Difficulty swallowing (dysphagia)

Some cancers and their treatments can cause problems with chewing and swallowing.

What causes swallowing problems?

Doctors call difficulty swallowing dysphagia.

Some cancer types are more likely to cause problems with chewing or swallowing. These include:

• voice box (larynx)
• thyroid gland
• mouth and tongue (oral cancer)
• throat (pharynx)
• nasal cavity and sinuses
• melanoma or other skin cancer on the face
• salivary glands
• food pipe (oesophagus)

You might have difficulty swallowing if a tumour is blocking part of your throat, voice box or food pipe.

Cancer treatments can also make swallowing difficult. You might have:

• had surgery to your head or neck area
• had a course of radiotherapy to your head or neck
• had a tube (stent) put into your food pipe
• had your voice box removed
• a sore mouth or throat due to chemotherapy, targeted cancer drugs or immunotherapy

The effects of surgery

Surgery for cancer of the head or neck may affect the muscles in this area. This can make chewing and swallowing difficult. How difficult it is will depend on the:

• size and position of the cancer
• type of operation you are having

Food and liquids can be difficult to control after surgery to your mouth (oral surgery). They can leak out of the side or front of your mouth.

Weak throat (pharynx) muscles might make it hard to move food and liquid from your mouth to your food pipe. This can cause coughing and choking at times because food or drink has gone down the wrong way.

After removal of the voice box (laryngectomy) for cancer of the larynx, your windpipe will no longer open into your mouth. This means food or drink going down the wrong way will not be a problem. But you may still have difficulty moving food from your mouth down into your food pipe (oesophagus).

Your sense of smell is also likely to be poor after a laryngectomy. This is because you can no longer breathe air into your nose. This affects your sense of taste. So you may prefer more strongly flavoured food than you used to.

The effects of radiotherapy

Radiotherapy to the head and neck can lead to:

• soreness in the throat and mouth
• a dry mouth because less spit (saliva) is made
• stiffness of the muscles and other tissues around the treatment area
• loss of taste
• pain and discomfort from teeth and gum problems

These effects can make it difficult to chew and swallow, and you might eat less. If you have pain, taking painkillers about an hour before you eat may help.

The effects of chemotherapy, targeted cancer drugs and immunotherapy

Chemotherapy, targeted cancer drugs and immunotherapy for any type of cancer may make your mouth and throat very sore. You might need to have a soft diet for a short while.

Talk to your doctor or nurse if your mouth is very painful and you cannot eat. They can suggest several ways to control pain. Taking regular painkillers can reduce the pain so that you may be able to eat and drink.

Your doctor or nurse will also suggest regular mouth care with mouthwashes. This can help to prevent infection and discomfort.

Coming to terms with swallowing or chewing problems

If you have had treatment for a head and neck cancer, you may:

• need to swallow often to help clear food from your mouth and throat
• have a voice that gurgles and sounds 'wet' after you swallow
• cough or choke when you are eating or drinking
• need to clear your throat after each mouthful of food
• have pain and dryness when swallowing

All these changes can be tough to come to terms with. Mealtimes may no longer be enjoyable. Some people feel they want to eat alone because they find it embarrassing to eat and drink in front of people.

You may need to switch to food that is easier to chew and swallow for a while. This is called a soft diet. A dietitian will tell you how to manage a soft diet. A soft diet can help to make things easier for you.

It may take a while to adjust to a soft diet. This may only be a temporary change for you, while you recover from treatment. But for some people, it may be permanent. If so, try to be patient with yourself and give yourself time to get used to things.