Throat Cancer - Kent Community Health Magazine

"I love my life"

Cancer treatments have come a long way over the past 50 years, but for many survivors, the cost of fighting the disease permanently transforms their body. For people diagnosed with laryngeal cancer, the price they pay includes a laryngectomy, where the larynx, commonly known as the voicebox, is surgically removed. This doesn’t just affect their ability to speak, but also how they breathe, eat and drink.

After surgery, many patients choose to be fitted with a sophisticated plastic device known as a voice prosthesis, which sits in the throat where the larynx was, behind the entrance of the windpipe. It means patients are able to safely eat and drink again and produce sound. They learn to breathe through a stoma, the opening at the front of the neck, and they have to cover this hole every time they want to speak.

At the back of the voice prosthesis is a one-way valve, or flap. It is designed to stay closed when people eat and drink to make sure nothing swallowed is caught in the prosthesis, travelling down into the windpipe. It can be incredibly dangerous if this happens and can lead to infection, choking and, in some cases, death.

The prosthesis lasts about six months before it needs replacing; however, in some patients, it can become a breeding ground for candida, a fungal infection which affects its performance.

Highly Specialist Speech and Language Therapist Leila Williams explained: “Candida can thrive on a voice prosthesis because of the abundance of carbon dioxide when we exhale. The infection grows and spreads on the prosthesis in plaques; they build up like rough barnacles on a ship. Once this growth takes over, the candida can prevent the valve at the back of the prosthesis from closing.

This is when patients are at risk of food or drink entering their airway. “Where we would normally expect a prosthesis to last about six months, in some patients we were having to change them monthly due to the candida infection putting them at risk of choking. It’s a simple procedure, but really inconvenient for patients to have to be coming back so frequently, not to mention the risk it poses to their health.”

 Working with colleagues at East Kent Hospitals University NHS Foundation Trust and the University of Kent, Leila embarked on a five-year research study to develop a protocol that could prevent and treat the candida from taking hold and spreading. The study found a combination of a short course of oral anti-candida medication to treat any existing infection, combined with ongoing daily application of anti-candida medication by the patient directly on their prosthesis, had impressive results.

 Leila said: “We have identified anti-candida medications to determine the best results depending on the individual patient and we are thrilled with the results. This programme has seen the average life expectancy of a prosthesis rise from around four weeks to 17 and, in some cases, as long as 14 months. “

“It was a collaborative project using joint expertise. It is having such a positive effect on patients. It’s not just improving their care, but also involving them in their care as they are able to manage the upkeep of their prosthesis at home.”

One patient who has benefitted is 74-year-old Mick Bush. The retired air force man from Ramsgate said: “I shouldn’t really be here. I have had cancer three times and survived 40 years in the RAF. I am a very lucky man.”

Seventeen years ago Mick, who is a proud grandfather and spends his days as a grounds-man for his beloved local cricket club, was diagnosed with laryngeal cancer. “I knew there was something wrong as I had a terrible pain when I swallowed,” said Mick.

Within days of his first doctor’s appointment, he was rushed to a specialist and had a laryngectomy. Soon after he was fitted with a voice prosthesis.

 “I was speaking through the prosthesis almost immediately. I have been very lucky with all the help and medical support I have had.” Mick was referred to Leila’s caseload in 2010 and she soon noticed that he was struggling with how candida was affecting his voice prosthesis.

She said: “There are no symptoms of having the candida on a voice prosthesis, but Mick would quickly start to notice that fluid would seep through the valve and cause him to cough. The infection was fast growing and at one point we had to change his prosthesis after only three weeks.”

Mick started on the candida protocol and he was soon noticing the difference. He said: “Every morning I gently brushed a little bit of medication around the inside of my prosthesis.

“It was really easy to manage. Having to have the prosthesis changed so much was a real pain as my throat is so sensitive that it would really make me cough. The longer I can make them last the better.”

 Since his initial diagnosis Mick has also battled oesophageal and prostate cancer. “The care I have received has been out of this world and, because of people like Leila, I absolutely love my life.”

Written by Chloe Crouch and published in KCHFT's Community Health magazine issue 17, Spring 2017

https://www.kentcht.nhs.uk/magazines/issue-17/