Cancer of the face, mouth, head and neck

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    The fear of cancer is deeply rooted in us all. The first thing that a person who starts to experience swallowing difficulties dysphagia may think of, is cancer. In some cases swallowing difficulties can be a symptom of cancer, but the most common causes of dysphagia are the consequences of a stroke or a hiatus hernia. However, treatment of cancer in the face, mouth, head, pharynx and neck regions can give rise to injuries that affect speech, eating and the swallowing function to various degrees.

    In this section we describe briefly how dysphagia can appear to be a symptom of cancer. Further we show how IQoro® can help those that are having problems in the face, mouth, head, pharynx and neck region in connection with, or after, a cancer treatment. IQoro® is a new and unique neuromuscular treatment method that requires just 30 seconds’ exercise, three times per day.

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    In Sweden approximately 1,000 people per year are struck by cancer in the mouth, pharynx or throat region. These forms of cancer are amongst the less common. Men over 65 years old are over-represented amongst those affected and amount to 70% of all victims; but women and younger people can be affected too. Of those that become ill, 50% develop cancer in the oral cavity, 25% in the pharynx, and 25% in the throat [1].

     

    Common symptoms of oral, pharynx and throat cancer

    The first symptoms can be hoarseness, lumps, warts or ulcers in the mouth which will not heal. Alternatively it can be a constant ’lump in the throat’ feeling, difficulties in eating and swallowing that may be more or less pronounced. General advice from the cancer charities is to seek medical advice if the symptoms are still present after 3 weeks. [1]

     

    If you always experience a blockage when trying to swallow food morsels above a certain size, this can indicate some form of narrowing of the esophagus, for example because of a build-up of scar tissue, or pockets forming in the side of the esophagus, or a tumour – so-called constant dysphagia. If this is suspected you should immediately asked to be referred to a specialist doctor, surgeon or gastroenterologist. [2]

    Read more about symptoms 

     

    Cancer of the oral cavity – oral dysphagia [1]

    • Difficulties in moving the tongue, chewing and swallowing.
    • Changes in the voice.
    • Irritation of the lips or in the mouth, for example ulcers, warts or lumps that will not disappear.
    • False teeth that no longer fit.

     

    Cancer of the pharynx – pharyngeal dysphagia [1]

    • Swallowing difficulties, including food inhalation.
    • Coughing and hoarseness.

     

    Sometimes also:

    • Problems with speech.
    • A wheezing or whistling noise when breathing in and out.

     

    Throat cancer – less common with dysphagia [1]

    • Hoarseness or changes in the voice; if the cancer is located on the vocal cords.

     

    Sometimes also more diffuse symptoms of:

    • Mild swallowing difficulty.
    • Sensation of a lump in the throat.
    • Pain that sometimes seems directed towards one ear.

     

    Cancer of the esophagus – constant esophageal dysphagia [1]

    This condition afflicts approximately 400 people per year in Sweden; mostly men. Those that are affected have often been smokers for many years, or have consumed excessive alcohol.

    • Swallowing difficulties, dysphagia, which amanifest themselves as always having a blockage in the chest for morsels of food above a certain size.
    • Weight loss.

    Sometimes also:

    • Pain when swallowing.
    • Bleeding.
    • Hoarseness.

     

    If you always have trouble swallowing food morsels above a certain size you should visit a doctor - this doesn’t however need to mean cancer. A benign narrowing can occur because of scar tissue from wounds that are caused by pills or too much stomach acid. [2,3]

     

    For more information about these forms of cancer, their symptoms and treatment we refer you to:

     

    Swallowing difficulties after an operation, radiation therapy or cytostatic treatment

    After an operation where, for example, a part of the tongue, jaw or face has been removed along with a cancer tumour, and radiation or cytostatic treatment has been used, it is usual that swallowing and speech difficulties occur in some form. Also, with skin cancer in the face or tumour in the brain, complications during or after the treatments can give rise to speech- or swallowing difficulties or a facial dysfunction – paralysis.

