Have a mouthful of trouble? Mucositis may be the name of your pain. Mucositis refers to the swelling and ulceration in the lining of your mouth and gastrointestinal tract resulting from cancer treatment. This dreaded complication affects almost all patients undergoing high dose chemotherapy and nearly 80% of those receiving radiation to the head and neck. Mucositis causes altered taste perception, significant pain, and difficulty swallowing; and severe mucositis can result in weight loss, infection, and dehydration. If you're suffering symptoms of oral mucositis (also called stomatitis) it's important to maintain oral intake and practice good oral hygiene to avoid potentially life-threatening complications.
Patients on high dose chemotherapy often experience symptoms four to five days after beginning treatment, with symptoms being most severe around day 10. Patients receiving head and neck radiation begin having symptoms near the end of the second treatment week; the pain and inflammation may last up to eight weeks. At the onset, your mouth's lining becomes thin and red and then begins to slough, leaving an inflamed ulcerated surface exposed and prone to infection and bleeding. At this time you may experience intense burning pain and difficulty speaking, eating, or even opening your mouth. Over time the ulcers develop a yellowish-white clot known as the "pseudomembrane" and they typically resolve over a period of a few weeks. During this time, you must take good care of your mouth and choose foods that are easier to tolerate to help you feel better and heal faster.
MEASURES TO LESSEN THE PAIN
Soft or liquid foods will be easier to tolerate.
• Smoothies or milkshakes
- Soft fruits, including bananas, applesauce, and watermelon.
- Canned fruits
- Peach, pear, and apricot nectars.
- Cottage cheese
- Mashed potatoes
- Macaroni and cheese
- Custards, puddings, or yogurt
- Scrambled eggs
- Oatmeal or other cooked cereals
- Warm soup
Some things go down easier than others
- Take small bites of food and chew it completely.
- Cook your food until soft and tender.
- Cut your food into small pieces.
- Process hard vegetables or meats with a blender until smooth.
- Eat foods cold or at room temperature when possible
- Add gravy, broth, or sauces to make foods easier to swallow.
- Use ice chips or flavored popsicles to numb your mouth
- Use straws to bypass mouth sores when drinking
Reduce your risk of cavities and other mouth infections:
- Schedule a dental visit before, during, and after your treatment for cancer
- Rinse your mouth after every meal and snack
- Brush your teeth three times daily
Avoid food and drink that could be irritating:
- Avoid rough, coarse, or dry foods, including raw vegetables, granola, toast, and crackers.
- Avoid foods that are spicy or salty and avoid foods that are acidic, such as vinegar, pickles, and olives.
- Avoid citrus fruits and juices, including orange, grapefruit, and tangerine.
- No smoking or alcohol!
Your doctor may recommend various mouthwashes that contain numbing agents to ease your pain, including "magic mouthwash" which is a mixture of Lidocaine, Benadryl, and Maalox. Your care team may also prescribe oral suspensions of glutamine, an amino acid involved in cellular repair, which is proven to decrease the severity and duration of mucositis.
A medication called Benzydamine hydrochloride has anti-inflammatory, analgesic (pain relieving), and antimicrobial effects that may be useful for patients with mucositis. Other new medications called "keratinocyte growth factors" (Repifermin and Palifermin) are said to stimulate the repair of tissues injured by cancer treatment and are in clinical trials right now to determine their usefulness in treatment or prevention of mucositis. Another option in the pipeline is Gelcair, a viscous gel mixture of polyvinylpyrrolidone, sodium hyaluronate, and glycyrrhetinic acid recently approved by the FDA for management of pain associated with oral mucositis.
CONTACT YOUR CARE PROVIDER:
Occasionally the pain from mucositis is so severe that you can't eat or drink and you may need to be hospitalized for pain control with morphine or other strong analgesic medications.
Call your doctor if you experience the following symptoms:
- Fever greater than100.7 for 24 hours
- Excessive gum or mouth sore bleeding
- Weight loss greater than 5 pounds in one week
- Inability to tolerate any food or drink for 24 hours
- Dizziness when standing or limited urination
Amy Thomas, M.D.
The author reports no financial disclosures
Published On: February 28, 2008