Difficulty Swallowing

Also called: dysphagia

People who have cancer sometimes have difficulty swallowing. This can affect their food and fluid intake.

Causes

The cancer itself may cause difficulty swallowing, especially if the tumour is blocking the throat or the esophagus. Cancer treatment can also be the cause:

• Swallowing can become painful because of an inflammation of the mucous membranes lining the mouth, throat and esophagus. This may be referred to mucositis, stomatitis or esophagitis. The most common causes are chemotherapy and radiation therapy, especially radiation given to the head, neck or upper chest.
• Dry mouth (xerostomia) caused by cancer treatments can also cause swallowing difficulties.
• Some surgeries to the head and neck or esophagus can affect swallowing.

Symptoms

Difficulty swallowing may include:

• the feeling that food is sticking in the throat
• difficulty in starting to swallow
• trouble moving food from the mouth to the throat
• pocketing of food in the cheeks
• coughing or choking when swallowing

Management

There are ways to help to make swallowing foods and fluids easier:

• Try different food textures to find ones that are easier to swallow. Foods that are soft or have a smooth texture, like mashed potatoes, are often easier to swallow.
• Use a blender or food processor to chop foods that are difficult to chew. Use fruit or vegetable juices, broth or milk to blend the foods together. A soft, blenderized diet is often a good way to continue to eat nutritious, tasty foods when swallowing becomes difficult or painful.
• Cut food into small, bite-sized pieces to make them easier to chew.
• Take small bites of food. Completely swallow each bite before taking another.
• Thicken liquids as much as needed to make them easier to swallow. Adding gelatin, puréed vegetables or fruits, instant potatoes, cornstarch, infant rice cereal or commercial thickeners may help.
• Make sure to include plenty of fluids every day to help prevent dehydration, especially water. Other sources of fluids include juices, soups, milk, popsicles, pudding, yogurt and ice cream. Thicken fluids if you have problems swallowing thinner liquids.
• Be careful with foods and fluids that contain a lot of sugar. They can contribute to tooth decay, especially if you have a dry mouth (xerostomia).
• Add gravy or sauces to foods to make them easier to swallow.
• Dip dry, crisp foods, such as biscuits, into milk, coffee or tea to make them softer.
• Avoid hard and dry foods, such as potato chips or pretzels.
• Limit spices such as chili powder, pepper, or curry and spicy foods. These can irritate the lining of the mouth, throat and esophagus.
• Avoid alcohol and tobacco.
• Sit upright for meals.
• Tell the doctor or healthcare team if swallowing becomes painful. Sometimes special pain-relieving mouth rinses or pain medications are prescribed.
• Check with the healthcare team or a registered dietitian for other suggestions on how to deal with difficult or painful swallowing.
• Tell the doctor or healthcare team if you are choking on food or if choking is frequent or persistent. A swallowing assessment may be recommended.

Tube or intravenous feedings

If swallowing problems become severe, the healthcare team may suggest using a feeding tube. A feeding tube is a thin, flexible tube that is usually placed into the stomach or intestines. Once the tube is in place, liquid nutritional supplements can be given through it (enteral feeding). Feeding tubes can help people get their nutritional needs when they find it too difficult to eat or drink, especially if they have lost a lot of weight. Total parenteral nutrition (TPN) is given in certain situations.