Dysphagia (difficulty swallowing)
Trouble swallowing, either because a tumour narrows the food pipe or throat, or because radiotherapy and surgery to the head, neck or chest have damaged the muscles and nerves that coordinate swallowing. It affects nutrition, dignity and the risk of food going into the lungs.
The presenting symptom of most oesophageal cancers (palliated by stents, brachytherapy or radiotherapy, and by effective chemotherapy) and the dominant late toxicity of head and neck chemoradiation, where a fifth of survivors remain partly tube-dependent. Dysphagia-optimised IMRT (DARS trial), proton therapy, swallowing exercises during treatment, speech and language therapy and avoiding prophylactic feeding tubes when possible reduce it; the swallowing outcome is a co-primary consideration in HPV-positive oropharynx de-escalation trials. After oesophagectomy, anastomotic strictures and reflux cause further swallowing problems, and dysphagia is a core item in head and neck quality-of-life instruments.
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