Swallowing Problems

Cancer and its treatments can sometimes cause a person trouble with swallowing. It may be a short-term side effect of chemo or radiation treatment to the throat or chest. It may also be caused by an infection of the mouth or esophagus (the swallowing tube that goes from the throat to the stomach), as well as other problems.

If you gag, cough, spit, feel pain or have other problems swallowing, try eating soft or liquid foods. You might be able to swallow thick fluids more easily than thin liquids. If you can't to eat enough regular foods to meet your nutritional needs, drink high-calorie and high-protein liquids.

Your doctor may refer you to a speech therapist. This is a health professional who can teach you how to swallow better and how to decrease coughing and choking when you eat and drink.

What to look for

  • Gagging, coughing, or vomiting of food as you try to swallow
  • Weight loss
  • Drooling or the sense you have too much saliva (spit)
  • Little or no saliva
  • Inside of mouth is red, shiny, glossy, or swollen
  • Open sores in the mouth
  • Pain in throat or mid-chest when you swallow
  • Feeling as if food is “sticking” on its way down
  • White patches or a coating on the inside of the mouth

What the patient can do

  • 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).
  • Take small bites, and swallow each bite completely 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.
  • Mash or puree foods (such as meats, cereals, and fresh fruits) so that they’re as soft as baby food. You might need to add liquids to dry foods before blending.
  • Dunk breads in milk to soften.
  • Refrigerate food (the cold helps numb pain) or serve cool or lukewarm. If pain gets worse with cold foods, try them at room temperature.
  • Try crushed ice and liquids at meals.
  • Frequent small meals and snacks may be easier to manage.
  • Crush pills or tablets and mix in juice, applesauce, jelly, or pudding. (Check with your nurse or pharmacist first, because some pills can be dangerous if crushed or broken. Others react badly with certain foods or must be taken on an empty stomach.)
  • Avoid alcohol and hot, spicy foods or liquids.
  • Avoid acidic foods, such as citrus fruits and drinks and fizzy soft drinks.
  • Avoid hard, dry foods such as crackers, pretzels, nuts, and chips.
  • Sit upright to eat and drink, and stay that way for a few minutes after meals.
  • If pain is a problem, use a numbing gel or pain reliever, such as viscous lidocaine (by prescription) or ask about taking pain medicine before eating. (See Mouth Sores.)
  • Ask about seeing a speech-language pathologist or swallowing therapist.

To make foods easier to swallow, try these thickeners

Gelatin: Use to help soften cakes, cookies, crackers, sandwiches, pureed fruits, and other cold food. Mix 1 tablespoon unflavored gelatin in 2 cups hot liquid until dissolved; pour over food. Allow food to sit until saturated.
Tapioca, flour, and cornstarch: Use to thicken liquids. Note that these must be cooked before using.
Commercial thickeners: Follow label instructions, and use to adjust a liquid’s thickness.
Pureed vegetables and instant potatoes: Use in soups. Note that these change the food’s flavor.
Baby rice cereal: Use to make a very thick product.

  • If thin liquids are recommended for you, try these: coffee, tea, soft drinks, liquid nutritional supplements, Italian ice, sherbet, broth, and thin cream-based soups.
  • If thick liquids are recommended for you, try these: buttermilk, eggnog, milk shakes, yogurt shakes, and ice cream.

What caregivers can do

  • Offer soft, moist foods. Baked egg dishes, tuna salads, and thick liquids such as yogurt may be easier to swallow.
  • Try soft desserts that don't require much chewing (like ice cream, pudding, soft cakes)
  • Use ground meats and ground meat casseroles, or fish. Sauces and gravies make meats easier to swallow.

Call the cancer team if the patient:

  • Gags, coughs, or chokes more than usual, especially while eating or drinking
  • Has a severe sore throat
  • Has a red, shiny mouth or ulcers in the mouth or on tongue
  • Has a fever of 100.5° F or higher when taken by mouth
  • Has trouble breathing
  • Has chest congestion
  • Has problems with food “sticking” as it goes down
  • Cannot swallow medicines or eat


The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Fauci AS, Braunwald E, Kasper DL, et al (Eds). Harrison’s Principles of Internal Medicine, 17th ed. New York: McGraw-Hill Medical, 2008.

Camp-Sorrell D, Hawkins RA. Clinical Manual for the Oncology Advanced Practice Nurse, Second Ed. Pittsburgh: Oncology Nursing Society, 2006.

Cope DG, Reb AM. An Evidence-Based Approach to the Treatment and Care of the Older Adult with Cancer. Pittsburgh: Oncology Nursing Society, 2006.

Grant BL, Bloch AS, Hamilton KK, Thomson CA. American Cancer Society Complete Guide to Nutrition for Cancer Survivors, 2nd Edition. Atlanta, GA: American Cancer Society; 2010.

Houts PS, Bucher JA. Caregiving, Revised ed. Atlanta: American Cancer Society, 2003.

Kaplan M. Understanding and Managing Oncologic Emergencies: A Resource for Nurses. Pittsburgh: Oncology Nursing Society, 2006.

Kuebler KK, Berry PH, Heidrich DE. End-of-Life Care: Clinical Practice Guidelines. Philadelphia: W.B. Saunders Co. 2002.

National Comprehensive Cancer Network. Palliative Care. Version 1.2015. Accessed at www.nccn.org/professionals/physician_gls/pdf/palliative.pdf on March 19, 2015.

Oncology Nursing Society. Cancer Symptoms. Accessed at www.cancersymptoms.org on April 3, 2013.

Ripamonti C, Bruera E. Gastrointestinal Symptoms in Advanced Cancer Patients. New York: Oxford University Press, 2002.

Varricchio CG. A Cancer Source Book for Nurses, 8th ed. Sudbury, MA: Jones and Bartlett, 2004.

Yarbro CH, Frogge MH, Goodman M. Cancer Symptom Management, 3rd ed. Sudbury, MA: Jones and Bartlett, 2004.

Last Medical Review: June 8, 2015 Last Revised: July 29, 2019

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