What’s the difference between perceived or imagined dysphagia and actual difficulty swallowing from esophageal cancer?

How can you tell them apart?

The idea of being diagnosed with esophageal cancer is just plain terrifying.

It’s not just because the prognosis is despairing for disease that’s spread beyond the esophagus.

There’s the added element of having your actual “food pipe” partially cut out and your stomach pulled up to compensate for the lack of length so that you can eat.

Difficulty swallowing, whether food or just saliva, is also called dysphagia.

A true dysphagia from a disease process, as well as a perceived or imagined dysphagia, are both common.

A number of diseases cause difficulties with swallowing.

People who are prone to health anxiety are at high risk for latching onto a particular disease when they begin believing they’re having problems swallowing food, beverages or saliva.

For some, it’s bulbar-onset ALS. For others it’s laryngeal cancer. And then for still some other people, it’s esophageal cancer.

Which illness they latch onto can be determined by personally knowing someone with that disease, or having stumbled upon online information about it, or, having it turn up high in the search results when googling their symptoms.

Perceived Dysphagia vs. the Real Thing from Esophageal Cancer

“There is a well-known phenomenon originally called ‘globus hystericus,’ now most frequently called globus sensation,” begins Alex Little, MD, a thoracic surgeon with a special interest in esophageal and lung cancer.

“The patient notes and complains of a sensation of a lump or some sort of object (called a foreign body by physicians) stuck in the esophagus, and there is frequently a sensation of difficulty swallowing.

“Globus sensation can be due to psychogenic factors, which is where the ‘hystericus’ came from, such as the feeling of a lump in your throat when saying goodbye or mourning someone.

“However, importantly it can be the manifestation of GERD, an esophageal motility disorder or even esophageal cancer.

“For me the important observation is that a complaint of dysphagia must always be taken seriously and investigated so that real disease, such as GERD, or — most importantly — esophageal cancer, can be diagnosed and treated if found.

“Better to get some easily performed and non-invasive tests such as a barium swallow X-ray or esophageal pH monitoring that are negative, than miss a chance to diagnose a treatable disorder like GERD or esophageal cancer while it is potentially curable.”

In perceived dysphagia, the “difficulty” never gets worse. It’s static. It’s the same over time. Also, it comes and goes.

It particularly goes while the sufferer is distracted by physical or cognitive activity while eating.

For example, after concentrating heavily on watching a suspenseful movie, socializing with family members or reading an exciting story, the sufferer may then realize that during that time, there had been no issues with swallowing the food they were snacking on.

The chips, cheese sticks, pretzels, candy, cookies, popcorn, fruit, salad, chicken, meatballs, pasta or bread went down without a hitch.

This alternates with periods when one seemingly struggles to get the food down their throat.

The struggling is preceded by anxiety that they may have esophageal cancer.

They’re preparing to eat and can’t push the intrusive thoughts out of their mind.

They sit down and take the first bite, mind fully on the question: “Will I have trouble swallowing this?”

Well of course, they WILL, because their throat tensed up from the anxiety and they fulfilled a prophecy.

Next day, while absorbed in a social activity while eating, swallowing harder foods is a breeze.

This on-and-off or come-and-go nature would not happen with esophageal cancer. An obstructing tumor does not come and go.

In fact, it gets bigger, making a clinical dysphagia increasingly more pronounced, and over a short period of time, too.

Thus, a person may have perceived dysphagia for months on end, with no worsening and no other suspicious symptoms such as unexplained weight loss and fatigue – yet still continue worrying like mad that they have esophageal cancer.

Meanwhile, a person with dysphagia from esophageal cancer will easily be aware that over just several weeks, things are getting worse.

They must switch to softer foods such as mashed potatoes, apple sauce, soup, etc., and are no longer eating tougher foods such as roast beef, chicken, bread, candy bars and apples.

  • A person with perceived dysphagia won’t be switching to a softer diet.
  • Esophageal cancer will force the sufferer to switch to a softer diet.

But it won’t stop there. As the tumor grows, food will literally get stuck.

Having no place to go, the food will be regurgitated. It’s at this point that a person, who’s been avoiding medical attention, will finally seek medical help.

If you’ve had dysphagia for months on end and are still eating steak, and it’s going down, even if it feels troublesome to get it to clear your throat – then relax, relax, relax!

On the other hand, if your apparent trouble with getting food down is new, only a week or so old … then you’ll need to endure a grace period to see if it gets worse – for instance, a sensation that a clump of food is sticking somewhere in your upper chest whenever you eat, and especially feeling fatigued lately for no reason.

But you don’t have to wait for the situation to worsen in order to see a gastroenterologist and undergo some testing.

Alex Little, MD, trained in general and thoracic surgery at the Johns Hopkins University School of Medicine; has been active in national thoracic surgical societies as a speaker and participant, and served as president of the American College of Chest Physicians. He’s the author of “Cracking Chests: How Thoracic Surgery Got from Rocks to Sticks,” available on Amazon.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.


Top image: Freepik.com/wayhomestudio