Esophageal Cancer and Its Connection to Coughing

Esophageal cancer can indeed lead to coughing and the production of phlegm, and there are several reasons behind this symptom. Understanding these causes can help patients and caregivers better manage the condition and seek appropriate treatment.

1. Radiation Therapy and Its Side Effects

Radiation therapy is a primary local treatment for esophageal cancer. Due to the close anatomical relationship between the esophagus and the trachea, the trachea can be exposed to radiation during treatment. This exposure may result in radiation-induced tracheitis, which increases mucus production in the airway lining and subsequently causes coughing and phlegm.

2. Aspiration Due to Esophageal Obstruction

Tumors in the esophagus can cause narrowing or blockage of the esophageal lumen. When this occurs, saliva or food particles may be accidentally inhaled into the trachea during swallowing, leading to choking and coughing. In such cases, the expelled mucus may contain visible traces of food.

3. Tracheoesophageal Fistula Development

In more advanced stages, esophageal tumors can invade nearby structures, including the trachea. This invasion can lead to the formation of a tracheoesophageal fistula — an abnormal connection between the trachea and esophagus. When this occurs, liquids consumed by the patient may pass directly into the trachea through the fistula, resulting in severe coughing and increased phlegm production.

4. Vocal Cord Dysfunction Due to Lymph Node Involvement

Esophageal cancer can also spread to lymph nodes in the upper mediastinum, which may compress the recurrent laryngeal nerve. This pressure can impair the function of the vocal cords and prevent the epiglottis from closing properly during swallowing. Consequently, food or liquids may enter the trachea, causing intense coughing fits.

In summary, coughing and phlegm production are not uncommon in patients with esophageal cancer, and they often result from treatment side effects, tumor progression, or complications such as fistulas and nerve damage. Early recognition and management of these symptoms are essential for improving patient comfort and quality of life.