4 Part Series of Cancer Physical Therapy Treatment:
Part 3: Head and Neck Cancer
Welcome to part three of our Physical Therapy Cancer treatment blog with we progress with our blog series here is a recap of what we provide here at Rehab Solutions. We have two providers that are specialized in Oncology Rehab. Tiffany Nielsen, PT, DPT and Emily Swanson, PTA work as a team to provide you with the best care to meet your goals during and after a cancer diagnosis. Both therapists are certified through Physiological Oncology Rehabilitation Institute (PORi), who are the leaders in Oncology Rehab.
Cancer diagnosis’s can become a lot to consider when discussing surgeries and treatment plans with your doctor. We want our treatment to help you feel at ease that we have solutions to help manage your pain, decrease musculature tightness, and help further navigate other options to help you through this time. Diagnosis testing may include a biopsy, endoscopy, CT/MRI/PET scans, or a barium swallow study. This will determine the tumor site and type to recommend treatment options, your oncologist will help you decide your best plan of care.
Head and neck cancer include cancer of mucosal linings of head and neck structures such as oral, nasal, pharyngeal, laryngeal, paranasal sinuses, salivary glands, as well as melanomas, sarcomas and lymphomas. The top treatments typically discussed are surgery, chemotherapy, and radiation. Surgery is a local intervention and surgery and radiation is concerned primary interventions and chemo as secondary. Lymph nodes will likely be removed to assess any potential spread of cancer to determine a stage of cancer and proceed with treatment. Surgeries again depend on diagnosis with the general idea of removing cancer cells from where the tumor was found along with lymph nodes in the area. Types of resections; neck dissection, single site, composite site, laryngectomy and each having a type of reconstruction along with it for healing and function. Lymph node removal does not mean you will get lymphedema but it increases the risk. Lymphedema is a chronic, progressive inflammatory lymphostatic disease caused by mechanical failure of the lymphatic system. Tiffany and Emily’s manual techniques help re-activate the lymphatic system to help with any edema that may be present or help keep edema away. Lymph node dissection and radiation therapy are NOT the CAUSE of lymphedema. They simply result in an overall functional loss and transport capacity SLOWING in the territory/local lymph system.
Side effects that can occur with these surgeries that we are aware of and can help navigate and refer to speech therapy as needed include; poor tongue mobility, nerve damage, scar tissue, decreased swallow function, change in voice, TMJ dysfunction. With head and neck cancer some of these problems can also result in the need for a speech therapy consultation to regain better function.
Chemotherapy is a systemic drug, meaning it is designed to seek out all rapidly growing and dividing cells in the body, cancerous and noncancerous. Common drugs for head and neck cancer include carboplatin, 5-FU, and docetaxel. Each of these drugs has pattern of side effects that Tiffany and Emily are aware of and try to track and help any of these symptoms that may come up, such as, peripheral neuropathy, vestibular problems, and cardio toxicity to name a few. Radiation treatment is localized to the treatment area, but may come with side effects such a burns, skin and muscular fibrosis, and loss of shoulder range of motion due to the fibrosis.
With head and neck cancer we will include assessments of cranial nerves to assess smell, ocular-motor function to name a few, musculoskeletal throughout cervical spine, TMJ, headaches and postural muscles, aerodigestive including breathing, dysphagia, mucositis and lymphatic system.
During your initial evaluation with Tiffany, she will take you back to one of our private rooms and ask about your diagnosis, what treatment you have or will be receiving, what your pain levels are, assess your motion of joints and goals you have during or after your treatments. Then she will provide part of our hands on treatment to assess your skin, any wounds that may still be healing, and help start initiating the process of our certified technique of manual therapy.
We hope to see you for one visit to establish a baseline of what is normal for you before your first surgery, then approximately three weeks after surgery we will resume treatment 1-2x per week depending on how you are feeling. Our treatments continue throughout your chemotherapy and radiation dependent upon how you are feeling and skin integrity with radiation. We love to help you beyond the current treatment to get you back to all your life goals.
We have connections to speech therapists in our area as you receive treatment from us we will help guide you in the appropriate direction as needed.
Through PORi we have learned a specific sequence of hands on techniques to help navigate your lymph fluid back to the main channels to allow your own body to improve it’s own healing and function. We provide education on movements to improve your motion, manage pain and understand stressors to improve your lymphedema. While providing these manual treatments it allows us to help monitor your healing phases and be aware of any red flags that another physician may need to look at. PORi has also integrated a body systems approach to our technique to involve your muscular, skeletal, lymphatic and neural systems to name a few. We want to help optimize and stabilize your system to help you feel like you again.