What causes dysphagia in lung cancer?

From the Guidelines

Dysphagia in lung cancer is primarily caused by a combination of factors including direct tumor invasion, extrinsic compression, and radiation-induced esophagitis, emphasizing the need for early nutritional assessment and intervention to prevent malnutrition and maintain quality of life. According to the study by D. De Ruysscher et al. 1, patients receiving concurrent chemotherapy and radiotherapy (CCRT) for lung cancer are at a high risk of worsening malnutrition due to esophagitis and dysphagia, resulting in inadequate nutritional intake. Key factors contributing to dysphagia in lung cancer include:

• Direct tumor invasion of the esophagus
• Extrinsic compression of the esophagus by the tumor or enlarged lymph nodes
• Radiation-induced esophagitis from cancer treatment
• Chemotherapy-induced mucositis
• Recurrent laryngeal nerve involvement by the tumor leading to vocal cord paralysis
• Paraneoplastic syndromes affecting neuromuscular function and impairing swallowing coordination The study 1 highlights the importance of nutritional risk assessment and counseling by trained professionals to improve energy and protein intake, body weight, and quality of life. Prevention of nutritional deficits should include early counseling on potential stressors, options to improve food intake and physical activity, and seeking professional help early in case of developing symptoms. Patients should be instructed to avoid certain foods and substances that can exacerbate esophagitis and dysphagia, such as alcohol, bulky food, spicy, hot or very cold food, citrus fruits, and products like orange juice 1. Management of dysphagia in lung cancer typically involves treating the underlying cancer while providing supportive care, including dietary modifications, swallowing therapy, and sometimes temporary feeding tubes to maintain nutrition during treatment. It is crucial to control pain induced by chewing or swallowing and to offer liquid or soft oral nutritional supplements in addition to normal foods 1. If oral intake is inadequate despite meticulous care, resulting in progressive weight loss of 5% from the initiation of CCRT, tube feeding should be initiated promptly 1.

From the Research

Causes of Dysphagia in Lung Cancer

• Dysphagia can occur in advanced lung cancer due to direct tumour invasion or nerve compression 2
• Anti-cancer treatments and co-morbid conditions may also cause or compound dysphagic symptoms 2
• The close anatomical relationship between the esophagus and the bronchial tree can cause malignant dysphagia in lung cancer patients 3

Prevalence of Dysphagia in Lung Cancer

• A study found that 18.1% of patients with advanced lung cancer had dysphagia 2
• Dysphagia can impact quality of life, with patients experiencing increased fatigue, meal time duration, difficulties with food selection, and reduced eating desire 2

Management of Dysphagia in Lung Cancer

• Speech and language therapy (SLT), medical and surgical interventions are available to address dysphagic symptoms in patients with lung cancer 2
• Esophageal stenting and bronchial tree stenting can improve dysphagia and dyspnea scores, as well as quality of life, in patients with malignant dysphagia due to lung cancer 3
• Injection laryngoplasty under local anaesthetic can offer immediate improvement in voice, swallowing, and overall quality of life in patients with advanced lung cancer 4

Treatment Options for Dysphagia

• Treatment options for dysphagia in lung cancer patients include esophageal dilatation, intraluminal stents, Nd:YAG laser therapy, photodynamic therapy, argon laser, systemic chemotherapy, external beam radiation therapy, brachytherapy, and combined chemoradiation therapy 5
• The choice of treatment modality depends on the clinical situation, local expertise, and cost effectiveness 5