Difficulty swallowing, also known as dysphagia, can be a symptom of several types of cancer. Some of the most common cancers that can lead to swallowing difficulties include esophageal cancer, throat cancer, and lung cancer.
Esophageal Cancer
Esophageal cancer is one of the leading causes of dysphagia. The esophagus is the long, hollow tube that runs from the throat to the stomach. When cancer develops in the esophagus, it can cause the pathway to narrow, leading to difficulty swallowing.
There are two main types of esophageal cancer:
– Squamous cell carcinoma – This cancer begins in the thin, flat cells that line the inside of the esophagus. It usually develops in the upper and middle parts of the esophagus.
– Adenocarcinoma – This type starts in the glandular cells in the lower portion of the esophagus. It often begins as a condition called Barrett’s esophagus, where the tissue lining the lower esophagus changes and becomes more like the tissue lining the stomach.
Some key facts about esophageal cancer and swallowing difficulties:
– Dysphagia is often one of the first noticeable symptoms of esophageal cancer. It occurs in around 50-75% of patients at diagnosis.
– The swallowing difficulties are often progressive, starting with solid foods becoming difficult to swallow. As the tumor grows, even swallowing liquids can become challenging.
– Along with trouble swallowing, esophageal cancer may also cause painful swallowing (odynophagia), chest pain, weight loss, hoarseness, chronic cough, vomiting, and heartburn.
– Esophageal tumors are staged based on size and location. Higher stage tumors that obstruct more of the pathway are more likely to cause severe dysphagia.
– Treatments like surgery, chemotherapy, or radiation therapy may further contribute to swallowing problems by causing scar tissue formation or nerve damage.
Throat Cancer
Throat cancer refers to cancers arising in the pharynx (throat) or larynx (voice box). The pharynx includes the nasopharynx, oropharynx, and hypopharynx. When cancer develops in these areas, it can cause structural changes that interfere with swallowing.
Some specific types of throat cancers include:
– Nasopharyngeal cancer – Cancer of the upper part of the throat behind the nose.
– Oropharyngeal cancer – Cancer of the middle section of the throat right behind the mouth.
– Hypopharyngeal cancer – Cancer of the bottom part of the throat.
– Laryngeal cancer – Cancer of the larynx, which houses the vocal cords.
Key facts about throat cancer and swallowing difficulties:
– As with esophageal cancer, dysphagia is often one of the first signs of throat cancer. It’s estimated to occur in up to 80% of patients at diagnosis.
– Trouble may start with solid foods but progress to soft foods and liquids as the tumor enlarges.
– Pain with swallowing is also common. It may feel like a burning, stabbing, or raw sensation.
– Other possible symptoms include voice changes, a lump in the neck, ear pain, weight loss, and coughing.
– The stage and location of the tumor impact swallowing ability. Larger tumors are more likely to obstruct the throat pathway.
– Treatments like radiation and surgery may scar tissue and restrict swallowing motion. Chemotherapy can also damage the lining of the throat.
Lung Cancer
Lung cancer does not directly obstruct the esophagus. However, it can still sometimes lead to swallowing difficulties in the following ways:
– Tumors in the top of the lungs, known as Pancoast tumors, can put pressure on parts of the throat.
– Enlarged lymph nodes from lung cancer may press on the esophagus.
– Some types of lung cancer can spread to the esophagus itself.
– Coughing from lung tumors can make swallowing painful.
– Chemotherapy and radiation therapy for lung cancer can damage the esophagus lining.
Statistics on lung cancer and swallowing problems:
– About 1 in 3 people with lung cancer experience dysphagia.
– Swallowing issues are more common if the lung cancer is advanced stage or spreads to the esophagus.
– Lung cancer patients with trouble swallowing are at higher risk of complications like aspiration pneumonia, malnutrition, and weight loss.
– Swallowing difficulties negatively impact quality of life in up to 75% of those affected.
Less Common Causes
While esophageal, throat, and lung cancers are among the most frequent causes, other cancers can occasionally also lead to dysphagia:
– Stomach cancer – Can obstruct the top portion of the stomach near the esophagus.
– Brain tumors – Can affect the cranial nerves involved in swallowing.
– Lymphoma – If lymph nodes press on the esophagus.
– Breast cancer – From metastasis to the esophagus.
– Thyroid cancer – From external pressure on the esophagus.
– Sarcoma – Tumors of connective tissues adjacent to the esophagus.
Diagnosing the Cause
If difficulty swallowing develops, it’s important to meet with a doctor to identify the cause. Some examples of tests used to diagnose cancer as the reason for dysphagia include:
– Physical exam – Checking for masses or enlargement in the neck that may impede swallowing.
– Endoscopy – A tiny camera on a flexible tube inserted into the esophagus to visualize tumors or blockages.
– Barium swallow – The patient swallows a chalky liquid that coats the esophagus. X-rays are taken as the patient swallows to highlight abnormalities.
– Biopsy – Removing a small tissue sample for examination under a microscope.
– Imaging – CT scans, MRIs, PET scans, or ultrasounds check for masses along the throat and esophagus.
Once cancer is confirmed as the cause of dysphagia, further testing determines the stage and ideal treatment options.
Treating Swallowing Difficulties from Cancer
The main cancer treatments of surgery, chemotherapy, radiation therapy, and targeted therapies work to combat the cancer and may sometimes resolve associated swallowing issues. But dysphagia often persists long after treatment as a side effect. Some approaches to managing it include:
– Diet modification – Switching to soft, moist foods that are easier to swallow.
– Feeding tubes – If swallowing becomes very difficult, tube feeding may be needed for nutrition.
– Dilators – Tubes inserted in the esophagus to stretch narrowed areas.
– Oral steroids – Help reduce inflammation from radiation.
– Pain medication – To make swallowing more comfortable.
– Speech therapy – Exercises and techniques to improve swallowing coordination.
The prognosis for dysphagia depends on the type and stage of cancer. Addressing swallowing problems is very important for staying nourished and preventing choking and aspiration pneumonia.
Coping with Cancer Dysphagia
Difficulty swallowing can greatly impact a patient’s quality of life. It can lead to social isolation, anxiety around eating, and weight loss. Some tips for coping include:
– Eating together with others can make mealtimes less stressful.
– Trying new recipes may help make food more appealing and easier to swallow.
– Asking for a referral to work with a speech-language pathologist for swallowing therapy.
– Joining a support group to connect with others experiencing similar challenges.
– Discussing concerns openly with your healthcare team.
– Relying on coping strategies like meditation, relaxation, and positive thinking.
Though dysphagia presents physical and emotional challenges, there are thankfully many people available to help cancer patients adapt and continue enjoying favorite foods and beverages as much as possible.
Conclusion
Difficulty swallowing is a common occurrence in certain cancers, especially esophageal, throat, and lung cancers. It occurs due to tumor obstruction and compression of the swallowing passageways. Other less common cancers like stomach, brain, and thyroid can sometimes also lead to swallowing impairment. If new difficulties arise with eating solid foods or drinking liquids, it is important to meet with a doctor to identify the cause. Cancer-related dysphagia may persist even after treatment. But with the help of dietary changes, swallowing therapy, and coping techniques, quality of life can be maintained. Addressing swallowing problems in cancer is key to ensuring adequate nutrition, preventing aspiration and choking, and supporting physical and emotional health.