Difficulty Swallowing: Noncancerous and Cancerous Causes

Swallowing issues are known to be an early symptom of cancer, but not always

Medically reviewed by Benjamin F. Asher, MD

Experiencing a new symptom of difficulty swallowing or feeling food getting stuck in your throat can be concerning. Typically, swallowing is a process people do reflexively, without thought. You want to know the cause and how it can be fixed. You may also wonder if difficulty swallowing is a sign of cancer.

Although cancer is one possible cause of difficulty swallowing, it is not the most likely. More commonly, difficulty swallowing is likely to be a noncancerous condition, such as gastroesophageal reflux disease (GERD) (chronic acid reflux) or dry mouth.

This article will review the causes of swallowing difficulty, as well as what symptoms to be concerned about.

Describing Difficulty Swallowing (or Dysphagia)

The medical term for difficulty swallowing is "dysphagia." It can be experienced and described in many ways. Dysphagia symptoms may come from the oral cavity or the esophagus (the food tube that runs from the mouth to the stomach).

Those with dysphagia symptoms from factors in the oral cavity may describe:

• Feeling of choking

• Coughing with eating or drinking

• Hoarse voice

• Hard time starting a swallow

• Needing to swallow multiple times to move food down

Those with esophageal causes of dysphagia may describe slightly different symptoms. They may experience:

• Food feeling "stuck" after swallowing, with solids, liquids, or both

• Pain with swallowing

Noncancerous Causes of Dysphagia Symptoms

Most causes of dysphagia are not due to cancer but are likely due to other reasons. The act of swallowing is a complex process that requires many things to function properly. Dysphagia can occur if any of the normal swallowing processes are affected.

Swallowing starts in the mouth with chewing, when saliva is mixed with the food to begin breaking it down and making it ready to digest. The tongue then helps to push this food bolus (a small round mass of food) down through the back of the throat and into the esophagus.

As it moves through, the epiglottis closes to keep food in the esophagus and not go into the trachea (windpipe), which goes to the lungs. Muscles along the esophagus help push the food down and into the stomach.

A condition that interferes with any part of the swallowing process can lead to symptoms of dysphagia. Some of these conditions include:

• Stroke (a blockage of blood flow or bleeding in the brain)

• Parkinson’s disease (a progressive neurological disorder)

• Dry mouth

• Enlarged lymph nodes in the neck

• Enlarged thyroid gland

• Taking medications that cause dry mouth

• GERD

• Esophagitis (inflammation of the esophagus)

• Infections such as Candida or herpes simplex esophagitis

• Taking medications that cause inflammation to the esophagus (e.g., bisphosphonates, nonsteroidal anti-inflammatory drugs, or NSAIDs) or those that cause the esophagus to lose muscle tone (e.g., alcohol, benzodiazepines, nitrates)

• A stricture (narrowing) of the esophagus

• Reduced muscle mass associated with aging

When Do Dysphagia Symptoms Point to Cancer?

Although it’s not necessarily the most likely cause, cancer can result from dysphagia. Cancer may be suspected if the dysphagia progresses, continuing to worsen over time and happening more frequently. Additionally, other symptoms may also be noted.

Other symptoms that may be associated with cancer can include:

• Ear pain

• Chest pain

• Significant weight loss

• Severe fatigue

• Black stools

• Lump in the neck

• Shortness of breath

• Hoarse voice

• Frequent, dry cough

• Sensation of pressure in the chest

Types of Cancer With Dysphagia as a Symptom

Multiple types of cancer may present as dysphagia as a symptom. These most commonly are cancers that directly affect the structures responsible for swallowing, such as head and neck cancer or esophageal cancer. Other cancers can include:

• Gastric (stomach) cancer

• Gastroesophageal junction cancer (where the esophagus meets the stomach)

• Thyroid cancer

• Salivary gland cancer

Chronic Conditions With Dysphagia as a Symptom

A disease or condition that affects any of the swallowing mechanisms can cause dysphagia. These types of conditions can include neurological disorders, which may affect memory or cause muscle weakness. They can also include conditions in which medications necessary to treat the disorder can lead to side effects of dysphagia.

Conditions that may produce dysphagia include:

• Parkinson’s disease

• Myasthenia gravis, an autoimmune disease affecting the muscles

• Dementia, which encompasses a variety of disorders affecting the brain, memory, thinking, and behavior

• Amyotrophic lateral sclerosis (ALS), a neurodegenerative condition

• Scleroderma, an autoimmune disease affecting connective tissue

Questions to Bring to a Provider Appointment

If you’re experiencing dysphagia, you may want to talk to a healthcare provider about what you’re experiencing. It can be important to note when the symptoms started and if there are any other symptoms.

You’ll also want to be prepared to ask a healthcare provider questions. Write them down and bring them with you so you don’t forget to ask them.

Some questions may include:

• What do you think is causing the difficulty swallowing?

• Do I have any risk factors that make cancer more likely for me?

• When should I be worried about experiencing dysphagia?

• What are the next steps if it doesn’t get better?

Summary

Dysphagia can be a distressing symptom when you experience it. Some may worry that it is being caused by cancer. Though it is possible, cancer is not the most likely cause. Other conditions, such as infection, GERD, or medications, can lead to dysphagia.

If you’re experiencing ongoing difficulty swallowing, talk to a healthcare provider and have your symptoms evaluated for the cause.