    Functionality of the face, mouth, pharynx and neck can be reduced by side effects of the cancer treatment: such as nerve and tissue injuries or bleeding. The functions in the face, mouth, neck and pharynx can be affected, and this will cause problems with swallowing and speech difficulties. With these types of injuries it is mostly that the muscle strength and the coordination between various muscle groups are affected or reduced. These are the muscles used for speech and the successive swallowing phases in the swallowing process. The entire swallowing process from the lips to stomach is complicated; involving 148 muscles, several salivary glands and five brain nerves: CN, (cranial nerve) Trigeminus, Facialis, Glossopharyngeus, Vagus and Hypoglossus. This complex system is sensitive to even small injuries, and these can limit quality of life as we shall see.

    Read more about The swallowing process here.

     

    Different degrees of swallowing difficulty

    Difficulties can vary from problems in closing the mouth or an unreliable swallowing reflex, to a problem that sits much deeper in the pharynx or esophagus. It’s also common that saliva production can be affected negatively and lead to dryness in the mouth, which makes it more difficult to process and break down food in the mouth, and to swallow it. Food regularly becomes stuck in the throat with the risk that it enters the air pathways - causing coughing fits as a result. Such a misdirected swallow can also occur without a subsequent coughing bout – a so-called ’silent aspiration’ – which is more serious since the coughing helps to clear the misdirected food.

    To minimise the risk of pneumonia it is very important to maintain good oral hygiene, that you brush your teeth with a soft toothbrush and clean between your teeth with dental floss or a toothpick. It is in fact not the misdirected swallowing itself that causes pneumonia, but the bacteria caused by poor oral hygiene which are drawn down into the lungs.

     

    Swallowing difficulties after cancer of the oral cavity [2]

    Most people with cancer receive radiation treatment before or after the operation, which can disable the salivary glands and cause dry, irritated or even wounded mouth membranes. Eating is painful, and you may have to anaesthetise the mouth with, for example, Xylocain gel. You may also have to drink a great deal of water to help wash down your food.

     

    Counteracting dryness of the mouth

    To counter dryness of the mouth you can salve your lips with beeswax and moisten your mouth with different types of gels or saliva substitute preparations, preferably with oily ingredients like sunflower oil. Choose a preparation without fluorine in order to be able to use it as often as you need. The production of saliva is also important for your teeth - so maintain good oral hygiene and drink water regularly.

     

    If a part of your tongue has been removed [2]

    The tongue is important both for speech and the swallowing function. Even if nearly half of the tongue has been excised a great deal of its function can be retained. However, if the majority of the rear of the tongue has been removed in an operation, severe swallowing difficulties will arise. Liquids can run into the pharynx in an uncontrolled manner, and into the air pathways causing coughing.

    Read here ”tips for safer swallowing after cancer treatment” below

     

    Damage to the front palate by radiation or surgical operation [2]

    The swallowing reflex is initiated when the food has passed the front palate – anterior palatal arch. If this is injured during an operation or subjected to radiation damage it is difficult to trigger the swallow reflex. It may help to lie down with a pillow under the crown of your head, preferably with your chin tucked down to your chest when you swallow. You should be in calm surroundings, and absolutely not talk whilst you’re eating. It can also be an advantage if you breathe in and hold your breath before you swallow. It is also important to not mix food with different consistencies in the same bite. For example, if you eat a bowl of chopped fruit in its syrup or juice, you should eat the fruit chunks and drink the juice, separately.

     

    Swallowing difficulties after cancer of the larynx [2]

    If the larynx has been removed

    If the entire larynx has been removed, then usually the musculature in the pharynx and upper esophagus mouth will be affected too. Food can easily lodge in the pharynx and also come up into the nose. On the other hand, the connection to the air pathways is closed, which reduces the risk of misdirected swallowing to the lungs, or suffocation.

    The best way to avoid blockage in the pharynx is to modify the consistency of the food. A power mixer or food processor can be of great assistance: the smoother and softer the food, the more easily it is swallowed.

