Hiccups and Cancer

Hiccups refer to involuntary spasms of the diaphragm – the main muscle involved in breathing – followed by rapid closure of the vocal cords. This produces a distinctive “hic” sound at the top of the windpipe.

Hiccups may be caused by damage to or irritation of the nerves that control the diaphragm, the use of certain medications, problems that affect the central nervous system, esophageal disorders, pressure on the stomach, and a number of other conditions.

Hiccups usually only last for a short period and pass within minutes or hours, but in some cases, hiccups persist for more than two days and, rarely, for longer than a month. Long-lasting or chronic hiccups may interfere with eating, breathing and sleeping, leading to exhaustion, dehydration, and malnutrition.

Cancer and Hiccups

Some types of cancers where individuals may find they experience hiccups include the following:

• Esophageal cancer
• Stomach cancer
• Pancreatic cancer
• Some brain tumors
• Tumors of the mediastinum
• Lung cancer

The hiccups may develop due to the nerves that serve the diaphragm becoming irritated, which may happen as a result of the following:

• Liver enlargement
• Increased tumor size
• Gastric distension
• Ascites (accumulation of fluid in the abdomen)
• Esophagitis (inflammation of the esophagus)

Symptoms of hiccups vary between individuals, depending on the specific cause and other factors. In most cases, symptoms occur occasionally and only last for short periods. Longer-lasting hiccups are categorized according to how long they persist. Those lasting up to two days are referred to as “acute hiccups,” those lasting longer than two days but less than one month are referred to as “protracted” or “persistent” hiccups, and those lasting longer than one month are called “intractable” hiccups.

Diagnosis

Patients who experience acute hiccups will have their medical history and physical health assessed by a doctor. In cases where the hiccups last a long time and the cause is not obvious, the following tests may be required.

• Blood tests
• Electrocardiogram (ECG)
• Chest X-ray
• Chest CT scan
• Endoscopy to look at the esophagus, stomach, and upper small intestine
• Magnetic resonance imaging (MRI) scan of the brain

Management

It is not always possible to determine the cause of hiccups, but when the cause can be established, healthcare providers suggest ways for patients to manage the problem. Medications may be recommended or in cases of gastric distension, the use of a nasogastric tube may be advised. Here, a thin, flexible tube is passed through the nose, down the esophagus and into the stomach to remove gastric air. Once the hiccups have stopped, the tube is removed.

Other techniques patients may be advised to try include the following:

• Deep and slow breathing into a paper bag
• Slowly drinking cold water
• Eating a teaspoon of granulated sugar
• Holding the breath for as long as possible

Caregivers supervising a patient experiencing problems with hiccups should watch the patient to make sure they can drink adequate amounts of fluids. They should also check for dizziness when a patient takes medication for their hiccups, as they may need help with standing or walking.

Caregivers should contact the patient’s cancer team if the patient develops difficulty breathing, a bloated stomach, or if the hiccups last for longer than one day.