.
So it really depends on the issues, but that patients are facing.
But we do anything from changing how we can medically treat our patients
by using more effective management for their reflux.
It's actually we're finding it's extremely common in our patients to have
undiagnosed acid reflux, and it seems to be making
a very big difference in how they feel in terms of their swallowing symptoms.
So anything from the scarring in the esophagus
can be worsened by having untreated acid reflux.
And then the types of treatment that I can do in terms of treating
scarring, changes based on whether they have acid reflux.
Sometimes that means just putting them on a pill.
Sometimes it means some more aggressive recommendations in terms of
other therapies that we have to refer them to our other colleagues for.
You work with a specific type of patient that you've had good results with.
Can you explain what that is? Yeah.
So one of the most common things that we've been finding
is that patients will have something called nasal pharyngeal reflux.
Basically, the valve that separates
our nose from our throat can get weaker after radiation to that area.
And we found that by doing a pretty simple procedure that I can do in the office,
we're able to prevent liquids and food
from coming up into the nose during this chewing and swallowing process.
And we've been very lucky
that patients have seemed to have very good outcomes from that.
What are some other ways you can improve patient outcomes?
Another way that patients really suffer is trismus
or difficulty opening their mouth due to scarring after radiation.
And so we've been working on different technologies
and research for the improvement of this problem.
Something as simple as injecting
sugar water, dextrose, into the jawbone, jaw joint has seemed to be effective
in helping people open their jaw wider and with less pain and everything
from chewing,
putting in your dentures to eating a burger really improves with that.
What about quality of life for these patients?
The wonderful thing about the efficacy
of our treatments nowadays is that patients are living for decades.
And so when they have swallowing problems, it's actually the most common thing
that will happen to them after they've now gotten over the cancer.
We found that 30%
of patients who have some kind of swallowing problem
will actually end up in the hospital from having food
or liquids go down into their lungs, resulting in a pneumonia.
So, yes, we want them to eat and drink the way we want to.
But this also ends up being about
mortality and their survival.
So it's very important for us to be able to treat these problems early.