Mucositis is the inflammation of the digestive tract’s lining and is one of the most bothersome side effects of chemoradiation. The lining of the digestive tract, also known as the mucous membranes, is the layer of epithelial cells that makes contact with the air and food that travels through the body. It serves as a barrier against germs from the outside world.
If these membranes are damaged, the patient is at increased risk for infection. Additionally, mucositis can cause a patient to experience significant pain. This may impede a patient’s ability to adequately eat and drink, potentially resulting in significant weight loss and malnutrition. Unfortunately, mucositis endures and progresses throughout radiation or combined chemoradiation.
How Mucositis Can Appear
Mucositis occurs in varying degrees/grades with symptoms escalating as the inflammation progresses. Severe cases may cause ulcers in the affected area. The oral cavity, or the mouth, is the most common location for this. Oral mucositis is one of the most common adverse effects of head and neck cancer treatments, and is mostly a result of radiation and chemotherapy.
As a patient undergoes treatment, their care team, which should include a speech therapist and a nutritionist, will work with the patient to manage their diet. This will assist patients to continue to safely and efficiently eat and drink while they are symptomatic. In some advanced cases of mucositis, a patient may be unable to meet their nutritional requirements. In such instances, a PEG (percutaneous endoscopic gastrostomy) tube may be indicated to ensure that adequate nutrition and hydration is consumed by mouth during treatment.
Signs & Symptoms of Mucositis
A few signs of mucositis.
- Swelling and redness (erythema) of the tongue and gums
- Mouth sores
- Pain while eating food
- Pain with swallowing and speaking
- Bloody saliva
- Pus in the oral cavity
What Causes Mucositis
A variety of factors can cause mucositis including certain head and neck cancer treatments. In particular, radiation and chemotherapy can cause mucositis through killing healthy cells and irritating remaining cells of the oral mucosa. Typically, onset of mucositis occurs approximately 2 weeks after a patient begins chemotherapy and radiation, and usually resolves 2 to 4 weeks after treatment is completed.
Other diseases not related to head and neck cancer are also known to cause mucositis. These diseases include HIV/AIDS, kidney disease, and diabetes. Some additional factors that can lead to mucositis include low body mass index, dehydration, and poor oral hygiene.
Diagnosis
Once a diagnosis of mucositis is made, the doctor and care team will recommend management options based on the severity of the symptoms. Mucositis is often graded by severity via the assessment tools provided by the World Health Organization (WHO) or National Cancer Institute (NCI). For instance, the NCI uses the Common Terminology Criteria for Adverse Events (CTCAE) which is graded on a scale of one through five, to properly diagnose the severity of oral mucositis. Grade 1 refers to mild symptoms that do not require medical intervention but may require diet adjustments, while grade 5 refers to death caused by the adverse event. Unfortunately, mucositis is one of the most troubling side effects of treatment that head and neck cancer patients must endure.
Managing Mucositis
The management of mucositis has 2 main goals: to decrease a patient’s discomfort so they can continue to eat and drink by way of the mouth and to prevent infections.
As mucositis generally lasts throughout treatment, the primary goal is to manage the symptoms to allow the patient to maintain hydration and nutrition orally. Patients experiencing mucositis can do a few things to manage their symptoms. These strategies include:
- Aggressive oral hygiene using a soft bristle toothbrush to keep their mouth as clean as possible.
- Frequent hydration to keep the affected areas moist.
- Oral rinses with a soothing non-alcohol based rinse (i.e. baking soda and water).
- Topical numbing medicines for temporary pain relief to allow for oral intake and systemic pain relief per your doctor’s recommendation.
- A doctor may suggest viscous xylocaine or magic mouthwash:
- The prescribed dose of viscous xylocaine, also known as viscous lidocaine, may be swished around in the patient’s mouth, then spit out, to provide temporary pain relief.
- Magic mouthwash is another solution often used to provide temporary pain relief. It is usually a mixture of antacid, antibiotics or antifungals, corticosteroids, and a local anesthetic. Magic mouthwash should be swished in the mouth for a couple of minutes before being spit out. This routine can be done every 4 to 6 hours. There is no standard solution for magic mouthwash, but your doctor will provide more specific instructions, as well as the necessary prescriptions.
Conclusion
Mucositis, a significant side effect of cancer treatments, causes intense discomfort and nutritional challenges. Effective management focuses on reducing pain and preventing infections to ensure patients can eat and drink. Approaches include meticulous oral hygiene, soothing oral rinses, and, if necessary, nutritional support through a PEG tube. Tailored care plans, based on severity assessments, are essential for alleviating this condition’s impact, emphasizing the need for a comprehensive, multidisciplinary strategy to support affected patients.
