Dysphagia (trouble swallowing) and cancer

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

The ability to enjoy food comfortably and safely is something every patient and his or her care team should tackle together. Good nutrition may help patients keep their strength up and maintain a healthy weight.

Patients who have trouble eating for more than two days should contact the care team right away.

What is dysphagia?

Dysphagia is the term doctors use when a patient has difficulty swallowing. This condition may be caused by tumors that interfere with the food passage (often head and neck cancers). In other cases, dysphagia may be a side effect of the specific cancer treatment used.

Dysphagia causes

The patient should work with his or her care team to identify the specific cause of dysphagia so a comprehensive treatment plan may be developed. Following are several potential factors that may lead to difficulty swallowing in cancer patients.

Cancerous tumors: The location of a tumor may impact the patient's ability to swallow. Head and neck cancers in particular may lead to dysphagia, as well as a tumor that places pressure on the esophagus or one that affects the brain, preventing it from sending the right messages to the patient's esophagus.

Cancer treatments: Radiation therapy and chemotherapy may cause dysphagia from mouth sores or pain when swallowing. Radiation therapy in particular may affect saliva, causing dry mouth, which also makes swallowing difficult. In addition, radiation therapy may cause scarring within the digestive tract, making swallowing challenging. Often, these side effects resolve quickly.

Other dysphagia 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

It's important to work with the care team to create a dysphagia treatment plan. Cancer patients may find relief by employing specific management techniques, like modifying their eating habits. The following tips may help patients ensure that they're consuming enough calories to boost their strength and keep 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 taking 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 for a referral to a therapist trained in how to manage swallowing difficulties. He or she may show the patient how to swallow more efficiently and avoid coughing or choking when eating and drinking. A registered dietitian may help the patient make the best food choices.
• If the patient is experiencing significant mouth pain, get the doctor’s OK to try a pain reliever or numbing gel prior to eating.
• If a dry mouth is causing pain when swallowing, work to stay hydrated and moisten the dry tissues.

Certain foods and cooking methods may 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 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.
• Try colder foods, such as ice cream and other frozen treats, to help numb pain from swallowing difficulties.

If thicker foods are easier 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 one tablespoon of unflavored gelatin in two 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 medication must be swallowed and the patient is finding it difficult, ask a doctor or nurse if it's possible to 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 the care team if the patient gags or coughs while eating, gets ulcers or another form of mouth irritation, or finds that food gets stuck in his or her throat or esophagus.

Ask for help. The cancer care team, particularly a dietitian, may help the patient find ways to eat uninterrupted and safely.