Swallowing problems from cancer and cancer treatments

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science.

This page was updated on March 2, 2022.

Cancer and cancer treatments may sometimes lead to dysphagia, or difficulty swallowing.

Your ability to enjoy food comfortably and safely is something you and your care team should tackle together to achieve. Good nutrition may help you keep your strength up and maintain a healthy weight.

If you have trouble eating for more than two days, contact your care team right away.

Causes of dysphagia

Cancer: The location of a tumor may impact your ability to swallow. Head and neck cancers in particular may lead to dysphagia, but so can a tumor that places pressure on the esophagus or one that affects the brain, preventing it from sending the right messages to your esophagus.

Cancer treatments: Radiation and chemotherapy may cause dysphagia due to mouth sores or pain when swallowing. Radiation therapy in particular may affect saliva, causing dry mouth, which also makes swallowing difficult. Often, these side effects resolve quickly.

Other causes: Some causes may not be directly related to cancer but happen to occur at the same time.

  • Infection in the mouth or esophagus
  • Neuropathy
  • Stroke
  • Conditions that affect the brain or nervous system
  • Heartburn
  • Indigestion
  • Excess saliva

Managing dysphagia

Modifying your eating habits may make it easier for you to swallow. These tips help ensure you’re consuming enough calories to boost your strength and keep your weight on.

  • Stick to foods that are mild, soft and smooth, but are also calorie- and protein-dense.
  • Eat more frequent small meals and snacks rather than larger meals.
  • Take small bites.
  • Completely swallow each bite of food before you take the next one.
  • When possible, use a straw for beverages and soft foods.
  • Sit upright when eating and drinking and avoid reclining right after meals to help with digestion.
  • Ask your doctor for a referral to a therapist trained in managing swallowing difficulties. He or she may show you how to swallow more efficiently and avoid coughing or choking when eating and drinking. A registered dietitian may help you make the best food choices.
  • If you’re experiencing significant mouth pain, get your doctor’s OK to try a pain reliever or numbing gel prior to eating.
  • If a dry mouth is causing pain when you swallow, do your best to stay hydrated and moisten the dry tissues.

Certain foods and cooking methods make swallowing easier.

  • Choose thicker liquids rather than thinner liquids—pureed fruit or fruit nectar instead of juice, milk- and/or yogurt-based shakes—if these are easier to swallow.
  • Mash or puree any food you’d like to eat to a baby-food consistency.
  • Consider foods such as scrambled eggs and cooked oatmeal or cereal.
  • Add gravy or sauces to make it easier to eat certain foods, such as meat and chicken.
  • Use a blender or food processor to create smoother mashed potatoes and other foods, and to make high-calorie shakes. It may be helpful to prepare these ahead of time and freeze portions for yourself.
  • Try colder foods, such as ice cream and other frozen treats, to help numb pain from swallowing difficulties.

If thicker foods are easier for you to eat, try to improve their consistency with thickeners and modifiers.

  • Flour, tapioca or cornstarch thicken liquids and sauces, but they work best in cooked foods because they can’t be eaten raw.
  • Dietary thickeners made for people with swallowing issues may be added to most foods and beverages. Follow the instructions on the label.
  • Mashed potatoes and pureed vegetables thicken broths, adding flavor as well as nutrients.
  • Gelatin acts as a thickener and may also be used to soften some “hard” foods such as sandwiches, cookies, cakes and crackers. Mix 1 tablespoon of unflavored gelatin in 2 cups of hot liquid, then pour it over the food. Once the gelatin completely saturates the food, it’s ready to eat.

Avoid items that may be irritating as well as hard to swallow such as:

  • Alcoholic beverages
  • Spicy foods and drinks
  • Foods high in acids, like citrus
  • Hard, dry foods and foods that require a lot of chewing

If you must swallow medication and are finding it difficult, ask your doctor or nurse if you may crush the pills and mix them into a food or beverage. Not every medication may be taken this way, so it’s essential to ask first.

Also be aware of complications from swallowing issues and contact your care team if you experience gagging or coughing while eating, get ulcers or another form of mouth irritation, or find that food gets stuck in your throat or esophagus.

Ask for help. Your cancer care team, particularly your dietitian, may help you find ways to eat uninterrupted and safely.

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