Mucositis

Mucositis : Causes, Picture, Symptoms, Diagnosis and Treatment

Sores can affect your life anytime. But, mucositis is different. It is the medical term used to define the esophagitis sores or oral sores. It is a painful side effect that many cancer patients need to undergo. The chemotherapy or radiation therapy can lead to the sores mouth, open sores or affect the gastrointestinal tract adversely. The chemotherapy is effective in killing the cancer cells. But, it also kills the swiftly dividing cells. Therefore, it can affect the lining of the entire gastrointestinal tract. The gastrointestinal tract consists of your mouth, throat, bowel, and stomach. So, all the area is susceptible to the damage.

What Is Mucositis?

Your entire gastrointestinal tract has a lining that has epithelial cells. The cells have a tendency to divide and replicate at a rapid pace. The whole lining is known as the mucous membrane that covers the entire digestive system from your mouth to the anus. The mucous membrane is the soft layer of tissue.

The chemotherapy or radiation therapy focus in the cancer cells around the mucous membrane. So, it can destroy the mucous membrane along with cancer cells. With chemotherapy or radiation, the membrane becomes inflamed. Hence, patients may experience pain and discomfort. The medical condition is referred to as mucositis. It affects the mucous cells, so does not affect people suffering from breast cancer. It is divided into two types based on the area of occurrence:

Oral Mucositis

As the name suggests, it occurs inside the mouth. So, it leads to the development of painful sores. The individual suffering from it may feel difficult to have food.

Gastrointestinal Mucositis

It occurs inside the digestive system. So, it can cause bowel issues including diarrhea. In some cases, it can affect the lining of the anus. Such condition is medically known as proctitis.

You need to get comprehensive information on both the mucositis to take adequate steps to prevent it. Cancer itself is a painful disease that can make people lose their peace of mind. So, avoiding more discomfort to the mix is important. Patients undergoing cancer treatment need to check for the symptoms of the condition regularly.

Symptoms Of Mucositis

The symptoms vary with the area affected. So, the signs appear differently for the oral and gastrointestinal mucositis.

Oral Mucositis Indications

Individuals undergoing chemotherapy can see the symptoms ten days after starting it. While patients undergoing radiation therapy can observe the issue after two weeks of commencing the treatment. Therefore, it is better to look out for the signs to get the medical help.

  • Soreness inside the mouth
  • White patches or ulcer on the mouth lining, around the lips or tongue
  • Painful ulcers restricting the food intake
  • Bleeding
  • Mouth infection
  • Reduced sense of taste
  • Dry mouth
  • Difficulty in talking
  • Bad smelling breath

The symptoms can last for 3-4 weeks depending on the area of chemo or radiation therapy. It takes up to eight weeks for mouth cancers.

Gastrointestinal Mucositis

The type of mucositis is very common in people getting chemotherapy compared to radiation therapy. But, people who receive radiation to the pelvic area due to abdominal cancer can get affected by the issue. Individuals can see the following symptoms two weeks after starting the treatment:

  • Diarrhea
  • Rectal bleeding
  • Ulcers in rectum and anus
  • Passing mucus from the anus
  • Bloating
  • Abdominal pain
  • Nausea
  • Difficulty swallowing

Apart from diarrhea, all other symptoms vanish once the treatment is finished. Diarrhea may persist for several months even after completing the treatment. In such cases, it is important to seek medical help.

Causes Of Mucositis

Both types of mucositis occur as a result of cancer treatment. But, apart from the cancer treatment, other treatment methods can also cause the issue.

Cancer Treatments

The radiotherapy and the chemotherapy are effectively used in the cancer treatments to kill the malignant cells. But, it can also change the DNA of the healthy mucous cells leading to damage. So, it results in the tissue lining the mucous membrane to break down. It ultimately results in the ulcer formation. Though oncologists, try their best to prevent the side effects in the patients, it becomes difficult to stop the issue.

Biological Therapies

It is the type of cancer treatment that targets the cancerous area in particular. So, the treatment can result in damaging the soft tissue in the mouth.

Diagnosis Of Mucositis

Depending on the description of the symptoms, the doctor can determine the issue. To confirm mucositis, the medical professional may conduct a physical examination. The diagnosis of the two types of mucositis differs from one another. Therefore, read ahead to know the difference.

Oral Mucositis Diagnosis

Patients receiving high-dose chemotherapy or radiation therapy are more prone to the issue. Therefore, the oncologist may suggest regular assessments of the issue until the risk of developing oral mucositis passes. The assessment is made after the following:

  • Examination of the mouth to check for sores or patches
  • Understanding the symptoms a patient is experiencing
  • Determining the comfort level of having food and drinks after therapy

Grading Of Oral Mucositis

Depending on the severity of the oral mucositis, it gets graded.The WHO (World Health Organization) has described the criteria for the grading.

