Mucositis is inflammation of the mucosa, the mucous membranes that line your mouth and your entire gastrointestinal tract. It’s a common side effect of cancer treatments involving radiation or chemotherapy. Mucositis is temporary and heals on its own, but it can be painful and carries certain risks. It requires self-care and medical care to manage.
What is Mucositis?
Mucositis is a painful inflammation of the mucosa — the protective mucous membrane that lines your entire gastrointestinal (GI) tract, from your mouth through your intestines. Mucous membranes line many cavities and canals in your body, but mucositis particularly affects those in your digestive system, especially your oral mucosa. It’s a common side effect of certain cancer treatments including chemotherapy, radiation therapy, or stem cell transplants (bone marrow transplants).
How does mucositis affect my body?
Therapies designed to treat cancer will attack any cells that rapidly divide. Unfortunately, that includes any mucosa in the area — these therapies can’t discriminate between the two. Mucous membranes line your entire GI tract, including your mouth, throat, esophagus, stomach and small and large intestines.
Ordinarily, rapid cell turnover is part of what makes your mucosa the protective barrier that it is. It allows the mucous membrane to regularly refresh itself, clearing out abrasive particles and pathogens and healing quickly from injuries.
Mucositis not only damages the existing cells in your mucosa, but also their ability to replicate themselves and heal. This means that parts of your body that normally require that protective barrier are now exposed to irritation from their everyday functions. In your digestive system, that’s eating. These parts are also more vulnerable to infection.
Mucositis most commonly affects your mouth and the inner lining of your cheeks (buccal mucosa). These mucous membranes are particularly sensitive. Oral mucositis makes the inside of your mouth inflamed — red, shiny, swollen, raw and painful. It often leads to mouth sores or white patches of pus in your mouth.
Oral mucositis can be mild or severe. Healthcare providers have a grading system for pain levels, with grades 1 and 2 being relatively mild and grades 3 and 4 being severe. Severe cases can interfere with eating and can cause people with cancer to reduce their treatment.
Some people also get gastrointestinal mucositis. This may manifest as abdominal pain and nausea if the inflammation is closer to your stomach, or as diarrhea or painful bowel movements if the inflammation is in your colon.
Who does mucositis affect?
Up to 50% of people receiving chemotherapy and 80% to 100% of people receiving local or whole-body radiation therapy or stem cell transplants (bone marrow transplants) develop mucositis.
Mucositis Symptoms and Causes
Inflammation causes redness, soreness, heat and swelling. It can cause other specific symptoms in different parts of your body.
# Oral mucositis may cause:
- Red, shiny, swollen mouth and gums.
- Dry mouth.
- Extra thick saliva.
- Mouth ulcers.
- Soft white patches of pus.
- Difficulty swallowing, talking or eating.
- Bleeding. White mucus coating.
# Gastrointestinal mucositis may cause:
- Redness (erythematous mucosa).
- Abdominal pain.
- Nausea and vomiting.
- Diarrhea.
- Blood or mucus in your poop.
What causes mucositis?
When healthcare providers talk about mucositis as a condition, they’re usually talking about mucositis of the GI tract (including the mouth) that results from cancer treatments. These treatments damage rapidly dividing cells, including those that make up the mucosa. High-dose radiation or chemotherapy to the whole body, or low-dose treatments to the local area, may affect your mouth or abdominal organs.
Inflammation of the mucosa can also occur in conjunction with other conditions, such as infection. But when this happens, it usually goes by a more specific name. For example, stomatitis is inflammation of the mouth, and gingivostomatitis is inflammation of the mouth that’s caused by infection.
How is mucositis diagnosed?
Mucositis is an expected side effect of cancer treatment and is easy to diagnose based on your symptoms, medical history and a look at the inflamed tissues. In the case of gastrointestinal mucositis, it may take an imaging test to see the tissues inside. Your healthcare provider may also want to test you for certain bacterial or fungal infections. They can do this with a simple blood test.
How is mucositis treated?
Mucositis will heal on its own after your course of cancer treatment has finished. If you have chemotherapy, mucositis usually appears one to two weeks after beginning treatment and heals after one to six weeks. If you have radiation therapy, mucositis appears two to three weeks after beginning treatment and heals within two to four weeks after your therapy has finished. How severe it is, and how well you take care of it to prevent additional irritation, can affect how long it takes to heal. While it’s healing, you’ll require:
# Pain Management
Pain is a serious problem with mucositis, especially in the mouth. Topical agents may not last long in your mouth, or may not be able to reach all the affected areas. You may need a combination of different approaches to manage your pain including topical gels and mouthwashes, over-the-counter pain medications and even prescription opioids. Don’t try to tough it out — it’s important that you’re able to eat and drink well enough to continue healing. Talk to your healthcare provider about pain management in cancer care.
# Pain treatments for mucositis include:
- Topical anesthetics.Some of these include lidocaine, benzocaine, dyclonine hydrochloride (HCl) and Ulcerease® (0.6% phenol).
- “Magic mouthwash.” A mix of lidocaine, diphenhydramine and Maalox®.
- GI cocktail.” A mix of Maalox, Nystatin® and Hurricane Liquid®.
- Acetaminophen. Like Tylenol®.
- Prescription narcotic pain medications. These will need to be combined with stool softeners to prevent constipation.
Mouth Care
When you have oral mucositis, you have to take special care of your mouth, not only to reduce discomfort, but also to protect it from additional irritation and infection. Even normal things like chewing, speaking and swallowing can contribute to breaking down your weakened mucosa. This means choosing gentle foods and products to help lubricate and coat your mouth and throat. Your weakened mucosa is especially vulnerable to infection, so hygiene is extra important, too.
What should I eat or drink while healing from mucositis?
Do eat:
- High protein foods.
- Nutritional shakes.
- Soft foods.
- Sugar-free popsicles.
Don’t eat:
- Spicy foods.
- Acidic foods.
- Greasy or fried foods.
- High-sugar foods.
Do drink:
- Chamomile tea.
- Lots of water.
Don’t drink:
- Carbonated beverages.
- Alcohol.
A Note
Mucositis is one of the most predictable and difficult side effects of cancer treatment. How severe it is will depend on many factors, including your overall health, the type of treatment you’re receiving and how well you take care of yourself after treatment. Some of these factors can’t be prevented, but you can help prepare and protect yourself by following basic health guidelines: avoiding smoking and alcohol and practicing good oral hygiene and nutrition.
If you do have severe mucositis, make sure to keep your healthcare provider informed of your condition and ask for the help you need. Mucositis is temporary, but it’s not worth suffering through when you can help it. These brief weeks following your cancer treatment are crucial to your good recovery, and the risks of undernutrition or infection during this period are real. Self-care and medical care are equally important when you have mucositis.
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