Swallowing Problems After Cancer: Diagnosis and Treatment
I can feel the lump right behind my right collarbone. Sometimes food catches on it, causing me to take several swallows to get food down. As an inflammatory breast cancer (IBC) survivor, I take lumps seriously, so when this one didn’t go away in a couple of weeks, I went to see my primary care doctor.
She explained that it might be a narrowing of my throat caused by scarring from acid reflux, not an actual lump. She mentioned several other possible causes and referred me to a gastroenterologist. He told me that frequently, people have the sensation of a lump in the throat even though there might not be one. Often an upper endoscopy can stretch the throat and take care of the problem while also allowing the doctor to check for tumors, lesions, or other issues. If he did find a lump, he could biopsy it to make sure that I didn’t have a new cancer or a recurrence of my IBC.
I had an endoscopy done as part of the diagnostic workup for my gastroparesis, so I know the procedure itself isn’t painful, but I was still worried about what it would reveal. To my great relief, the procedure showed that I have a perfectly normal-looking esophagus. That was good enough for me. No lump — no cancer — great news!
But the gastroenterologist wanted to do two more tests. He wanted to check out my swallowing function. He said that chemo and radiation could have damaged the nerves and muscles in my throat, causing difficulty swallowing, a condition called dysphagia. These tests could pinpoint any difficulty and provide a baseline of my functioning in case it got worse over time.
The next test I had is called a modified barium swallow test or video fluoroscopic swallowing exam. This test checks from the back of the throat to the top of the esophagus. I took swallows of foods with varying consistencies while the technician and a speech pathologist watched my throat work in real time with a X-ray technique called fluoroscopy. The food was coated with barium, a chalky powder that shows up white on the fluoroscope screen. Though not delicious, the barium taste wasn’t as bad as I had feared.
The barium swallow test I had on another day checked the rest of my esophagus. It was similar to the modified barium swallow, but instead of real food, I swallowed a fizzy drink and a tablet. It also took pictures while I was standing and lying down. During part of this test, I was standing where I could actually see the liquid going down my throat on the screen—fascinating!
The two barium swallow tests didn’t show any major problems, thank goodness. No strictures, tumors, or inability to swallow. They did show that my throat is not swallowing efficiently. The report labels the problem as “mild.”
Both my gastroenterologist and oncologist agree that a possible cause for this issue is the radiation I had for IBC in 1999. Because I had 16 positive lymph nodes under my arm, my doctors thought it was quite likely that there was cancer in the lymph nodes under my sternum and collarbone. So my radiation treatments included these areas, which are close to the upper throat and esophagus. The effects of radiation can show up years later, causing swallowing or other digestive issues.
Swallowing problems also increase for elderly people, so it might be that this would have happened to me anyway as I got older. Strokes, certain medications, and general muscle weakening are some reasons dysphagia increases with age.
People I know with other types of cancers have similar problems. My friend who is several years out from thyroid cancer treatment is still having trouble swallowing. A neighbor who was treated for throat cancer needed help from a speech therapist to learn how to swallow again. He still must be especially careful with certain foods, like steak and hamburger, to avoid choking.
What can you do?
Take swallowing problems seriously. Don’t brush them off! You might want to note problems on a calendar to see how often they are occurring. Everyone might choke occasionally or have trouble getting a too-big bite of beef down, but if you notice a pattern, call your doctor.
The American Cancer Society suggests that a speech therapist is a good resource to get help with swallowing issues. The speech therapist will have tips for the best food consistencies for you as well as other ideas.
Pay attention to the types of foods that give you problems. Some people have more trouble with liquids, and others with solids. You may be able to avoid the most troublesome foods.
My doctor suggested that I take small bites, chew my food thoroughly, and wash it down with frequent sips of liquid. I had already been doing those things instinctively for a long time. It wasn’t until I thought I felt a lump in my throat that I finally went to the doctor.
In some ways it seems as if I went to a lot of effort to learn what I already knew. I have to eat carefully to get my food down and avoid choking! However, I’m glad that I did get this problem checked out. The “lump” is still there, but I know it’s not cancer.
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