| Mouth, nose & throat cancers | Diagnosing mouth, nose & throat cancer | Treatment for mouth, nose & throat cancer |
| Recovery & follow-up care |
Reviewed by: Stephen Kleid (MB,BS FRACS); Otolaryngology/Head & Neck Surgical Oncology, Peter MacCallum & Western Hospital; Jacqui Frowen (B.SpPath. Hons), Speech Pathologist, La Trobe University
On this page: Eating and swallowing | Talking again | Changed appearance | Prostheses | Coping with other people's reactions | Follow-up care
Recovery and follow-up are different for everyone and depend on the treatment you have. It takes time to recover. There are physical and emotional changes to cope with, maybe changes in the way you look, the way you speak, or what you can eat.
You may need to talk to your employer about how the treatment may affect your work, and with your family about the support you need.
‘It probably took a few months after the treatment to get back on my feet.' Ron, aged 62
Some people will not have difficulties eating and swallowing after surgery. If you do have these problems after surgery, or during the weeks you are having radiotherapy, the speech pathologist will be a vital part of your treatment team.
The speech pathologist will see you soon after the operation to examine your mouth and assess how well you can swallow. They may order a special x-ray called videofluoroscopy. In this test, you will be x-rayed while swallowing spoonfuls of food or drink containing a substance that shows up on x-rays. The moving image will be recorded on videotape, and if any food is escaping into your lungs, this will show up clearly. The test takes 10 to 20 minutes.
The first aim of therapy is always to ensure food and drink goes into your stomach and not into your airway and lungs. As well as being uncomfortable and causing coughing and spluttering, this can also cause serious chest infections.
The speech pathologist may give you special exercises, or advise you to change your posture while eating, to make swallowing easier.
The speech pathologist will also help to find the easiest and safest foods for you. Different textures will be easier for different people. Usually, at the start, food with a thicker consistency (for instance, yoghurt or fruit puree) is easier and safer than fluids, which don't hold together well and can travel through your throat too quickly. A dietitian may also be called in to help plan an interesting, enjoyable and balanced diet that you can swallow.
‘For a while after the operation, I used to avoid eating out socially because I felt self-conscious.' June, aged 47.
Your surgeon will let you know when you can wear dentures again. If these no longer fit, you will need to visit the dentist. If you have had radiotherapy, it is best to see a dentist who specialises in post-radiotherapy dental care. If you have had surgery to your palate, you may need a plate to close any gap and help with speech and swallowing. This is called an obturator. It will be made by a maxillofacial technician and fitted by a specialist dentist called a prosthodontist.
Surgery to the mouth or throat often affects speech. For some, this will only be a minor or temporary problem and speech will return to normal or near normal. For others, it will be more significant and cause permanent changes: for example, slurred speech sounds or a weak or harsh voice. It is important to remember that, immediately after surgery, there will be swelling and bruising, and your speech will improve as you heal.
‘I have to think now about how I speak, as well as what I am saying. Some people understand everything I say, but others just can't.' Carl, aged 70
Speech therapy generally begins as soon as possible after surgery and usually continues after you return home. The aim is to find the best way for you to communicate. This may involve exercises to strengthen mouth movements, or finding new ways to produce speech sounds. Some people will rely on methods other than speech, from a pencil and pad to a computer-based system that generates voice.
For people who have had a total laryngectomy, there are various approaches to regaining voice, using either an artificial device that produces voice, or a voice produced by vibrating air in the food pipe. Even after complete removal of the voice box most people can talk reasonably well within a month. You can obtain further information from your speech pathologist, or from the Cancer Helpline on 13 11 20.
‘I've always been a fast talker, but I am learning to speak more slowly, which helps people to understand me the first time.' (Connie, aged 73)
People you know will very quickly get used to your changed speech or voice. The reactions of strangers may be harder to get used to. Some may be curious, some embarrassed. You may feel that some people treat you differently because your speech is different. You may find yourself having to put others at ease, as well as dealing with your own problems. If you can be comfortable, open and informative about your speech or new voice, curiosity will be satisfied, embarrassment overcome, and you can get on with things. This will not always be easy. Try to find someone with whom you can talk over these difficulties, or simply ‘let off steam'.
If surgery affects your face, then no matter how well prepared you are for surgery, looking at your face for the first time after the operation may be very hard. It will help to have someone with you who understands the surgery and the healing process.
Be prepared to feel upset or angry. You will need time and help to come to terms with changes. Don't forget that you are seeing it at its worst. Swelling and bruising will go away as you heal, and scars will fade over time.
Enormous advances have been made over recent years to help people to achieve an excellent cosmetic result after surgery. Depending on the extent of the operation, you may be offered camouflage make-up: specially designed creams to disguise scars, suitable for men and women.
You may be offered a prosthesis: a specially designed, soft plastic replacement for the part of your face that has been removed. These prostheses are fitted permanently and blend extremely well with your own skin and features. While they can never feel like your own tissue, they generally look very good.
If you are likely to need a prosthesis, the doctor will discuss this with you before the operation. You could also ask to see a prosthodontist before surgery. Your doctor or speech pathologist may also be able to put you in touch with someone who has a prosthesis.
Coping with other people's reactions can be difficult. Some people have found that it has helped, first, to get used to looking at themselves, and to gather strength with their partner or close family.
‘I've had to make a few adjustments, but I find I can do most of the things I enjoy in life.' Brian, aged 58
Whether it is your appearance or your speech that has changed, try to get out and about as soon as possible after the operation. The longer you leave it, the harder it may be. Take someone with you at first, to give you moral support, and be prepared for mixed reactions. Some people may stare or make remarks that hurt you. Some may look away in embarrassment. Others may not even notice any change, despite your self-consciousness.
People care about you because of the person you are inside, not because of your face or your voice. If you can be open about your reaction to your changed appearance, people often find that this openness can help to remove any embarrassment. And given the chance, most people will be keen to reassure you that they care about you in just the same way as they did before your surgery.
Many people find it helpful to talk about their difficulties with a trained counsellor. Your hospital may be able to put you in touch with someone suitable, or contact the Cancer Council Helpline on 13 11 20. Never be afraid to ask for help. There are many people who are very willing to listen and give you their full support.
Regular follow-up health checks are very important. Your doctor and dentist will monitor your healing and look for any signs that the cancer may have returned. These check-ups will include x-rays and examinations. Patients with mouth dryness from radiotherapy should see the dentist regularly. You may need to see a dietitian if weight loss or eating problems continue. You may also need to keep seeing a speech pathologist if swallowing problems continue or you need to continue speech or voice therapy.
Health check-ups are always an anxious time, but even if the doctor finds further signs of cancer, there are many things that can be done to help you. If you have any worries about your health between check-ups, don't wait for the next appointment. See the doctor promptly.
The check-ups will continue for a number of years after your treatment finishes. This can make it hard to put the experience of cancer behind you. You might feel quite anxious at check-up time. Finding a way of supporting yourself each time is part of living with cancer.
