Mouths made bad by cancer treatment

For too many people, chemo- and radiotherapy mean oral mucositis. So, before you start cancer therapy here’s what you need to know:

What is Oral Mucositis?

Oral mucositis is a side effect of cancer therapy and is characterised by a red, swollen and ulcerated mouth and tongue

• The hallmark of oral mucositis is pain. The pain can become so severe that it is hard to eat, drink and even speak
• There are 4 stages of oral mucositis. Stage 1 and 2 are mild and characterised by soreness and the beginning of ulceration. During stage 3 and 4, oral mucositis is more severe. At stage 3, sufferers cannot tolerate solid food and so switch to a liquid only diet. Eating is not possible at stage 4 so people may need further help getting enough nutrients1
  
• Many people develop mild oral mucositis as a result of cancer therapy, but stages 3 and 4 are less common
  
• Oral mucositis is called stomatitis by some doctors and nurses

What causes it?

Chemo- and radiotherapy

• Chemo- and radiotherapy work by preventing the growth of new cancer cells by killing rapidly dividing cancer cells that are already there
  
• Healthy mouth cells quickly divide and replace surface cells in the mouth with new cells. However, cancer therapy also kills these dividing mouth cells meaning the surface cells cannot be replaced, causing ulcers to form
  
• The combination of chemo- and radiotherapy increases the risk of developing severe oral mucositis.2 The symptoms of oral mucositis also tend to get worse the longer radiotherapy treatment lasts3
  
• Glands that produce saliva (spit) are also damaged so the mouth becomes dry and more likely to be injured by hard food
• There are many types of chemotherapy that are known to cause oral mucositis. Some of these therapies are listed below:4
  — 5-fluorouracil
  — methotrexate
  — doxorubicin
  — etoposide
  — melphalan
  — cytosine arabinoside
  — cyclophosphamide
• All radiotherapy that passes in and near the mouth is very likely to cause oral mucositis

Who gets it?

Most people receiving chemo- or radiotherapy are at risk. However, almost everyone receiving head and neck radiotherapy or a Hematopoietic Stem Cell Transplant (HSCT) (sometimes called a Bone Marrow Transplant [BMT]) will
get oral mucositis

• The likelihood of developing oral mucositis varies depending on the situation, lifestyle and medical history of the person
  Those at particular risk are:
  — young people and the elderly
  — those with previous oral health problems or oral mucositis
  — people who have poor oral hygiene during treatment
  — smokers
  — people who drink alcohol
  — diabetic patients
  — those receiving certain types of chemotherapy (see above)

How long does it last?

With chemotherapy:

• Typically people start noticing symptoms 5 to 8 days after starting chemotherapy. The symptoms can last between 7 to 14 days before healing begins
  
• With each cycle of chemotherapy the risk of developing oral mucositis increases and the severity of the condition often worsens3
• In some patients oral mucositis may last longer

With radiotherapy:

• Oral mucositis develops later with radiotherapy (at 2 weeks) and healing doesn’t begin until the end of therapy. Therefore, the symptoms can continue for up to 8 weeks

What are the consequences?

Pain

• Pain can make it very difficult to eat and drink, at a time when people with cancer need the physical strength to cope with aggressive cancer therapies

Infection

• The sores and ulcers that line a mouth are at serious risk of infection. If they do
  get infected, the infection may be able to move into the blood. This is called a blood infection or septicaemia
  
• People receiving a Hematopoietic Stem Cell Transplant (HSCT) are more likely to get septicaemia, as treatment means their bodies are less able to fight off infection
  

Loss of taste

• If the tongue is exposed during radiotherapy, the taste buds on the tongue’s surface may become damaged. Some patients may even experience a complete loss of taste
  
• The taste buds will usually begin working normally again within 4 months of finishing treatment, although the long-term effect is different from person-to-person and in some cases the taste buds may never fully recover

Treatment outcome

• Many people develop oral mucositis so severely, that it affects the dose of chemotherapy their body can cope with. This could ultimately influence the success of the cancer treatment

Other

• People with oral mucositis can sometimes feel ashamed of their condition and so they spend less and less time with their family, children and friends. This, coupled with the inability to eat and talk, can lead to social isolation and psychological distress
  
• In head and neck cancer patients, thick and sticky mucus often builds up inside the mouth and throat. The use of a suction pump is sometimes required to dislodge this stringy saliva
  
• The use of a feeding tube may be necessary to ensure the person receives enough food to cope with their therapy. The tube will be inserted through the nose if feeding is only needed for a short time, but it can be inserted directly into the stomach if longer term feeding is necessary

For information on how to treat and prevent oral mucositis speak to your doctor or nurse.

These articles are sourced from various avenues, all contents within Pure and Gentle Skincare website is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any health care professional. Pure and Gentle Skincare is not responsible or liable for any diagnosis made by a user based on the content of Pure and Gentle Skincare website or advisors. Always consult your own GP if you're in any way concerned about your health as he or she will be able to advise in greater details.