  • Grade 1: The patients may experience mouth soreness without the ulcer presence
  • Grade 2: The individuals may have ulcers in the mouth. But, eating or drinking is possible.
  • Grade 3: Eating solid food becomes very difficult while swallowing liquid is possible.
  • Grade 4: Eating, drinking or swallowing solid or liquid food is impossible as it causes severe discomfort.

Depending on the grade of the oral mucositis, the doctor suggests treatment. For grades 1 and 2, no need for hospitalization. Simple home remedies can clear the issue. But, grades 3 and 4 need immediate medical attention. As the individual’s body gets deprived of essential nutrients, they may become weak. So, if your friend or a family member has the issue, getting the help of a doctor is necessary. The hospital can administer nutritional support through IVs. It also helps in monitoring the health.

Gastrointestinal Mucositis Diagnosis

The doctor generally starts the diagnosis by asking about the symptoms. It can help determine the severity of the issue. Depending on the severity of the issue, additional testing is suggested. It can determine the serious complication arising due to the gastrointestinal mucositis like perforated intestine or bowel obstruction.

CT Scan

The computerized tomography scan uses the multiple X-rays from the different angles. the images put together to form a complete picture. Therefore, it helps the doctor get a clear picture of what is happening inside the body of the patient. Depending on the severity, the doctor takes adequate steps to overcome the pain and discomfort.

Treatment Of Mucositis

The treatment for each type of mucositis differs with the severity of the issue. The doctor uses the diagnosis to determine the treatment option best for the individual. Understanding the underlying cause of the issue is necessary to get the right treatment.

Oral Mucositis Treatment Options

Depending on the grading, mucositis gets treated. The Grade 1 and 2 refer to the less severe problem. Therefore, the self-care and home remedies work well. The Grades 3 and 4 suggests a severe complication that needs medical attention.

Self-Care

brush

Having a good oral hygiene is important for overcoming the oral mucositis. It effectively reduces the severity of the issue and the duration of the problem. Brushing teeth gently, using mouthwash, and using saline water for gargling can reduce the discomfort.

Ice Cubes

doctors recommend sucking the ice chips or ice cubes to get relief from the discomfort due to oral mucositis.

Pain Relief

Oral mucositis accompanies with pain. Therefore, patients get pain relief medication available in the form of spray, gel, or mouth rinse. If the pain is more severe, then the doctor can prescribe a painkiller. For the mild form of pain, the doctor suggests over-the-counter pain medications. It can help the individual get relief at home. The more severe pain requires opioid like morphine to dull the sensation.

The doctors generally ask the cancer patients to stay from non-steroidal anti-inflammatory drugs. For some, it may offer relief. But, it causes adverse effects in people receiving a certain form of chemotherapy. It can lead to kidney damage. Therefore, people need to follow only the painkillers suggested by the doctor.

Palifermin

Doctors offer the patients undergoing stem cell transplant palifermin injection to overcome the damage of the mucous membrane lining. The medication triggers the growth of new cells on the damaged lining. Subsequently, it reduces the severity of the symptoms. It also avoids the ulcer formation. Therefore, it can ensure fast healing.

Low-Level Laser Therapy (LLLT)

It another treatment option for the oral mucositis. In the treatment method, the affected area is subjected to the low energy laser beam. The laser beam, in turn, stimulates the cells. So, it can speed up the healing process. Only a professional with the expert training of using the equipment can implement the treatment option. Therefore, it is only available at high-specialty clinics or specialist cancer centers.

Infected Ulcers

Oral_lichen

The possibility of the mouth ulcers caused by the mucositis getting infected is very high. It also increases the risk of oral thrush. Therefore, the doctor offers the following to prevent issues:

  • Medication to prevent infection
  • Mouthwash to avoid getting additional infections
  • Antifungal medication to overcome oral thrush

Gastrointestinal Mucositis Treatment Options

The gastrointestinal mucositis can cause several issues. Each problem is treated specifically to get relief and comfort. Therefore, the treatment options for the side-effects are:

Diarrhea

The main complication of the issue is the loose stools that can result in dehydration. Therefore, the doctor may suggest some self-care methods or medications depending on the severity.

Self-Care Method

Drinking-Water

Good hydration is important to restore the lost fluids due to diarrhea. So, taking regular, small sips of water can hydrate the body. The patients must drink as much water as possible to reduce the ill-effects of dehydration.

Another self-care method is to change the diet. Reducing the fat amount in the diet and taking a low-residue diet is good. It reduces the frequency and amount of stools the patient passes.

Medications

For severe diarrhea, the treatment team may suggest medications. The following medications work well to control the loose stools.

