Radiotherapy to the chest might cause swelling and soreness in the throat and food pipe (oesophagus) and you might have difficulty swallowing (dysphagia). This side effect usually starts with a feeling of a lump in the throat.
Whether you have problems swallowing depends on where exactly you are having treatment and if your throat or oesophagus is in the radiotherapy treatment area. It also depends on the amount (or dose) of radiation given. Difficulty swallowing may be worse and can last longer if you have chemotherapy at the same time as radiotherapy.
If you are having radiotherapy to your oesophagus this area will be targeted directly with treatment and the lining of the oesophagus will become irritated during the treatment. Let your health care team know as soon as swallowing becomes uncomfortable. They can prescribe soothing medication to help.
There is a very small risk of damage to the oesophagus which can cause an ulcer or hole to develop, that may need surgery.
Occasionally, if you cannot swallow at all, a temporary feeding tube will need to be inserted. Sometimes this is a fine tube down the throat (a nasogastric or ‘NG’ tube), or sometimes through the skin of the abdomen into the stomach (a PEG or a RIG tube).
As with all radiotherapy side effects, they tend to build up over time. This means you might experience problems after about a week and then this can continue for around 2 weeks after radiotherapy.
In some hospitals, you'll see a dietician weekly during treatment. If not you can ask to see a dietitian if you're having problems.
Food and drink tips
You might find you'll need to make changes to the food and drink you usually eat. A soft, plain diet is usually best.
Try different foods to find out which are easiest to swallow. This includes:
- soup or broth
- cool drinks and ice cream
Avoid eating things that may irritate your throat or oesophagus. Such as:
- dry foods
- spicy foods
- very hot foods or drinks
- alcohol, particularly spirits
You could try grazing or snacking and eating little amounts often, rather than sitting down to bigger meals at regular meal times.
You can try adding calories to your diet (calorie loading), so add cream in your coffee, swop to full fat milk or add cheese and butter to mashed potatoes. This way you are increasing your calorie intake without having to eat lots of food.
High calorie drinks can also boost your calorie intake, such as:
- Build Up
Other high calorie food supplements are available on prescription. You can ask your specialist nurse, radiographer or dietitian to advise you.
Remember to drink plenty of other fluids too.
Medicines that can help
Your doctor or nurse can prescribe medicines to reduce the soreness, including:
- liquid medicines
You could take painkillers about half an hour before meals to make eating less uncomfortable.
Radiotherapy can cause many different side effects, such as tiredness. The side effects you get will depend on the area you're having treatment to but there are some general side effects you might experience regardless of where your cancer is. This video is about the side effects you might have when having radiotherapy to the chest.
On screen text: Difficulty swallowing
Martin (Radiographer): Radiotherapy can irritate the lining of your oesophagus, also known as your food pipe, which can cause soreness and swelling and make it more difficult to swallow.
David: After about two weeks it started to get more difficult to swallow. The more it progressed, the worse it got and ended up couldn't eat anything solid at all so it was virtually down to liquids.
Laurel: I wasn't physically able to swallow anything whatsoever and that was quite challenging because I was thirsty and I was hungry, but, you know, nothing was happening.
Martin (Radiographer): Eating foods which are softer and easier to swallow can be helpful. Things such as soup and porridge or mashed potatoes.
Laurel: Yoghurt or custard were easier because I don't need to chew on anything.
David: Soups, trifles, tiramisus. It's down to trial and error and keep trying to eat what you can because you really have to keep your body up to scratch.
Martin (Radiographer): I'd recommend avoiding very spicy foods and avoiding foods which are very hot or very cold.
Laurel: Spicy food, definitely avoid the peppers and stuff like that.
Martin (Radiographer): For chest radiotherapy, we would recommend that you avoid alcohol as this can cause more irritation in the area we're treating.
Laurel: I had a dietitian and either on the phone or they'd pop in.
David: So they noticed that my weight was coming down so they got a dietitian in and she prescribed all these protein drinks.
Martin (Radiographer): You can replace the calories by swapping foods for high calorie alternatives, or your dietitian can recommend high calorie drinks and food supplements. If you're experiencing pain or heartburn during treatment, speak to your team and they can prescribe medication that can help with that.
On screen text:
- Try different foods to find out which are easiest to swallow
- Avoid eating foods that may irritate your throat
- Avoid smoking and alcohol, particularly spirits
- You might need high calorie drinks to boost your calorie intake
- Drink lots of water
- Let your team know if you need painkillers
- Ask to see a dietician
On screen text: Feeling or being sick
Laurel: Yes, being sick was one of the worst things happening.
David: I was just constantly being sick. I would have my porridge in the morning, wait a couple of minutes and it would be up again so it was just one of these things.
Martin (Radiographer): What you eat and drink can affect how sick you feel during treatment. You can drink fizzy drinks and eat ginger, which can help reduce sickness and we'd recommend avoiding fatty foods or big heavy meals, which can make you feel more sick.
Laurel: But I didn't realise, okay, you can get medication for the anti-sickness until the medical team realises that's what was needed. It's helped me slowing not being sick as often as I would have done because a lot of things I would just be gagging.
Martin (Radiographer): If you are having problems eating and drinking during your treatment, there are dieticians available which can help you.
On screen text:
- Your doctor can prescribe anti sickness medication
- Relaxation techniques such as mindfulness and visualisation might help
- Avoid certain foods
- Eating a few hours before treatment can help
- Drink lots of liquid, taking small sips slowly throughout the day
- See a dietician for advice – there is help available
On screen text: Shortness of breath
Martin (Radiographer): Having radiotherapy to the chest can affect your breathing. This may come on about two weeks after treatment begins and will continue throughout the rest of treatment. Once you've finished treatment, the breathlessness may continue for a couple of weeks, but then recovers after that. Depending on your diagnosis and treatment you may experience long term breathing problems and your doctor will discuss that with you before you start treatment.
David: So I've been constantly shortness of breath and I take inhalers twice a day now. I just have to be careful in what I do. I can walk for miles on the flat but as soon as an incline, that's when I start to get short of breath. I go out walking or cycling everyday, so that's just a constant to try and keep it going.
Martin (Radiographer): If you are experiencing shortness of breath, we would recommend speaking to your team as soon as you notice it, just to make sure there isn't something else going on, such as an infection or blood clots.
On screen text:
- Shortness of breath can happen during and after radiotherapy
- It usually improves after treatment finishes
- It can continue long term
- Always let your specialist or radiographer know if you are short of breath
If you're experiencing a side effect that hasn't been covered in this video, you can find more information on the Cancer Research UK website.
On screen text: For more information go to: cruk.org/radiotherapy/side-effects