Understanding Oral Mucositis: Cancer Treatment Mouth Sores

Cancer patients often develop unpleasant side effects as a result of treatment, particularly those going through chemotherapy (chemo) or radiation therapy. If you or a love one are going through one or a combination of these treatments, you may have heard about mouth sores, also known as oral mucositis.

What is Oral Mucositis?

Oral mucositis is a common and debilitating side effect of chemotherapy and/or radiation treatment. The condition occurs when the tissues lining the mouth gets thin from the damaged cells, then becomes inflamed and ulcerated. The ulcerative lesions or sores of the tissues occur in the mouth including the lips, cheeks, gums, tongue, and the floor and roof of the mouth. However, tissue damage and resulting ulcers or sores can occur in other areas along the gastrointestinal (GI) tract, including the esophagus, the tube leading to your stomach. The ulcers of oral mucositis are frequently very painful. They can have a negative impact on patient nutritional status and may increase the risk of infection, reducing the quality of life of patients going through cancer treatment.

What Patients Are More Likely to Develop Oral Mucositis?

Oral mucositis usually affects patients going through chemotherapy and/or radiation treatment in areas involving the oral cavity. This condition can particularly affect those receiving radiation treatment to the head, neck, chest, or abdomen. Studies indicate that approximately fifty-one percent (51%) of patients receiving chemotherapy for solid tumors or lymphoma develop mucositis. The same study reports that almost all patients treated with radiation for head and neck cancer develop some degree of oral mucositis, while twenty-nine to sixty-six percent (29-66%) develop severe oral mucositis.

Symptoms of Oral Mucositis

Inflammation and ulcerations are the main symptoms of oral mucositis, or mouth sores. You may experience some redness to the lining of the mouth or develop ulcerations that are covered by a yellowish or white clot. The mouth sores can be very painful depending on the ulceration size and tissue damage. The pain can lead to difficulty speaking, opening the mouth, or even eating and drinking.

Because of the pain associated with oral mucositis, patients are at risk of developing anorexia, as well as cancer associated malnutrition (CAM), a type of malnutrition that affects the muscles and the metabolic processes of the body.

In addition to pain, cancer patients with oral mucositis may develop dysgeusia, an altered sense of taste or “taste blindness”. Dysgeusia is usually a temporary symptom caused by damage to the taste buds that causes patients to perceive food as too sweet, bitter, or of a metallic taste. Furthermore, patients can develop a more severe form of oral mucositis referred to as GI mucositis. GI mucositis affects organs beyond the mouth that can lead to internal bleeding and diarrhea.

Diagnosis of Oral Mucositis

Mucositis is diagnosed based on the symptoms of the patient. The signs of discomfort and the appearance of the tissues of the mouth are used to evaluate the patient’s condition. The severity of the condition is evaluated by examining the phases of oral mucositis and using assessment tools such as The Oral Toxicity Score, The National Cancer Institute Common Toxicity Criteria for Oral Mucositis, and The Oral Mucositis Assessment Scale.

How Long Can Oral Mucositis Last?

Oral mucositis can start within days of initial treatment for patients going through chemotherapy. It is reported that the condition peaks at around day ten (10) of treatment, improving slowly over several weeks. On the other hand, mucositis associated with radiotherapy tends to appear after the second week of treatment with symptoms lasting from six to eight weeks. However, it is important to acknowledge that the initiation and duration of oral mucositis can vary depending on the severity of the condition and your treatment plan.

Can Oral Mucositis Interfere with Treatment?

Patients with oral mucositis can develop complications that interfere with treatment. The ulcers can become infected and for some patients may be life threatening during times of immunosuppression. Patients with severe mucositis may become too weak to withstand treatment as a result of inadequate nutritional intake from painful swallowing. Furthermore, this condition can lead to clinical complications and unplanned hospitalizations that can interfere or disrupt the cancer treatment plan, potentially having a negative impact on treating the patient tumor.

It is important to become familiar with the physical and financial burdens of oral mucositis. Talk to your doctor about oral mucositis treatments and the measures you can take before treatment to reduce the duration and severity of mucositis.

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