The redness, swelling, inflammation, and atrophy of the mucus membranes lining the mouth known as mucositis is a common complication of both chemotherapy and radiation. About 40 per cent of all chemotherapy patients develop mucositis. For patients undergoing preparation for hemapoietic cell transplantation, the proportion jumps to 75 per cent.
Recognizing Mucositis
Mucositis typically begins 5 to 10 days after the first chemotherapy treatment and lasts 10 to 14 days. When the top layers of the lining of the mouth are shed, they are not replaced. The first symptom is a whitening, or leukoplakia, on the lining of the mouth. These patches on the mouth can simply be areas of pallor or possibly milky-white. They disappear if the mouth is stretched.
As the condition progresses, the white patches turn red and inflamed. They may then be covered with a white fibrous clot, but break open with various stresses from eating, drinking, and oral care.
If the salivary glands are involved, the tongue may become "hairy" and a candidal infection, thrush, may grow in the mouth and throat. Many patients experience excessive bleeding through the sores.
Most Common in Leukemia and Lymphoma
Leukemia and lymphoma are more likely to result in mouth sores than other forms of cancer. This is in part due to the drugs used to treat these blood cancers. Treatment with drugs that interfere with vitamin use in cancer cells are especially likely to cause mucositis. These agents include 5-fluourouracil, cytarabine, and methotrexate.
Other risk factors for mouth sore include:
- Radiation of the head and neck also increases the likelihood of mouth sores.
- Children and young adults have greater problems with mucositis than older adults because their mouth tissues grow more rapidly.
- Poorly fitting dentures increase the risk of mucositis.
- Yeast infections and bacterial infections do not cause mouth sores, but they are more likely when there are mouth sores.
Sometimes the Most Difficult Challenge in Fighting Cancer
People trying to beat cancer often find mouth sores their most serious challenge. The constant irritation of the mouth makes it difficult to get enough water and nutrients. The open sores can serve as a portal for bacterial infections that can spread through the rest of the body.
Streptococcal infections entering the body through mouth sores kill from 6 to 30 per cent of all cancer patients who develop mucositis. A physician's care is necessary for managing systemic bacterial infection, but there is a great deal you can do to keep mouth sores under control.
What You Can Do About Mucositis
There are many measures you can take to prevent and ameliorate these "canker sores" caused by chemotherapy. Most of these interventions, however, require some advanced planning.
- If at all possible, see your dentist several weeks or months before taking chemotherapy. This is to remove potential sources of infection before your immune resistance is low. Cavities should be filled and bad teeth pulled before chemo or radiation.
- Never eat hot foods or drink hot liquids if you have any symptom of mucositis. Even tissues that do not hurt can be injured by heat. Eat foods cold or lukewarm.
- Avoid spicy and acidic foods such as curry, chili, hot peppers, black pepper, lemon juice, and vinegar. Do not drink alcohol.
- Instead of eating raw vegetables, drink them. You should only drink the juice of non-acidic fruits and vegetables such as apples, beets, carrots, and celery. Avoid lemon, grapefruit, or orange juice, and ginger.
- If you only have sores on your tongue and not on the lining of your mouth, avoid irritation by drinking fluids through a straw.
- Do not eat dry foods such as crackers, toast, and granola.
- Keep your mouth moist. Sip water or suck on ice chips throughout the day.
- If your doctor tells you not to brush your teeth, do not brush your teeth. This is to prevent infection. Rely on rinses instead.
- The fluoride rinses used in treating mucositis are not designed to prevent cavities. They are designed to kill bacteria. Although fluoride is not ideal for long-term use, it may be necessary to prevent a life-threatening bacterial infection such as septicemia.
- Sucking on lozenges may moisten a dry mouth.
If your pain is so severe you cannot drink or eat, call your healthcare provider. It is essential to avoid dehydration and malnutrition to benefit from treatment.
Sources:
- Branda RF, Naud SJ, Brooks EM, Chen Z, Muss H. Effect of vitamin B12, folate, and dietary supplements on breast carcinoma chemotherapy-induced mucositis and neutropenia. Cancer. 2004 Sep 1;101(5):1058-64.
- Suresh A, Varma PP, Sinha S, Deepika S, Raman R, Srinivasan M, Mandapal T, Reddy CO, Anand BB. Risk-scoring system for predicting mucositis in patients of head and neck cancer receiving concurrent chemoradiotherapy [rssm-hn]. J Can Res Ther 2010;6:448-51.
Join the Conversation