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Swallowing problems

Some people with cancers of the head and neck or cancer of the brain may experience swallowing problems. Speech therapists (speech-language pathologists) assess and treat swallowing problems. They work closely with surgeons and oncologists to make sure you get the help that you need.

Causes

Swallowing problems can happen because of a blockage by the cancer or as a side effect from treatment.

These side effects of treatment can cause swallowing problems:

  • scarring or stiffness in the throat, esophagus or mouth
  • infections in the mouth or esophagus
  • swelling or narrowing of the throat or esophagus
  • changes to the mouth, jaw, throat or esophagus after surgery

Preserving an organ (such as the tongue) is a main consideration when treating head and neck cancer with surgery or radiation therapy. Organ-sparing treatments have evolved and improved and have resulted in better swallowing function.

Types of swallowing problems

Swallowing problems can occur if any part of the swallowing process is changed or interrupted. Swallowing problems can affect your ability to eat and enjoy eating. This may lead to poor nutrition, dehydration, weight loss and poor health.

Problems may include:

  • difficulty chewing or controlling food or liquid in the mouth
  • coughing, gagging or choking when food or liquid enters the airway (aspiration)
  • feeling like food is getting stuck in the throat or esophagus
  • pain in the throat or chest when swallowing
  • little or no saliva

It is important to report any concerns about swallowing or eating to your healthcare team.

Diagnosis

If you have difficulty swallowing, a speech therapist may do a swallowing assessment.

Physical exam

During an assessment, the speech therapist may ask you questions about swallowing problems and may watch you swallow different types of food.

Imaging tests

The speech therapist may order a videofluorographic swallowing study (VFSS). A VFSS is an imaging test that uses barium (a chalky, white liquid that shows up clearly on an x-ray) and x-rays to produce pictures of the mouth, throat and esophagus. This test is also called a modified barium swallow (MBS).

During a VFSS, you are given foods and liquids of various consistencies to which barium has been added. A special x-ray (fluoroscopy imaging) captures moving images of the food and liquid as they pass through the mouth and down the throat. This allows the speech therapist to identify the type, severity and cause of any swallowing problems in the mouth and throat.

Swallowing rehabilitation

You may need to learn to swallow in a new way after cancer treatment. The speech therapist will consider different swallowing rehabilitation techniques and suggest the one that is most helpful for you. They may suggest:

  • tucking your chin down toward your chest to help prevent food and liquid from going into the airway
  • lifting your chin to help widen the oropharynx and force the food to the back of the mouth
  • turning your head to the side of the throat that is stronger or has more control to help move the food into the esophagus
  • swallowing harder to help the tongue put more pressure on the palate, improve the movement of the base of the tongue and move the food down your throat

Managing swallowing problems

Once the cause of swallowing problems is known, your healthcare team can suggest ways to manage it.

Changes to diet or the way you eat

Changes to your diet may help make swallowing foods and liquids easier.

  • Thicken liquids by adding gelatin, puréed vegetables or fruit, instant potatoes, cornstarch, infant rice cereal or commercial thickeners to make them easier to swallow.
  • Add gravy or sauces to foods to make them easier to swallow.
  • Dip crisp foods, such as biscuits, into milk, coffee or tea to make them softer.
  • Avoid hard and dry foods.
  • Try different food textures. Foods that are soft or have a smooth texture, like mashed potatoes, are often easier to swallow.
  • Take small bites of food and swallow each bite completely before taking another bite.
  • Drink plenty of water and other fluids such as juices, soups, milk, popsicles, pudding, yogurt and ice cream to help prevent dehydration.
  • If medicines are hard to swallow with water, try taking them with thick liquids or soft foods, such as applesauce or ice cream. Some medicines may be crushed and mixed with food or liquid. But it is important to check with a pharmacist first because some medicines should not be crushed or cut in half.

Tube or intravenous feedings

If swallowing problems become severe and you’ve lost a lot of weight, your healthcare team may suggest tube feeding. A thin, flexible tube is placed into the stomach or intestines. Once the feeding tube is in place, liquid nutritional supplements and medicines can be given through it. If tube feeding is not possible, your healthcare team may suggest intravenous nutrition (giving nutrients directly into a vein) (also called parenteral nutrition).

Find out more about tube feeding and parenteral nutrition.

Finding support

Learning to swallow again can be very hard. Some people find it helpful to have emotional and practical support from other cancer survivors. The International Association of Laryngectomees has support groups in Canada.

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