Mucositis: Difference between revisions
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==Background== | ==Background== | ||
<ref>Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, Filipauskas A. Prevention and Treatment of Chemotherapy and Radiotherapy Induced Oral Mucositis. Medicina (Kaunas). 2019;55(2):25. Published 2019 Jan 22. doi:10.3390/medicina55020025</ref> | *One of the most common side effects of cancer treatment with chemotherapy or radiation<ref>Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, Filipauskas A. Prevention and Treatment of Chemotherapy and Radiotherapy Induced Oral Mucositis. Medicina (Kaunas). 2019;55(2):25. Published 2019 Jan 22. doi:10.3390/medicina55020025</ref> | ||
*Occurs in almost all cases of head or neck radiation | *Occurs in almost all cases of head or neck radiation | ||
*20-80% of people who receive chemotherapy | *20-80% of people who receive chemotherapy | ||
*Major dose limiting toxicity of chemotherapy and head and neck radiation therapy | |||
==Clinical features== | ==Clinical features== | ||
[[File:PMC3948915 pone.0091733.g001.png|thumb|Oral mucositis is a side-effect of radiation treatment.]] | |||
[[File:PMC2902123 IJPC-15-95-g001.png|thumb|Oral mucositis in a patient who have undergone radiotherapy.]] | |||
*Stomatotoxic effect begins approximately 7 days after therapy | |||
*Erythema of the soft tissue of buccal mucosa or soft palate and burning sensation in mouth->elevated, white desquamative patches->epithelial sloughing leading to shallow ulcerations with pseudomembranous look->coalesce into large, painful ulcerations | |||
*Erythema and ulcerations of the mucosal lining of the gastrointestinal tract | *Erythema and ulcerations of the mucosal lining of the gastrointestinal tract | ||
*Causes dysphagia, changes in taste, secondary infections, weight loss | *Causes [[dysphagia]], changes in taste, secondary infections, weight loss | ||
**Oral mucositis is associated with increased inpatient hospitalization duration, bacteremia and higher 100‐day mortality. | **Oral mucositis is associated with increased inpatient hospitalization duration, [[bacteremia]] and higher 100‐day mortality. | ||
**GI mucositis is associated with nausea | **GI mucositis is associated with [[nausea/vomiting]], bloating, [[diarrhea]], intestinal cramping and anal pain. | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Oral candidiasis | *[[Oral candidiasis]] | ||
*Herpes simplex virus infection | *[[Herpes simplex virus]] infection | ||
*Acute | *Acute [[graft-versus-host disease]] | ||
==Evaluation== | ==Evaluation== | ||
*Diagnosis is typically clinical, based on history and exam | |||
*Grading system: National Cancer Institute Common Terminology Criteria for Adverse Events(CTCAE)<ref>Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0, November 2017, National Institutes of Health, National Cancer Institute. Available at: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf (Accessed January 6th, 2020)</ref> | |||
*Grade 1 - Aysymptomatic or mild symptoms, no intervention needed | |||
*Grade 2 - Moderate pain or ulcer that does not interfere with oral intake, modified diet indicated | |||
*Grade 3 - Severe pain, interfering with oral intake | |||
*Grade 4 - Life threatening consequences; urgent intervention indicated | |||
*Grade 5 - Death | |||
===Workup=== | ===Workup=== | ||
*Typically clinical diagnosis | |||
==Management== | ==Management== | ||
2020 guidelines from Multinational Association of Supportive Care in Cancer and International Society for Oral Oncology (MASCC/ISOO): | 2020 guidelines from Multinational Association of Supportive Care in Cancer and International Society for Oral Oncology (MASCC/ISOO): | ||
*Prevention with multi agent, combination oral care<ref>Elad S, Cheng KKF, Lalla RV, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126(19):4423-4431. doi:10.1002/cncr.33100</ref> | *Prevention with multi agent, combination oral care<ref>Elad S, Cheng KKF, Lalla RV, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126(19):4423-4431. doi:10.1002/cncr.33100</ref> | ||
**Tooth brushing, flossing, mouthwashes (bland rinses, reduce bacterial build‐up) and applying moisturizing agents to the oral mucosal surfaces | |||
*benzydamine mouthwash for prevention | *benzydamine mouthwash for prevention | ||
