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Difficulty swallowing, or dysphagia, is a possible late-stage symptom of pleural mesothelioma. It is uncomfortable, painful, and contributes to poor appetite and weight loss. Changing diet and eating habits can help, but some patients may need palliative surgery to make swallowing easier.
What Is Dysphagia?
- Pain when swallowing or an uncomfortable sensation in the throat and chest when swallowing
- Regurgitation of food
- Coughing or gagging when eating
- Being unable to swallow at all
- Hoarseness in the throat
- Heartburn or acid backup into the throat
- Weight loss
How Does Mesothelioma Cause Dysphagia?
According to a study of mesothelioma patients with dysphagia, the main underlying cause was mediastinal adenopathy. This is the enlargement of the lymph nodes in the chest, which then constrict the esophagus.
Tumors can also constrict and put pressure on the esophagus, narrowing, its circumference. In some cases, the cancer can invade the esophagus itself, causing dysphagia.
There may be other minor factors that contribute to less severe dysphagia. For instance, chemotherapy can cause sores and dry mouth. This makes it more difficult to swallow.
Is Difficulty Swallowing an Early or Late-Stage Mesothelioma Symptom?
Difficulty swallowing is not a typical early sign of mesothelioma but might be noticeable as the cancer progresses. It is a late-stage symptom caused by the spread of the tumor compressing on the esophagus.
A review of 250 mesothelioma patient records found just one patient with difficulty swallowing before receiving the cancer diagnosis. The median onset of dysphagia was 18 months after diagnosis. This illustrates that difficulty swallowing is most often a late-stage symptom of mesothelioma.
Treatments for Mesothelioma Dysphagia
Treatment options ultimately depend on the underlying cause. For issues caused by chemotherapy or radiation, several prescriptive options can help aid the discomfort by treating any fungal infections caused by therapy. Others are topical liquids that can help make swallowing easier.
Treatments focused on palliation and relieving symptoms are important for dysphagia. Not only does this improve symptoms, but it can also prohibit further weight loss by making eating more comfortable.
In rare cases, when a tumor is causing such severe compression of the esophagus, a surgical procedure might be an option. Often, it requires an outpatient endoscopy and stent placement. This mesh-like material can help keep the esophagus open enough for food to pass through.
It is not without risk, as the stent can erode through the esophagus, creating a fistula (hole), a severe medical situation that may not be fixable. Given this can also occur in the late stages of the cancer, thoughtful discussions can be helpful to review the risks and benefits this procedure may provide.
Management of Dysphagia
For patients who live with difficulty swallowing because of mesothelioma, eating becomes a challenge, leading to other complications, like weight loss. If treatment is not possible or does improve the symptom, different management strategies may help:
- Work with a therapist. A speech therapist can help patients through swallowing therapy. They work with cancer patients to exercise the swallowing muscles and stimulate nerves. They also help patients find specific ways to eat that are easier, including positioning the head in a particular way.
- Eat foods that are easier to swallow. Changing diet can make swallowing easier and maintain good nutrition. Soft foods, like soups, smoothies, protein shakes, eggs, yogurt, and others, are easier to get down. A speech therapist can provide specific instructions.
- Choose nutrient-dense foods. Weight loss is always a concern in mesothelioma patients, and dysphagia makes it worse. Choose soft food with a lot of nutrients and calories or add supplements to increase calorie intake.
- Change eating patterns. The manner of eating can also be important in combatting dysphagia. Sit upright to eat; eat smaller meals multiple times per day; cut food into smaller pieces; use straws for shakes and nutritional drinks.
Dysphagia is an uncomfortable complication, but it can usually be improved depending on the underlying cause. Communicate to your medical team to help develop a plan to make eating easier and ensure your nutrition stays healthy and adequate.Get Your FREE Mesothelioma Packet
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.