Swallowing problems

Some types of cancer or cancer treatments can affect the head and neck and make it hard to swallow. Swallowing problems can make it difficult for you to eat and drink. Swallowing problems may also be called dysphagia.

Swallowing problems can be caused by a tumour that blocks the throat or the esophagus. They may also be caused by cancer treatments including chemotherapy, radiation therapy and surgery.

Chemotherapy and radiation therapy, especially to the head, neck and upper chest, can cause:

• painful swelling of the mucous membranes lining the mouth (called stomatitis), throat (called mucositis) and esophagus (called esophagitis)
• dry mouth (called xerostomia)
• infections of the mouth or esophagus
• swelling or tightening of the throat or esophagus

Surgery can cause physical changes to the mouth, jaw, throat or esophagus that make it difficult to swallow. It can also cause swelling or tightening of the throat or esophagus.

Symptoms of swallowing problems can vary depending on their cause and other factors. Symptoms of swallowing problems include:

• coughing, choking, gagging or vomiting when swallowing
• feeling like food is stuck in the throat
• difficulty starting to swallow
• trouble moving food from the mouth to the throat
• food getting stuck in the cheeks (also called pocketing)
• pain in the throat

If symptoms get worse or don't go away, report them to your doctor or healthcare team without waiting for your next scheduled appointment.

Your doctor, a registered dietitian and a speech therapist (also called a speech language pathologist) will try to find the cause of your swallowing problems. You may have a special x-ray test called a swallowing assessment. This test helps to see why you are having problems swallowing and determine how to manage them.

Once the cause or causes of your swallowing problems are known, your healthcare team can suggest ways to manage them. You can also try the following to help manage swallowing problems.

Check with your healthcare team, including a registered dietitian, for suggestions on how to deal with swallowing problems. Tell your healthcare team if swallowing becomes painful. Sometimes they will give you a pain-relieving mouth rinse or other medicines. A speech therapist can help you learn how to use the muscles in your mouth and throat to make swallowing easier and avoid choking and gagging when you eat. They may also suggest special swallowing techniques to make swallowing safe for you.

Ways to change what you eat and how you eat include:

• Choose soft or smooth foods, such as yogurt and mashed potatoes.
• Add gravy or sauces to foods to make them easier to swallow.
• Choose foods that are high in protein and calories like puddings, milkshakes and cream soups.
• Dip dry, crisp foods, such as cookies or toast, into milk, coffee or tea to make them softer.
• Avoid hard and dry foods, such as potato chips, pretzels or crackers.
• Cut food into small, bite-sized pieces or use a blender or food processor to chop foods that are difficult to chew.
• Take small bites and completely swallow each bite before taking another.
• Make liquids thicker by adding pureed vegetables or fruit, instant potatoes, cornstarch, infant rice cereal or commercial thickeners.
• This can make liquids easier to swallow.
• Eat cold foods to help numb pain, or eat foods that are at room temperature.
• Limit spicy foods (such as curry and peppers) and acidic foods (such as citrus fruits and fizzy soft drinks) because they may irritate the lining of the mouth, throat or esophagus.
• Avoid alcohol and tobacco.
• Limit foods or drinks high in sugar. They can increase your risk of tooth decay, especially if you have a dry mouth.
• Sit upright when eating.
• Take your time and avoid distractions like conversations when eating.

Talk to a registered dietitian before making changes to what and how you eat to make sure it is safe for you.

Tube feeding is a way to get liquid nutrition directly into your stomach or intestine using a thin, flexible tube. If swallowing problems become severe, your healthcare team may suggest using a feeding tube until swallowing gets easier again. A feeding tube can help you meet your nutrition needs when you find it too difficult to eat or drink, especially if you have lost a lot of weight.

Find out more about tube feeding and intravenous (IV) nutrition.

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