Difficulty swallowing, called dysphagia, occurs when a person has trouble getting food or liquid to pass down the mouth or throat. Some people may gag, cough, or choke when trying to swallow, while others may feel like food is stuck in the throat.
One cause is the cancer itself, especially mouth, throat, or esophageal cancers, which can cause the passages to become restricted or narrowed. It is also a common side effect of some cancer treatments, such as radiation therapy, surgery, and, less commonly, chemotherapy. Side effects of cancer treatment that may also cause swallowing difficulties include:
- Fibrosis, which is scarring or stiffness in the throat, esophagus, or mouth
- Infections of the mouth or esophagus from radiation therapy or chemotherapy
- Swelling or narrowing of the throat or esophagus from radiation therapy or surgery
- Physical changes to the mouth, jaws, throat, or esophagus from surgery
- Mucositis, which is soreness, pain, or inflammation in the throat, esophagus, or mouth. Pain associated with mucositis may worsen swallowing problems.
- Xerostomia, commonly called dry mouth, from radiation therapy or chemotherapy may also worsen swallowing problems.
Relieving side effects, also called symptom management, palliative care, or supportive care, is an important part of cancer care and treatment. Talk with your health care team about any symptoms you experience, including any new symptoms or a change in symptoms. To best manage problems with swallowing, it is important to distinguish between feeling like food is sticking in your throat or going the wrong way from pain while swallowing.
Your doctor may refer you to a speech pathologist to teach you how to swallow more easily and avoid choking and gagging while eating and drinking. A speech pathologist is a professional who specializes in helping people use the muscles in the mouth and throat. Speech pathologists with advanced skills in swallowing may be identified by Board Certification in Swallowing and Swallowing Disorders (BCS-S). Rather than waiting for swallowing problems to begin, it is often better for many patients, particularly those with cancer involving the throat, to meet with a speech pathologist to begin swallowing therapy before starting cancer treatment.
If you are experiencing painful swallowing, called odynophagia, your doctor may prescribe medications to reduce inflammation and pain. Some pain medications are mouth rinses used directly before eating. People with a mouth or throat infection, such as a fungal infection like thrush, may be given medication to treat the infection.
If swallowing problems make it hard to eat a nutritious diet, it may be necessary to receive food and/or liquids through a tube that passes through the nose or wall of the gut into the stomach until swallowing becomes easier.
Eating tips for people with difficulty swallowing
Depending on the severity and cause of swallowing problems, certain approaches may work better for some people than for others. Try different types of food and ways of eating until you find what works best, while remembering the goal to eat a nutritious diet that has enough calories, protein, and vitamins and minerals. Here are some more tips.
- Eat soft, smooth foods, such as yogurt, pudding, or ice cream.
- Mash or blend foods, or moisten dry foods with broth, sauce, butter, or milk.
- Try thickening liquids by adding gelatin, tapioca, baby rice cereal, or commercial thickening products. Thicker liquids can be easier to swallow.
- Use a straw to drink liquids and soft foods.
- Eat foods that are cold to help numb pain or at room temperature.
- Take small bites, and chew slowly and thoroughly.
- Sit upright when eating or drinking.
- If you are losing weight, eat small, frequent meals, and choose foods that are high in calories and protein, such as eggs, milkshakes, casseroles, and nutritional shakes.
- Avoid dry, coarse, or hard foods and foods that need a lot of chewing.
- Meet with a speech pathologist to learn about the foods, and the ways to prepare them, that may be easiest or safest for you to swallow.
- Ask for a referral to meet with a registered dietitian for additional advice on eating a balanced diet.