Difficulty swallowing is also called dysphagia. Some types of cancer or cancer treatments can affect the head and neck and make it hard to swallow. Some people may gag, cough or choke when they try to swallow. Other people have pain or feel like food is stuck in their throat. Difficulty swallowing can affect your ability to eat and drink.
Difficulty swallowing can be caused by a tumour that blocks the throat or the esophagus. It may also be caused by cancer treatments, including chemotherapy, radiation therapy and surgery.
Chemotherapy and radiation therapy, especially to the head, neck or upper chest, can cause:
- painful inflammation of the mucous membranes lining the mouth (stomatitis), throat (mucositis) and esophagus (esophagitis)
- dry mouth (xerostomia)
- infections of the mouth or esophagus
- swelling or tightening of the throat or esophagus
Surgery can cause physical changes to the mouth, jaws, throat or esophagus that make it difficult to swallow. It can also cause swelling or tightening of the throat or esophagus.
Symptoms of difficulty swallowing can vary depending on their cause and other factors. Symptoms may include:
- feeling that food is sticking in the throat
- difficulty in starting to swallow
- trouble moving food from the mouth to the throat
- food getting stuck in the cheeks, which is also called pocketing
- coughing, choking or gagging when swallowing
Managing difficulty swallowing
Once the cause of difficulty swallowing is known, your healthcare team can suggest ways to manage it. You can also try the following to help you manage difficulty swallowing.
Change your diet
Try foods with different 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. 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.
Cut food into small, bite-sized pieces to make them easier to chew. 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, pureed diet is often a good way to continue to eat nutritious, tasty foods when swallowing is difficult or painful.
Take small bites. Completely swallow each bite before taking another.
Make sure to include plenty of fluids every day, especially water, to help prevent dehydration. Other sources of fluids include juices, soups, milk, popsicles, pudding, yogurt and ice cream. Thickening liquids may make them easier to swallow. Try adding gelatin, pureed vegetables or fruit, instant potatoes, cornstarch, infant rice cereal or commercial thickeners. Use a straw to drink liquids and soft foods.
Eat foods that are cold (to help numb pain) or at room temperature. 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.
Make every mouthful count by choosing foods that are high in protein and high in calories. Try not to eat foods or drink fluids that contain a lot of sugar. They can contribute to tooth decay, especially if you have a dry mouth, or xerostomia.
Sit upright when eating meals.
Talk to your healthcare team
Check with your healthcare team or a registered dietitian for other suggestions on how to deal with difficulty swallowing. Tell your healthcare team if swallowing becomes painful. Sometimes they will prescribe special pain-relieving mouth rinses or other medicines.
Choking or gagging while trying to swallow is a frightening experience. If you choke on food or if choking is frequent or constant, the healthcare team may recommend a swallowing assessment. A speech therapist can help you learn how to use the muscles in the mouth and throat to make swallowing easier and avoid choking and gagging when you eat.
Tube or intravenous feedings
If swallowing problems become severe, the healthcare team may suggest using a feeding tube until swallowing gets easier again. Feeding tubes can help people meet their nutritional needs when they find it too difficult to eat or drink, especially if they have lost a lot of weight.
A feeding tube is a thin flexible tube that is usually placed into the stomach or intestines. Liquid nutritional supplements can be given through the feeding tube, which is called enteral feeding.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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