    Read also,”Tips for safer swallowing after cancer treatment

     

    If only the upper portion of the larynx has been removed

    Some people with cancer of the larynx have only the upper part of the larynx and the epiglottis removed, whilst the vocal chords remain. The function of the epiglottis is to protect the air pathways during swallowing. In the absence of the epiglottis there is very poor protection and a risk of misdirected swallowing and suffocation.

    Read also,”Tips for safer swallowing after cancer treatment

     

    Swallowing difficulties after cancer in the neck lymph glands [2]

    If you have been struck by cancer in the lymph glands, for example a secondary tumour in the neck, you would usually have powerful radiation treatment in the neck region. Radiation therapy can thought of as like a burn injury in the tissue which causes scar tissue to build in the lower layers of the skin and its underlying tissue. This can cause, as well as nerve damage, locking in the pharynx musculature which makes swallowing more difficult and can allow misdirected swallowing.

    Read also,”Tips for safer swallowing after cancer treatment

     

    Tips for safer swallowing after cancer treatment

    To make swallowing easier, and minimise the risk of swallowing incorrectly after cancer treatment to the face, mouth, head or neck, read the following tips.

    1. Liquids should be mixed with a thickening agent or gelatine product to produce a more viscous consistency. It is also important not to mix food with different consistencies in the same bite. For example, if you eat a bowl of chopped fruit in its syrup or juice, you should eat the fruit chunks and drink the juice separately.
    2. Adjust your sitting position. Sit upright, look straight forward and hold your head slightly inclined downwards.
    3. Before swallowing, breathe in and hold your breath tightly; this closes the vocal cords.
    4. After swallowing, make a short cough to clear your throat and to force out any food remains that have lodged above the vocal cords.

    Treatment with IQoro®

    – with normal-, or partially retained sensitivity

    IQoro® is a new and unique neuromuscular treatment method that requires just 30 seconds’ exercise, three times per day. Training with IQoro® after a cancer treatment can improve muscle strength and coordination, for a safer and more effective swallowing function. Exercising with IQoro®, a natural neuromuscular treatment, reaches the muscles in the face, oral cavity, pharynx, esophagus, and down to the diaphragm, and in this way can improve a range of various functions: even for those that have been treated for cancer of the face, mouth, head and neck. This can include a better ability to be able to use the face’s expressive musculature, and to speak, eat and swallow more easily.

    Training with IQoro® also contributes by stimulating the glands in the lower lip and palate roof which produce the lubricating saliva, as well as the salivary glands in the cheeks and under the tongue which produce the thin, fluid saliva. This helps to counter dryness in the mouth, and is explained as follows:

    Training with IQoro® reaches the brain’s control system for the swallowing process, in which signals are sent via various fibres, so-called motorneurons, to the brain stem, and down to the muscles and glands which are to be activated. There are three different types of fibre, of which the third, the General Visceral Efferent (GVE) nerve is included in the brain nerves CN Facialis and Glossopharyngeus and sends signals to the tear glands and the saliva glands, amongst others. This explains why treatment with IQoro® can have a positive effect on dryness in the mouth.
     

    It is not yet scientifically proven that training with IQoro® has an effect on the possible complications of treatment of cancer of the face, mouth, head and neck. But it is credible from earlier clinical experience and over 20 years’ research, that IQoro® can function effectively as an alternative treatment, or as a complement to other treatments. This research shows, amongst other things, that the musculature in the face, oral cavity, pharynx and the esophagus, and down to the diaphragm achieve an improved function through training with IQoro®. Read more about the research here.
     

    Research [5] shows that IQoro® acts on, and regenerates, the entire swallowing process. It stimulates the sensory nerves in the mouth, and by doing this reaches the brain’s control system for the swallowing process, which is closely linked to the control systems for other bodily functions [6], including breathing, the ability to form sounds (speech), facial expression, postural control [4], stomach and intestine functions, and more. This explains why exercising with IQoro® can have a positive effect on so many different bodily functions.

