🧭 When to suspect

Dysphagia – difficulty swallowing – is an alarm symptom in any adult and mandates urgent investigation. It may herald an oesophageal or gastric cancer, a head and neck cancer, or another malignancy, so cancer must be excluded first. Many benign causes coexist (neurological, structural, motility, infective), but they are diagnoses reached after a sinister cause has been considered.

Unlike the weight-loss referral criteria, dysphagia has no lower age limit – new, unexplained, true difficulty swallowing in a person of any age warrants a suspected cancer pathway referral. The first task is to characterise it: is the problem in the throat (oropharyngeal) or the food pipe (oesophageal), and does it affect solids, liquids, or both?

Oropharyngeal ("high")	Oesophageal ("low")
• Difficulty initiating the swallow; trouble moving food out of the mouth.	• Food or liquid sticking retrosternally a few seconds after swallowing.
• Coughing, choking or nasal regurgitation at the moment of swallowing; drooling.	• Sensation of hold-up behind the breastbone.
• Recurrent aspiration / chest infections.	• Solids then liquids, progressive → mechanical obstruction (cancer, peptic stricture, ring/web).
• Usually neuromuscular – stroke, Parkinson's, MND, MS, myasthenia, or head/neck cancer, surgery or radiotherapy.	• Solids and liquids together, intermittent → motility disorder (achalasia, spasm, systemic sclerosis).

Progressive dysphagia and odynophagia (pain on swallowing) are particularly concerning and should raise the threshold for urgent referral.

🧠 Clinical pearl

A persistent "lump in the throat" that is felt between meals and tends to ease when food is swallowed is globus (the "feeling of something stuck in the throat"), and is rarely cancer. This is not true dysphagia – the discriminator is whether food or liquid actually sticks during the act of swallowing. Reassure, but reconsider promptly if true dysphagia, pain or weight loss appear.

Source: NICE NG12

🔒 Sign up free to read the full topic

You're viewing a free preview. Create a free account to unlock the rest.

Inside the full topic 🔒 History🔒 Red Flags🔒 Examination🔒 Patient Explanation🔒 Investigations🔒 Management🔒 Non-pharmacological Treatment🔒 Pharmacological Treatment🔒 Special Notes🔒 Referral Pathways🔒 Take Home Messages

Sample topics are open to everyone in the Free Sample Bundle.

Part of The Ocean Library, 450+ structured clinical topics mapped to the primary care curriculum. Companion audio in Echo · one-page summary in The Scope.