Difficulty Swallowing (Dysphagia)

This section has been reviewed and approved by the PLWC Editorial Board, 02/05

Difficulty swallowing (dysphagia) occurs when a person has trouble getting food or liquid to pass down the throat. Some people may gag, cough, or choke when trying to swallow, while others experience pain or feel like food is stuck in the throat.

Causes

Difficulty swallowing can be a result of cancer itself, especially throat or esophageal cancers that can cause the esophagus to become restricted or narrowed. Difficulty swallowing is also a relatively common side effect of some cancer treatments. Potential side effects of surgery, radiation treatment, or chemotherapy that can cause swallowing difficulties include:

• Soreness, pain, or inflammation in the throat, esophagus, or mouth (mucositis)
• Dry mouth, from radiation treatment or chemotherapy
• Infections of the mouth or esophagus, from radiation treatment or chemotherapy
• Swelling or constriction of the throat or esophagus, from radiation treatment or surgery
• Physical changes to the mouth, jaws, throat, or esophagus, as a result of surgery

Management

Choking or gagging while swallowing can be frightening. Your doctor may refer you to a speech therapist, a professional who specializes in helping patients use the muscles in the mouth and throat. A speech therapist will teach you how to swallow more easily and how to avoid choking and gagging while eating or drinking.

Your doctor may also prescribe medications to reduce inflammation and pain. Some pain medications can be given in liquid form to be used as a mouth rinse 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 difficult to eat a nutritious diet, it may be necessary to receive food through a tube (usually a nasogastric tube that passes through the nose into the stomach) until swallowing becomes easier.

Diet and eating tips for patients with difficulty swallowing

Depending on the severity and cause of swallowing difficulties, different tips may work better for some patients than for others. Try different types of food and ways of eating until you find what works best.

• Eat soft, smooth foods, such as yogurt, pudding, and ice cream.
• Mash or blend foods to make homemade shakes or moisten dry foods with broth, sauces, 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 protein and calories, 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 registered dietitian (RD) for additional advice on eating a balanced diet.

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