Speech and Swallowing Support After Lung Cancer Relapse

What happened, in summary

A 75-year-old patient was diagnosed with adenocarcinoma of the left lung in December 2014. Treatment included removal of the left upper lung lobe with lymph-node dissection, followed by 2 cycles of adjuvant chemotherapy. The patient remained active in retirement and was also the main caregiver for family members.

In January 2018, a new hoarse voice led to assessment by an ear, nose, and throat specialist. Examination showed paralysis of the left vocal cord. CT imaging then confirmed that the lung cancer had returned, with enlarged mediastinal and left supraclavicular lymph nodes and metastatic disease in both lungs. A speech and language therapist also identified significant swallowing difficulty with silent aspiration.

The therapist recommended turning the head to the left while swallowing, reducing distractions during meals, and avoiding foods that mixed solids and liquids. These strategies initially prevented material from entering the airway. An injection laryngoplasty later improved the patient’s voice, although swallowing did not improve and the earlier head-turn strategy stopped being effective. Fluid consistency was then modified. The patient continued regular review in the lung clinic, remained able to eat and drink with support, and had not developed complications such as aspiration pneumonia at the time described.