Mucositis
Background
- One of the most common side effects of cancer treatment with chemotherapy or radiation[1]
- Occurs in almost all cases of head or neck radiation
- 20-80% of people who receive chemotherapy
- Major dose limiting toxicity of chemotherapy and head and neck radiation therapy
Clinical features
- Stomatotoxic effect begins approximately 7 days after therapy
- Erythema of the soft tissue of buccal mucosa or soft palate and burning sensation in mouth->elevated, white desquamative patches->epithelial sloughing leading to shallow ulcerations with pseudomembranous look->coalesce into large, painful ulcerations
- Erythema and ulcerations of the mucosal lining of the gastrointestinal tract
- Causes dysphagia, changes in taste, secondary infections, weight loss
- Oral mucositis is associated with increased inpatient hospitalization duration, bacteremia and higher 100‐day mortality.
- GI mucositis is associated with nausea/vomiting, bloating, diarrhea, intestinal cramping and anal pain.
Differential Diagnosis
- Oral candidiasis
- Herpes simplex virus infection
- Acute graft-versus-host disease
Evaluation
- Diagnosis is typically clinical, based on history and exam
- Grading system: National Cancer Institute Common Terminology Criteria for Adverse Events(CTCAE)[2]
- Grade 1 - Aysymptomatic or mild symptoms, no intervention needed
- Grade 2 - Moderate pain or ulcer that does not interfere with oral intake, modified diet indicated
- Grade 3 - Severe pain, interfering with oral intake
- Grade 4 - Life threatening consequences; urgent intervention indicated
- Grade 5 - Death
Workup
- Typically clinical diagnosis
Management
2020 guidelines from Multinational Association of Supportive Care in Cancer and International Society for Oral Oncology (MASCC/ISOO):
- Prevention with multi agent, combination oral care[3]
- Tooth brushing, flossing, mouthwashes (bland rinses, reduce bacterial build‐up) and applying moisturizing agents to the oral mucosal surfaces
- benzydamine mouthwash for prevention
- Topical morphine 0.2% mouthwash
- Honey
- Mucosal-protective agents(oral antacids, Gelcair, Orabase, Episil, topical kaolin/pectin) without any concrete evidence showing effectiveness
- Saline and sodium bicarb rinses
- No strong evidence but relatively harmless, expert opinion level of recommendation
Chewing gum was NOT effective in preventing oral mucositis in pediatrics
Disposition
- Admit for PO intolerance, significant weight loss, otherwise typically discharge
See Also
External Links
References
- ↑ Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, Filipauskas A. Prevention and Treatment of Chemotherapy and Radiotherapy Induced Oral Mucositis. Medicina (Kaunas). 2019;55(2):25. Published 2019 Jan 22. doi:10.3390/medicina55020025
- ↑ Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0, November 2017, National Institutes of Health, National Cancer Institute. Available at: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf (Accessed January 6th, 2020)
- ↑ Elad S, Cheng KKF, Lalla RV, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126(19):4423-4431. doi:10.1002/cncr.33100
- Epstein JB, Schubert MM. Oropharyngeal mucositis in cancer therapy. Review of pathogenesis, diagnosis, and management. Oncology (Williston Park). 2003;17(12):1767-1792.
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