Causes and risk factors
Mucositis is caused as a result of side effects of radiation and chemotherapy. It is more commonly seen in hematological cancers. Chemotherapy causes lowering of white blood cells while radiation energy can lead to inflammation and necrosis of the mucous membrane. Low immunity in people suffering from certain diseases like HIV, underweight and malnourished people are at high risk for developing mucositis. Certain risk factors have been laid down which can increase the chances of developing mucositis. It includes smoking, chewing tobacco, alcohol usage, and poor dental hygiene. Viral and fungal infection and decreased salivation favors this condition. Treatment received for cancers, especially head and neck cancers, increase the chances of developing mucositis.
Clinical presentation:
Clinical features vary depending upon the part affected. The complaints are seen 7-14 days after the exposure to radiation or chemotherapy. Oral mucosa being sensitive is more commonly affected. The symptoms can vary from mild ones, which can be easily managed to the serious complaints, which are often rare. The patient complains of soreness in the mouth. Eating and drinking becomes difficult. Some complain of development of ulcers in the mouth. Alteration in taste and dryness of mouth occurs. Halitosis is another common complaint. Affection of the digestive tract mucosa leads to pain in abdomen along with a distended feeling. The bowel habits are altered, in most of the cases diarrhea occurs. Nausea, vomiting along with difficulty in swallowing food is the other complaint seen. The stools passed are dark colored as it contains blood. In a few cases, formation of ulcers is seen in the digestive tract. Confluent mucositis is a worst condition characterized by thick white coating all over the mucous membrane of mouth.
Investigations:
The symptoms narrated by the patient along with details of chemo and radiation therapy are noted down. Examination of mouth and abdominal palpation is must. In gastrointestinal mucositis, if required, investigations like various imaging tests can be done. For oral mucositis, the WHO has laid down certain criteria and diagnosis can be done on that basis:
Grade I: Soreness of mouth occurs, but there is no ulcer formation.
Grade II: Ulcers in mouth are present, but the person can eat food.
Grade III: Ulcers are present in mouth; the person cannot eat solid food, but can swallow liquids.
Grade IV: Swallowing both solid and liquid food is difficult.
Treatment:
Usually, the complaints start 4-14 days before the radiation and chemotherapy and lasts for 3-6 weeks after that. In a few cases, the symptoms may last for a longer period. There is no single treatment for mucositis. Medications for symptomatic relief are administered. For oral mucositis, it is essential to adopt certain preventive measures before and during the initiation of chemotherapy and radiation therapy. Low-level laser therapy done in case of oral mucositis is helpful. One should undergo a dental assessment before undergoing cancer treatment. Regular brushing of teeth twice daily, regular flossing is needed. Avoid chewing tobacco. Drinking plenty of fluids and having a healthy and nutritious diet is must.
Other Modes of treatment:
Certain other modes of treatment can also be helpful in coping up with the symptoms. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints.
