Should we learn about mouth/stomach ulcers (mucositis) that come with cancer treatment?

When undergoing cancer treatment, sometimes you get unbearable painful sores inside your mouth and throat, right? There are times when you can't even eat or drink, and it's hard to talk. That's the condition we're going to talk about today, called mucositis . Don't worry, this is something that happens to many people, and there are ways to manage it. Let's take a closer look at it.

What is Mucositis? Simply put...

Mucositis is an inflammation and injury of the lining of our gastrointestinal (GI) tract , or mucosa . Think of it as the moist, smooth, pink lining of our mouth. That's the lining that lines our entire digestive tract. It's what protects us from germs and the harsh chemicals in our food.

However, some cancer treatments, especially chemotherapy , radiation therapy , or stem cell transplants , such as bone marrow transplants , can damage this delicate lining. This is when mucositis occurs. This condition is most commonly seen in the mouth as oral mucositis .

How does this mucositis affect our body?

Now, look, cancer cells are a type of cell that divides very quickly. So, the treatments given for cancer are designed to destroy those rapidly dividing cells. But the problem is, the cells in our mucous membranes are also a type of cell that divides and renews very quickly. So, cancer treatments cannot tell the difference between the two. So, along with the cancer cells, the cells in our protective membrane are also damaged.

Normally, this mucous membrane protects us because it regenerates quickly. Even a small wound heals quickly. But in mucositis, not only are the cells in this membrane damaged, but the ability of those cells to regenerate and heal wounds is also reduced. What happens then? This membrane begins to be damaged even more by ordinary activities like eating and talking. Not only that, but the risk of infections also increases significantly.

In oral mucositis, the inside of the mouth becomes red, shiny, swollen, and sores appear. Sometimes , white patches of pus may appear in the mouth. Some people may feel less pain, but others may experience unbearable pain. Doctors have divided this pain into levels. Levels 1 and 2 are relatively mild, but levels 3 and 4 are severe pain. In these severe cases, you may not be able to eat or drink, and even cancer treatment may have to be reduced.

Some people may develop gastrointestinal mucositis, not just in the mouth, but also in the intestines. This can cause symptoms such as stomach pain, nausea, and vomiting . If it is close to the stomach, these symptoms may occur. If there is inflammation in the colon, you may experience diarrhea or pain during bowel movements.

Who is more likely to develop mucositis?

Mucositis develops in about 50% of people receiving chemotherapy, and between 80% and 100% of people undergoing radiation therapy or stem cell transplants. This means it is very common.

Also, you may be at higher risk of developing or worsening this condition for reasons such as:

• If you smoke or chew tobacco .
• If you use alcohol excessively.
• If the body is dehydrated .
• If there is a protein deficiency .
• If your body mass index (BMI) is low .
• If you have dental implants or use dentures .
• If you have gum disease .
• If you have kidney disease .
• If you have diabetes mellitus .
• If you have HIV infection .

What are the symptoms of Mucositis?

When an inflammation occurs, it usually causes redness, soreness, heat, and swelling . Along with this, it can also show symptoms that are specific to each area.

Symptoms of oral mucositis:

• The inside of the mouth and gums become red, shiny, and swollen .
• Dry mouth .
• Extra thick saliva .
• Mouth ulcers .
• Soft white patches of pus .
• Difficulty swallowing, talking, eating, and drinking .
• Bleeding .
• A white mucous coating on the white of the mouth.

Symptoms of gastrointestinal mucositis:

• Redness of the mucous membrane (erythematous mucosa) .
• Abdominal pain .
• Nausea and vomiting .
• Diarrhea .
• Blood or mucus in your poop .
• Painful bowel movements .

What are the main causes of mucositis?

When doctors talk about mucositis, they are often referring to the inflammation of the lining of the mouth and digestive tract caused by cancer treatments. As we have discussed, these treatments damage cells that divide rapidly, including the cells in our mucous membranes. The mouth or stomach can be affected in this way by high-dose radiation or chemotherapy given to the whole body, or by low-dose treatments given to only a specific area.

Sometimes, inflammation of the mucous membranes can occur with other conditions, such as infections. But then they are called by other, more specific names. For example, inflammation in the mouth is called stomatitis , and inflammation in the mouth due to an infection is called gingivostomatitis .

What are the possible complications of Mucositis?

This is something to be a little careful about.

• Undernutrition: Pain in the mouth, throat, esophagus, or stomach can make it difficult to eat or drink. This can be even more serious for people with cancer, who already have problems with appetite and weight loss. It is important to provide them with good nutrition. About 70% of people may need to be hospitalized for tube feeding.
• Chronic diarrhea: If you have persistent diarrhea, or if you have blood in your stool, you may need to be hospitalized and monitored to prevent dehydration or anemia.
• Infection: When the mucous membranes are damaged, one of the most important protective shields in our body is lost. People with cancer have low white blood cell counts, which means their immune system is also weakened. When wounds develop due to mucositis, germs are more likely to enter the bloodstream. People who have mucositis, who are undergoing chemotherapy, and who have low white blood cell counts (neutropenia) are at particular risk of developing a serious blood infection (septicemia).
• Reduction of cancer treatment: In cases of severe mucositis, some cancer patients have to delay or reduce their treatment. This is another risk to their health. It is said that more than 30% of patients stop treatment due to this condition.

How is Mucositis diagnosed?

Mucositis is a common side effect of cancer treatment. It can be easily diagnosed by looking at your symptoms, your medical history, and the areas of inflammation. If you have gastrointestinal mucositis, look into imaging tests.You will need to have one. Also, your doctor may want to check if you have any bacterial or fungal infections. This can be done with a simple blood test .

