Symptoms - Difficulty Swallowing

Reviewed by: HU Medical Review Board | Last reviewed: January 2017.

Many patients with lung cancer experience difficulty in swallowing. The medical term for this symptom is dysphagia and refers to any dysfunction in swallowing. Dysphagia can occur due to a number of reasons, including the direct impact of tumors, chemotherapy, radiation therapy, and targeted therapies such as EGFR (epidermal growth factor receptor) inhibitors.1

The normal process of swallowing

Normal swallowing of food and liquids is a complex interaction as the act of swallowing moves from the mouth (oral phases) through the pharynx (the part of the throat directly behind the mouth) and into the esophagus (the tube leading to the stomach). The oral phases are voluntary (deliberate) and are followed by an involuntary reflex. The involuntary part of swallowing requires coordination between the sensory input (perceived by senses, such as taste) and motor function of the body. When food or liquid is swallowed, the epiglottis covers the larynx (voice box) and the entrance to the trachea (windpipe). This prevents food or liquid from entering the lungs, or “going down the wrong way.”

When swallowing gets complicated Dysphagia can occur

Dysphagia may increase the risk of inhalation into the lungs of food or liquids and has the potential to create life-threatening complications. Dysphagia can also lead to dehydration, which can eventually negatively affect kidney function, and malnutrition.1,2

How to assess difficulty swallowing

Dysphagia is first examined clinically. In a clinical examination, the physician takes a medical history, examines the mouth and pharynx, and conducts swallowing trials (assessments). The medical history should include any history of swallowing difficulties; incidents of coughing, choking, or vomiting; difficulty with or avoidance of any foods; poor nutrition; presence of a feeding tube; any prior surgery to the oral or pharynx areas; radiation therapy to the throat; history of pneumonia or other respiratory diseases; and any prior neurological problems. Swallowing trials are conducted using various food and fluid consistencies to observe the effects and what can be modified for the patient.1

Assessment of swallowing function is also frequently performed using videofluoroscopy of swallowing (VFSS) or modified barium swallow (MBS). The patient swallows a variety of liquids and foods that have been mixed with barium and video x-rays are taken during swallowing to view how these materials move through the mouth and into the esophagus.1

Managing difficulty swallowing

The treatment for dysphagia will depend on the assessment results and may include:

  • Exercises to coordinate the swallowing muscles and nerves
  • Swallowing techniques to modify how the body is positioned to ease swallowing
  • Esophageal dilation, which uses an endoscope with a special balloon to gently stretch the width of the esophagus
  • Surgery to clear the esophageal path
  • Medications to reduce stomach acid, or possibly corticosteroids if there is inflammation in the esophagus
  • Special liquid diets
  • Feeding tube 3

Additional symptoms of lung cancer

While difficulty swallowing is one of the common symptoms in lung cancer, others include:

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