Brain And Head And Neck Cancer From The Scope Of An SLP
Written by: Kendra Wormald / Medical Rehabilitation / June 21, 2023 / 10 minutes read
This piece serves as a contribution to the series investigating neurodegenerative conditions from the perspective and scope of a Speech-Language Pathologist.
Cancer is defined as a genetic disease whereby uncontrolled division of abnormal cells in a part of the body occurs, which may spread to other parts of the body.
Cancer Cells Vs Normal Cells
(National Cancer Institute, 2021)
Cancer Cells:
Grow without a signal telling them to grow
Ignore signals that tell a cell to stop dividing
Invade nearby areas
Signal the blood vessels to grow towards the tumor, which supply the tumor with oxygen, nutrients, and blood
Hide from the immune system and trick it to allow the cancer cells to stay alive
Duplication and deletions of chromosome parts
Normal Cells
Only grow when a signal is received
Follow signals to stop dividing or when to die
Stop growing when encountering other cell, typically don’t move around the body freely
Immune system works to eliminate damaged or abnormal cells
Primary Brain Tumor: Tumors that originate in the brain, may spread to other areas of the brain but rarely spread to other parts of the body
Metastatic Tumor (secondary): Tumor that starts in another part of the body and spreads to the brain
Benign brain and spinal cord tumors grow and put pressure against the brain, rarely spreading to other tissues but this may recur.
Malignant brain and spinal cord tumors grow quickly and likely will spread to other brain tissues (National Cancer Institute, 2021).
(National Cancer Institute, 2021)
Head and neck squamous cell cancers entail oral cavity, oropharyngeal, hypopharyngeal, and laryngeal cancers
Oral Cavity: Includes the lips, the front two-thirds of the tongue, the gums, the lining inside the cheeks and lips, the floor of the mouth under the tongue, the hard palate (bony top of the mouth), and the small area of the gum behind the wisdom teeth.
Throat (pharynx): This structure is a cartilaginous ~ 5 inch hollow tube that originates behind the nose and extends to the esophagus (breathing tube). Included here are the nasopharynx, oropharynx and hypopharynx
Voice box (Larynx): This is where your vocal folds reside. It’s a short cartilaginous passageway. A small tissue called the epiglottis moves to protect the larynx when eating to avoid food or liquid entering the lungs (aspiration)
Nasal Cavity: Hollow cavities inside the nose
Salivary Glands: Major glands are in the floor of the mouth and by the jawbone. Salivary glands produce the two major types of saliva, serous and mucous. Serous saliva is involved in solubilizing dry food, maintaining good oral hygiene and initiating the digestion of starch. Where mucus lubricates the oral cavity to aid in food transport
Causes and Prevalence
Changes in the genes that support cell function, especially the division and growth of cells, leads to cancer (National Cancer Institute, 2021). Genetic changes that can occur include: cell division errors, damage to DNA caused by environmental substances (tobacco, ultraviolet rays from the sun), or through genetic inheritance (National Cancer Institute, 2021).
The specific cause of the majority of adult brain and spinal cord tumors is not known, and symptoms may present differently across every person.
“It is estimated that 55,000 Canadians are surviving with a brain tumor and that 27 Canadians are diagnosed with a brain tumor each day…There are over 120 different types of brain tumors, making effective treatment very complicated…23.5 new cases of primary brain tumors were estimated per 100,000 population per year (using data from Alberta, British Columbia, Manitoba, Ontario)” (Brain tumor foundation, 2023).
“Head and neck cancer accounts for about 4% of all cancers in the United States. In 2023, an estimated 66,920 people (49,190 men and 17,730 women) will be diagnosed with head and neck cancer. Worldwide, an estimated 562,328 people were diagnosed with head and neck cancer in 2020.” (American Society of Clinical Oncology, 2022)
Impact on Communication and Swallowing
“When a tumor grows into or presses on an area of the brain, it may stop that part of the brain from working the way it should. Both benign and malignant brain tumors cause signs and symptoms and need treatment” (American Brain Tumor Association, 2022) .
The impact of a brain tumor is dependant on the location in which the tumor resides:
Frontal Lobe: Difficulty with problem solving, word finding, expressing thoughts in speech and writing, planning and sequencing of motor movements to generate speech and nonverbal communication
Temporal Lobe: Difficulty with long and short-term memory, trouble hearing and comprehending what is said, learning may be disrupted
Occipital Lobe: Difficulty with processing visual information, recognizing common objects, faces, and words, and impaired reading
Cerebellum: Difficulty with balance and coordination of muscle movements including muscles for voice generation. Difficulties with posture may impact breath support in speech
To learn more about how to optimize breath support in communication, see our Masterclass.
Brain Stem: Difficulty with movements of the tongue may make speaking a challenge and may impact the safety and efficiency of swallowing
Cerebellar-Pontine Angle: Pressure here impacts the 7th and 8th cranial nerves which affect hearing, balance and facial movement. Often one-sided facial weakness is common which will impact the clarity and effectiveness of speech
Thalamus: Difficulty with staying alert and following a conversation, impact on memory, vision and hearing. Tremors during purposeful movement may also be present
Speech: Reduced overall intelligibility due to imprecise speech, distortions of speech sounds, reduced mobility, tongue resections/reconstruction
Voice: Changes in pitch, loudness, quality of voice may because hoarse, breathy or sound strained (dysphonia), loss of voice (aphonia)
Resonance: Hyper or hypo nasality, cul-de-sac resonance
Hearing: hearing loss of varying severity, ringing in the ears (tinnitus) or dizziness
Eating and Swallowing: Difficulty chewing, lack of control of food in mouth could lead to spillage or piecemeal, nasal regurgitation, impairment of the epiglottis could leave the airway unprotected and at heightened risk for food or liquid going into ‘down the wrong tube’ (aspiration), impaired muscular digestive movement (peristalsis), GERD
Speech and language therapy is beneficial for all stages of brain and head and neck cancer treatment. Support may be provided through compensatory strategies, voice training, augmentative and alternative communication, and eating, drinking and swallowing management.
To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.