Can Cancer Treatment Make It Difficult to Swallow?

What can I do to address the difficulty swallowing I’ve been having since my treatment?

Katherine Hutcheson, speech pathologist at the University of Texas MD Anderson Cancer Center in Houston

Dysphagia is difficulty swallowing food or liquids. This medical condition differs from painful swallowing, which typically involves inflammation and ulcers in the lining of the mouth, throat and esophagus. Dysphagia can happen for many different reasons and is especially common in people with cancers of the mouth, throat and esophagus.

A tumor may be obstructing the passage of food and liquids through your mouth, throat or digestive tract or putting pressure on the nerves or muscles involved in swallowing. Surgery to remove tumors and nearby tissue can cause an abrupt change in how you swallow. Radiation can cause inflammation and scarring that makes it difficult to swallow foods or liquids too. Chemotherapy may exacerbate these side effects from radiation.

The tumor itself or swelling or scarring from cancer treatment may cause weakness in the “pump” that pushes food down or a narrowing, or stricture, in the passageways. Your difficulty also may be related to any changes in how your lips, mouth, cheeks, tongue or throat feel following treatment. Dysphagia can arise even years or decades after treatment if scarring or fibrosis leaves tissue constrained or stiff over time.

All these causes require different referrals and management. Because of this complexity, seek a specialist to help determine the root cause of your dysphagia. Share with your oncologist precisely what you’re experiencing. Do you have this problem with liquids, solids or both? Does it feel hard to get anything down, or does it hurt? Are you choking? Are food or liquids getting into your lungs or windpipe? Does it feel like food is getting stuck in your throat? To help further investigate, a radiologist can take X-rays or images while you swallow to see where the problem is and help decide on next steps.

When the problems are related to moving things through your mouth or throat, a speech pathologist can offer rehabilitation and help you adjust how you swallow to help direct food and liquids in the right way. You might benefit from swallow therapy exercises or massage techniques. If the problem is lower in your esophagus, a gastroenterologist or an ear, nose and throat specialist may need to perform a procedure called an endoscopic dilation to widen the esophagus.

If you have lingering difficulty swallowing, a dietitian can help identify nutritionally dense foods and liquids that are easier for you to swallow. In severe cases, a feeding tube can ensure you get the nutrition you need until swallowing becomes easier.

For many people, trouble swallowing does get better with time. Our bodies are amazingly resilient. We heal and can learn to make things work, even when there are parts missing. However, someone who specializes in dysphagia can help speed up your rehabilitation and ensure you recover as fully as possible.

TACKLING SWALLOWING TROUBLE // The American Cancer Society offers eating tips for when it’s hard to swallow. // The National Institutes of Health explains the complex process of swallowing and the many ways in which it can go wrong.

The expert’s response was edited for clarity and based on an interview with Kendall K. Morgan.