     

    Some feeling remaining – a precondition for optimal effect

    Because both the nerve system and the musculature are triggered by stimulation through the sensory nerves, it follows that functioning feeling is important for optimal effect when training with IQoro®. The preconditions for the treatment to work are that some sensitivity: to pressure, to touch, by taste and temperature, have been retained in the face, oral cavity or pharynx.

     

    Do you have feeling in the face, oral cavity and pharynx?

    You can test yourself, or with the help of somebody else, whether you still have feeling, by touching the outside of your cheeks with one hand on each side. You can also test the sensitivity in your lips, tongue, inside of your cheeks, pharynx, front (hard) palate on the left and right hand side by using a toothbrush. If some sensitivity has been retained in some area, then there are good conditions to improve the whole, or parts of, the muscle chain from face, oral cavity, pharynx and esophagus down to the diaphragm and the stomach.

    If you are uncertain contact an Ear, Nose and Throat specialist for an opinion on the sensitivity in your face, oral cavity and pharynx to be able to decide how treatment with IQoro® should work for you.

     

    How quickly will I see an effect of treatment with IQoro®?

    Depending upon the background to the sickness, and other factors the treatment period with IQoro® varies from a few to several months, or more.

    How you train with IQ look here
     

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    Cancer of the face, mouth, head and neck

    Cancer of the face, mouth, head and neck

     

     

     

     

    ​The health care system ought to make IQoro® available

    “In the beginning of 2013 I was diagnosed with cancer of the tonsils. I answered “Yes” to the question whether I wanted to take part in a study, and was randomly selected to be treated with the antibody Erbitux in combination with radiation therapy. I was injected with Erbitux weekly and I was radiated altogether 34 times to the neck and the nearby lymph glands. The treatment brought with it serious radiation injuries which caused me to develop difficulties in eating and swallowing.

    My tongue and jaw also suffered considerable loss of function and I developed a sort of pocket in the esophagus where food could become lodged. I had great difficulty in opening my mouth more than a few millimetres. It was impossible to eat via the mouth and I received my nutrition via a PEG in my stomach.
     

     Read patients' own stories here


    Text by: Dr. Mary Hägg, Doctor of Medicine, Post-doctoral researcher at Uppsala University specialising in orofacial medicine, Head of Department at the Speech and Swallowing Faculty: Ear, Nose and Throat Clinic at Hudiksvall Hospital, Sweden. Registered Dentist. In cooperation with MYoroface.

    October 2016. (Translation from the original Swedish text by T.W.Morris, MYoroface)


    Reference sources  

     

    1. Cancerfonden, (2015), munhåle-svalg-strupcancer.

      (ny adress: https://www.cancerfonden.se/om-cancer/huvud-hals-cancer
      (English translation, ”Cancer of the oral cavity, pharynx and throat”).
       

    2. Tibbling Grahn L., Med dr., professor emerita, (2004), Svenska dysfagiförbundet – Cancer och dysfagi, pdf.

      (English translation, ”The Swedish dysphagia association – Cancer and dysphagia”).
       

    3. Cancerfonden.se (2014), Matstrupscancer, text granskad, Jesper Lagergren Professor, Karolinska universitetssjukhuset

      https://www.cancerfonden.se/om-cancer/matstrupscancer
      (English translation, ”Cancer of the esophagus”).
       

    4. Hägg M., Tibbling L. Effect of IQoro® training on impaired postural control and oropharyngeal motor function in patients with dysphagia after stroke. Acta Otolaryngol 2016; 136 (7):742-748. DOI:10.3109/00016489.2016.1145797 http://dx.doi.org/10.3109/00016489.2016.1145797

       

    5. Forskning bakom IQoro® – se separat artikellista, klicka här.

      (English translation, ”The research behind IQoro® - see separate list of articles”).
       

    6. Ekberg O, (2011), Röntgendiagnostiska avdelningen, Universitetssjukhuset MAS, Malmö, Normal sväljning inklusive anatomi och fysiologi, (pdf). Hämtad 2015-12-05,

      http://media1.dysfagi.se/2011/06/svaljningssvarigheter.pdf
      (English translation:” Normal swallowing including anatomy and physiology”).

     

     

     

        

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