Swallowing Problems
When we eat and drink, food and liquids move from the mouth to the stomach through the esophagus (swallowing tube) through a process called swallowing. Cancer and cancer treatment can sometimes cause problems with swallowing. This is called dysphagia and can happen for many reasons.
What causes swallowing problems?
Swallowing problems can affect a person’s quality of life. Not being able to eat or drink enough can cause weight loss and weakness. Trouble swallowing can also make it more likely that a person will get food or liquids into their lungs (aspiration). This can lead to infection and breathing problems.
Swallowing problems can happen when something changes the normal process of swallowing. This can come from damage to the mouth, tongue, or esophagus, or when swallowing becomes painful.
Common causes of swallowing problems are:
- Head and neck cancer
- Cancer treatments, such as radiation therapy or surgery to the mouth, jaw, throat, or esophagus
- Mouth sores
- Infection in the mouth or esophagus
- Swelling or narrowing of the esophagus from the cancer or treatment
- Dry mouth and not having enough saliva (spit)
- Hiccups
- Heartburn and indigestion
- When messages from the brain telling the esophagus to swallow are blocked
Symptoms of swallowing problems
The symptoms you have will depend on what is causing the swallowing problems. Some symptoms are:
- Coughing or choking when you try to swallow
- Feeling like you can’t swallow
- Feeling as if food is “sticking” on its way down
- Vomiting (throwing up) after eating
- Heartburn, indigestion, or burping
- Pain in your throat or mid-chest when you swallow
- Losing weight without trying
- Drooling or feeling like you have too much saliva (spit)
Be sure to tell your cancer care team if you are having trouble swallowing. They will ask you about your symptoms and look at your mouth and throat. They may watch you swallow to see if anything doesn’t look right. You may need to have swallowing and imaging tests to look for changes. You might also need an endoscopy, which is a test that lets the doctor look down your throat.
Treatment for swallowing problems
Treating the cause
- Treating the cancer if it is pushing on or blocking the esophagus.
- Treating an infection if is it causing swelling or causing pain with swallowing.
- Widening (dilating) the esophagus. Sometimes a tube (stent) is put in the esophagus to help keep it open.
- Using medicines to treat pain and swelling that make swallowing harder.
If mouth pain is a problem, you may have mouth sores (mucositis). Talk to your cancer care team about how to best manage this pain.
Swallowing therapy
Your cancer care team may suggest that you work with a speech pathologist. Many speech pathologists have special training to help people with swallowing problems. They can help you learn how to swallow better and avoid choking and gagging.
Eating and drinking
Eating and drinking when you have swallowing problems can be hard. Your cancer care team might want you to work with a registered dietitian nutritionist (RDN) or registered dietitian (RD).
They will work with you to figure out the best way to help you get the food and liquids you need to keep you from losing too much weight.
The RDN or RD will talk with you about what you are able to eat and drink and if you have lost weight. They might want you to change how you currently get food and fluids and suggest things like:
- Nutritional supplement drinks or other products (such as Ensure, Boost, etc)
- A feeding tube
- Intravenous (IV) fluids or nutrition
The RDN or RD will work with you and your cancer care team to come up with the best plan that will meet your needs.
Tips to manage swallowing problems
If you are able to swallow food and liquids but have some trouble, these tips might help.
- Eat bland foods that are soft and smooth but high in calories and protein (such as cream-based soups, pudding, ice cream, yogurt, and milkshakes).
- Eat small meals and snacks throughout the day.
- Take small bites and swallow before taking another.
- Use a straw for liquids and soft foods.
- Try thicker liquids (such as fruit that has been pureed in the blender or liquids with added thickeners), because they’re easier to swallow than thin liquids.
- Sit upright to eat and drink and stay that way for a few minutes after meals.
- Choose foods high in calories and protein if you are losing weight. This includes eggs, milkshakes, casseroles, and nutritional shakes.
- Mash or puree foods (such as meats, cereals, and fresh fruits) so that they’re soft like baby food. You might need to add liquids to dry foods before blending.
- Dip breads in milk to soften.
- Refrigerate food (the cold helps numb pain) or serve cool or lukewarm. If cold foods make the pain worse, try them at room temperature.
- Try meal replacement or nutritional supplement beverages.
Stay away from:
- Foods that need a lot of chewing.
- Hard, dry foods such as crackers, pretzels, nuts, and chips.
- Alcohol and hot, spicy foods or liquids.
- Acidic foods, such as citrus fruits and drinks and fizzy soft drinks.
To make foods and liquids easier to swallow, try these tips
- Use gelatin to help soften cakes, cookies, crackers, sandwiches, pureed fruits, and other cold food. Mix 1 tablespoon gelatin in 2 cups hot liquid until dissolved; pour over food. Let food sit until soaked through.
- Tapioca, flour, and cornstarch can thicken liquids. These must be cooked before using.
- Use commercial thickeners to adjust how thick the liquid is.
- Use pureed vegetables and instant potatoes in soups. These can change the food’s flavor.
- Use baby rice cereal to make a very thick product.
- If thick liquids are recommended for you, try buttermilk, eggnog, milk shakes, yogurt shakes, and ice cream.
Talking with your cancer care team
Let your cancer care team know if you have any of the following symptoms that might mean you have swallowing problems.
- Gagging, coughing, or choking more than usual, especially while eating or drinking
- Problems with food “sticking” as it goes down
- Can’t swallow your medicines
- Severe sore throat
- Red, shiny mouth or sores in your mouth or on your tongue
- Chest congestion
- Not able to keep any food or fluids down for more than 24 hours
Go to the emergency room or call 911 if you
- Are having trouble breathing
- Have a new or worsening fever
- Are feeling weak or dizzy
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Society of Clinical Oncology. Difficulty Swallowing or Dysphagia. Accessed at cancer.net. Content is no longer available.
American Speech-Language-Hearing Association. Swallowing Problems From Head and Neck Cancer Treatment. Asha.org. Accessed at https://www.asha.org/public/speech/disorders/swallowing-problems-after-head-and-neck-cancer/#treatment on February 2, 2024.
Freedman K & Hole A. Gastrointestinal complications. In: Eggert JA, Byar KL & Parks LS, ed. Cancer Basics. Oncology Nursing Society; 2022: 313-331.
Frowen J, Hughes R, Skeat J. The prevalence of patient-reported dysphagia and oral complications in cancer patients. Support Care Cancer. 2020;28(3):1141-1150. doi:10.1007/s00520-019-04921-y
Kenny C et al. Dysphagia prevalence and predictors in cancers outside the head, neck, and upper gastrointestinal tract. Journal of Pain Symptom Management 2019;58(6):949-958.
Okuni I, Otsubo Y, Ebihara S. Molecular and Neural Mechanism of Dysphagia Due to Cancer. International Journal of Molecular Sciences. 2021; 22(13):7033.
Last Revised: June 26, 2024
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