Difficulty swallowing or dysphagia is a common ENT complaint. It’s the ENT surgeon bread -butter version complaint. Today I will tell you about the danger hidden behind such a common and innocuous symptom.

A few months back a 75-year-old man had come to my clinic with his daughter-in-law. The complaint was the inability to swallow food for one month. On detailed questioning, the initial complaint of dysphagia started almost two months back with on and off the review by quacks(you know my thoughts about that) and alternative therapy. He had never visited an ENT doctor for his complaints. He also had not been given any prescriptions for alternative medical therapy.

He was suffering so much, that swallowing his own saliva was difficult. He was severely dehydrated, hardly ate anything. But he was still smoking. Without going into too many details, I can tell you that his HRCT of the thorax(chest) showed a growth obstructing more than two-third of his food pipe. I referred them to Apollo Kolkata and Tata Medical Centre Kolkata and explained to them about the need for urgent intervention.

Time is crucial for malignancies as such and more so for your breathing tubes and food pipe.If every time you swallow saliva

It has a long list of causes and can be divided easily into acute or chronic.
The most infectious condition with pain throat also has difficulty swallowing like in tonsillitis and Pharyngitis. If you have hawking, repeated clearing of the throat and a postnasal drip, that can cause dysphagia too.

When it’s difficulty swallowing with pain, its called odynophagia.

Fear of swallowing or Phagophagia occurs in Rabies, hysteria, tetanus
Globus hystericus is a sensation of a lump in the throat often associated in chronic anemia and common in women.

Today I will talk about malignancy causing dysphagia and the signs you should be aware of.

The Early warnings

Its the progressively increasing painless difficulty swallowing. Most common in a smoker with a history of regular high volume alcohol intake. Presenting with maybe a hot potato voice is cause for worry /Cancer of the upper part of the throat, often present with difficulty swallowing. So does cancer of the esophagus.

There may or may not be a lump in the throat/change of voice and difficulty breathing. Sudden significant unexplained weight loss is common in cancer of food pipe.

Anything more than two weeks’ duration needs the help of diagnostic tests . A Fibreoptic laryngoscopy is an office procedure to have a peek into the pharynx/larynx and pyriform fossa. If that looks clear, you need a Barium, swallow esophagus, and a CECT Neck and HRCT thorax as further workup.

As a rule of thumb, if the malignancy arises from the vocal cords and then spreads to food pipe, hoarseness precedes dysphagia.

Malignancy causing Dysphagia

Pharyngeal malignancy
Oesophageal malignancy
Laryngeal malignancy involving food pipe.

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Treatment depends on the site, size, spread, and type of cancer.
Prognosis is dependent on histological type, local spread, metastasis, and patient profile. In more cases, the correlation between smoking and alcohol abuse is very high in such cancers. Surgery and adjuvant therapy are planned after a full review . Nowadays Proton therapy is another modality that is considered.

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