*Topical morphine 0.2% mouthwash | *Topical morphine 0.2% mouthwash | ||
*Honey | *Honey | ||
*Saline and sodium bicarb rinses | *Mucosal-protective agents(oral antacids, Gelcair, Orabase, Episil, topical kaolin/pectin) without any concrete evidence showing effectiveness | ||
*Saline and sodium bicarb rinses | |||
**No strong evidence but relatively harmless, expert opinion level of recommendation | **No strong evidence but relatively harmless, expert opinion level of recommendation | ||
| Line 33: | Line 45: | ||
==Disposition== | ==Disposition== | ||
*Admit for PO intolerance, significant weight loss, otherwise typically discharge | |||
==See Also== | ==See Also== | ||
| Line 43: | Line 55: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
*Epstein JB, Schubert MM. Oropharyngeal mucositis in cancer therapy. Review of pathogenesis, diagnosis, and management. Oncology (Williston Park). 2003;17(12):1767-1792. | |||
[[Category:ENT]] | |||
Latest revision as of 06:11, 6 January 2022
Background
- One of the most common side effects of cancer treatment with chemotherapy or radiation[1]
- Occurs in almost all cases of head or neck radiation
- 20-80% of people who receive chemotherapy
- Major dose limiting toxicity of chemotherapy and head and neck radiation therapy
Clinical features
- Stomatotoxic effect begins approximately 7 days after therapy
- Erythema of the soft tissue of buccal mucosa or soft palate and burning sensation in mouth->elevated, white desquamative patches->epithelial sloughing leading to shallow ulcerations with pseudomembranous look->coalesce into large, painful ulcerations
- Erythema and ulcerations of the mucosal lining of the gastrointestinal tract
- Causes dysphagia, changes in taste, secondary infections, weight loss
- Oral mucositis is associated with increased inpatient hospitalization duration, bacteremia and higher 100‐day mortality.
- GI mucositis is associated with nausea/vomiting, bloating, diarrhea, intestinal cramping and anal pain.
Differential Diagnosis
- Oral candidiasis
- Herpes simplex virus infection
- Acute graft-versus-host disease
Evaluation
- Diagnosis is typically clinical, based on history and exam
- Grading system: National Cancer Institute Common Terminology Criteria for Adverse Events(CTCAE)[2]
- Grade 1 - Aysymptomatic or mild symptoms, no intervention needed
- Grade 2 - Moderate pain or ulcer that does not interfere with oral intake, modified diet indicated
- Grade 3 - Severe pain, interfering with oral intake
- Grade 4 - Life threatening consequences; urgent intervention indicated
- Grade 5 - Death
Workup
- Typically clinical diagnosis
Management
2020 guidelines from Multinational Association of Supportive Care in Cancer and International Society for Oral Oncology (MASCC/ISOO):
- Prevention with multi agent, combination oral care[3]
- Tooth brushing, flossing, mouthwashes (bland rinses, reduce bacterial build‐up) and applying moisturizing agents to the oral mucosal surfaces
- benzydamine mouthwash for prevention
- Topical morphine 0.2% mouthwash
- Honey
- Mucosal-protective agents(oral antacids, Gelcair, Orabase, Episil, topical kaolin/pectin) without any concrete evidence showing effectiveness
- Saline and sodium bicarb rinses
- No strong evidence but relatively harmless, expert opinion level of recommendation
Chewing gum was NOT effective in preventing oral mucositis in pediatrics
Disposition
- Admit for PO intolerance, significant weight loss, otherwise typically discharge
See Also
External Links
References
- ↑ Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, Filipauskas A. Prevention and Treatment of Chemotherapy and Radiotherapy Induced Oral Mucositis. Medicina (Kaunas). 2019;55(2):25. Published 2019 Jan 22. doi:10.3390/medicina55020025
- ↑ Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0, November 2017, National Institutes of Health, National Cancer Institute. Available at: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_8.5x11.pdf (Accessed January 6th, 2020)
- ↑ Elad S, Cheng KKF, Lalla RV, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer. 2020;126(19):4423-4431. doi:10.1002/cncr.33100
- Epstein JB, Schubert MM. Oropharyngeal mucositis in cancer therapy. Review of pathogenesis, diagnosis, and management. Oncology (Williston Park). 2003;17(12):1767-1792.