Loperamide

It is the over the counter medication that can relieve the symptoms of diarrhea. So, it does not require a prescription to get the medicine.

Octreotide

People who fail to respond to loperamide can take the alternative medication. Octreotide is effective in treating loose stools. Therefore, the synthetic hormone can relieve the symptoms of the issues.

Ulcers And Rectal Bleeding

The high-dose radiation to the pelvic area results in rectal bleeding. Patients undergoing cancer treatment can also suffer from inflammation of rectum and anus. So, the following medications are provided by the medical team to ease the symptoms.

  • Colifoam (Hydrocortisone Acetate)
  • Proctosedyl (Cinchocaine Hydrochloride)

The medications are suppositories inserted into the rectum to relieve the inflammation and pain. Both the medication contain anesthetic. So, it numbs the pain in the area. The corticosteroid in both the medicines reduces swelling effectively.

Ignoring or overlooking the symptoms is not good for the cancer patients who suffer a lot of pain. Therefore, family members and people close to the patients need to check frequently for any signs of discomfort. Getting medical help may help reduce the intensity of pain and other discomforts.

Complications Due To Mucositis

The different types of mucositis can lead to other severe complication that can pose danger. So, patients experiencing the symptoms of the issue need to seek assistance from their doctor. Ignoring the issue can lead to complications like:

Severe Pain While Swallowing

The oral mucositis can lead to pain during swallowing of food. So, patients may resort to having liquid food or softer food. But, as the symptoms progress, it becomes difficult to swallow liquid food and drinks. Then, it results in severe dehydration and malnutrition. Therefore, it can slow down the healing and makes the patients feel tired.

As the patients become weak and exhausted, the doctor suggests getting a nasogastric tube. It is a tube that passes through the nose into the stomach of the patients. The feeding tubes make it easier to give food without the discomfort of swallowing. The tube gets removed after the ulcer heals.

Blood Poisoning

blood poison

Cancer can weaken the immune system. So, the oral and gastrointestinal mucositis can become infected. Therefore, it increases the risk of the infection spreading to other organs. The infection can also seep into the bloodstream. The condition is referred to as sepsis or blood poisoning. It is a life-threatening condition that can prove fatal. It can lead to multiple organ damage. So, the condition can prove fatal. Patients may require admission in the intensive care unit to restore the organ functions while controlling the infection. Therefore, avoiding such issues can prevent severe damage. It is important to seek medical help as the patient notices the symptoms. You can help your loved ones get the right treatment by urging them to speak about their discomfort.

Prevention Of Mucositis

The doctors take extra care during the radiation therapy or chemotherapy to reduce the severity of the mucositis. It will help reduce the severity and duration of the issue. Unfortunately, prevention is not entirely possible. Therefore, the doctor can adopt the following preventive medication to offer some relief to the patients.

Oral Mucositis

The oncologists may use other medications to the patients undergoing radiotherapy or the high-dose chemotherapy. It can prevent the damage of the mucous members to an extent. Therefore, it can reduce the severity of the sores. The medications that can provide relief are:

  • Palifermin
  • Benzydamine

Other than the two medication, patients can use other methods at home to reduce the severity. You need to check with your doctor before adopting any method. But, some home tips can reduce pain and discomfort like:

  • Sucking on the ice during and after cancer treatment
  • Smearing honey inside the mouth to cover the mucous membrane
  • Using Aloe-Vera gel or mouthwash for oral hygiene
  • Allopurinol mouthwash

The researchers suggest another medication called rapamycin is effective in the symptom reduction of oral mucositis. But, it requires more research to implement it in the treatment options.

Gastrointestinal Mucositis

The medication offered can aid in reducing the inflammation and relieve the pain. Therefore, the medication opted for the purpose are:

Sulfasalazine

Cancer patients who undergo radiation therapy in the pelvic region take the medication. It can effective blocks the chemicals in the body that trigger the inflammation process. So, it reduces the digestive system infection.

Amifostine

Rectal cancer patients undergoing the radiation can take the medication. It can reduce the inflammation in the anus and rectum. Patients undergoing treatment for their head and neck cancer can also take the medication to reduce the symptoms of dry mouth. Therefore, the medication reduces the acid levels in the body as well as provide protection against infection.

Omeprazole or Ranitidine

The medicines relieve the gullet and stomach pain. It reduces the acids levels in individuals undergoing chemotherapy.

All the medication have some level of side-effects. You need to discuss it with your doctor. An informed decision is helpful in meeting the challenges posed by the issue.

Conclusion

Mucositis is the side-effect of cancer treatments. Even with a good team of doctors, the complication is unavoidable. Therefore, bracing for the issue with the right information can help overcome the discomfort. People close to cancer patients and patients themselves need to understand the severity of the problem. So, it will avoid complication due to overlooking the problem.

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