What are the treatments for Mucositis?

Mucositis usually goes away on its own after your cancer treatment is over. If you are having chemotherapy, mucositis will appear within a week or two of starting treatment and will go away within one to six weeks. If you are having radiation therapy, mucositis will appear within two to three weeks of starting treatment and will go away within two to four weeks of finishing treatment. The time it takes to get better can vary depending on how severe it is and how well you take care of it so it doesn't get worse. While you are getting better, you will need the following:

Pain management

Pain is the most serious problem with mucositis, especially when it occurs in the mouth. Topical agents may not last long or may not reach all areas. You may need to use a combination of methods to manage your pain. You may need mouthwashes, over-the-counter pain relievers, and even prescription opioids. Don't tolerate the pain. You need to be able to eat and drink well to get well. Talk to your doctor about pain management during cancer treatment.

Some pain relief treatments for mucositis:

• Topical anesthetics: These include things like `lidocaine`, `benzocaine`, `dyclonine hydrochloride (HCl)` and `Ulcerease® (0.6% phenol)`.
• "Magic mouthwash": This is a mixture of `lidocaine`, `diphenhydramine`, and `Maalox®`.
• Anti-inflammatory drugs: For example, prednisone.
• "GI cocktail": This is a mixture of `Maalox®`, `Nystatin®` and `Hurricane Liquid®`.
• Acetaminophen: Similar to `Tylenol®`.
• Prescription narcotic pain medications: These should be taken with stool softeners to prevent constipation.

Mouth care

When you have oral mucositis, you need to take special care of your mouth. This can not only reduce pain, but also protect it from further damage and infection. Even simple things like eating, talking, and swallowing can damage your weakened mucous membranes. This means choosing soft foods and things that can keep your mouth and throat moist and protected. Since your weakened mucous membranes are more susceptible to infection, cleanliness is also very important .

Treatment for oral mucositis:

• Brush your teeth more – but gently: At least three to four times a day. Use a soft-bristled toothbrush and a gentle fluoride toothpaste. Avoid whitening agents. If toothpaste irritates your mouth, use a salt and baking soda paste. Floss gently . Clean dentures daily.
• Mouth rinsing: Rinse your mouth with salt water or a solution of salt and baking soda five to six times a day. This is the gentlest and most effective way to clean mouth sores and kill germs. You can also use alcohol-free antiseptic mouthwashes.
• Diet: Your diet should be bland and less spicy . Avoid acidic, spicy and crunchy foods. Avoid sugar and alcohol. These can damage the membrane and promote the growth of bacteria and fungi. Protein shakes are a good idea to increase nutrition and hydration.
• Hydration: You may need to drink more fluids to compensate for your dry mouth and decreased moisture in your digestive tract. You may want to try an enzyme-based artificial saliva product like Oral Balance®. Some people find that sucking on ice chips helps to moisturize and soothe their mouth. You may also want to protect your lips by applying lip balms.

Treating complications

If you are severely dehydrated, malnourished, or infected, you may need:

• Enteral nutrition
• Giving saline (IV fluids)
• Antibiotics

What should I eat and drink until mucositis heals?

Good things to eat:

• High protein foods
• Nutritional shakes
• Soft foods
• Sugar-free popsicles

Things not to eat:

• Spicy foods
• Acidic foods
• Greasy or fried foods
• High-sugar foods

Good things to drink:

• Chamomile tea
• Lots of water

Things that are not good to drink:

• Carbonated beverages
• Alcohol

Can Mucositis be prevented?

There is currently not much we can do to prevent mucositis from cancer treatment, but doctors are researching it. Several drugs are currently being tested that may help reduce the severity and duration of this condition in some people. Some of them include:

• Cryotherapy: Sucking ice cubes before and during chemotherapy treatments can help prevent oral mucositis.
• Palifermin: This is a synthetic form of a substance produced by our bodies called keratinocyte growth factor (KGF). KGF works to protect and repair cells in the mouth and digestive tract. It has been shown to help reduce the severity and duration of mucositis in people with blood cancer and those who have had bone marrow or stem cell transplants.
• Topical agents: Gelclair® and Zilactin® have been shown to reduce oral mucositis by coating and protecting the mucosa prior to radiation therapy.
• Amifostine: This medication can reduce the severity of oral mucositis in people undergoing radiation therapy to the head and neck. However, nausea can be a side effect.

If I have this condition, what should I expect?

This will usually go away on its own after your cancer treatment is finished, but it can take two to six weeks. You may need to take painkillers prescribed by your doctor to help you cope during this time. Taking extra care of your mouth and keeping it clean to prevent infection can help it heal faster. If you develop an infection or have difficulty eating or drinking, be sure to seek medical advice.

When should I see my doctor?

If you notice these symptoms, seek medical advice immediately:

• When the first symptoms of mucositis appear.
• If you have symptoms of an infection, such as a fever .
• If you have difficulty eating and drinking .
• If you lose weight .
• If you have persistent diarrhea .
• If you frequently bleed from your mouth or with your stool.

Mucositis is one of the most common and difficult side effects of cancer treatment. How severe it is depends on many factors, including your general health, the type of treatment you receive, and how well you take care of yourself after treatment.

Finally, remember this (Take-Home Message)

Mucositis is temporary, but it doesn't have to be a burden, and there is help available. The first few weeks after your cancer treatment are crucial to your recovery. There is a real risk of malnutrition or infection during this time. Both self-care and medical care are important when you have mucositis. Don't be afraid to talk to your doctor and get the help you need. You are not alone!

` Mucositis, cancer treatment, mouth sores, stomach inflammation, chemotherapy side effects, radiation treatment side effects, oral care