Often in cancer patients, after treatment with cytostatics, mucositis develops. What it is? Doctors call mucositis inflammation with the formation of ulcers on the mucous membrane. The pathological process most often affects the oral cavity, but in advanced cases it can affect the digestive organs. How to identify and treat this complication of chemotherapy? The answer to this question is presented in the article.
Pathology Description
Mucositis of the oral cavity is an inflammatory process in the soft tissues, in which painful bleeding ulcers appear on the mucous membrane. Erosions form on the gums, the inner surface of the cheeks and tongue.
This disease causes severe discomfort. It becomes painful for the patient to drink and eat. A person begins to avoid eating food and fluids, which leads to severe weight loss, exhaustion and dehydration.
Mucositis of the oral mucosa is a dangerous disease. If you do not deal with treatment, then ulcerative inflammation can go to the throat and organs of the digestive tract. In addition, bacteria and fungi can get into bleeding wounds. This leads to aggravation of the inflammatory process, suppuration, and sometimes to sepsis.
Etiology
Most often, mucositis develops after chemotherapy. This is the reaction of the body to the action of drugs used in cancer practice. High doses of antitumor drugs negatively affect not only cancer cells, but also healthy tissues. Mucositis may also appear after radiation therapy of cancer.
In more rare cases, the following factors can provoke the development of mucositis of the oral mucosa:
- decreased immunity after infections;
- chronic stomatitis;
- thrush of the oral cavity;
- caries;
- metabolic disorders;
- pathology of the digestive tract;
- complications after bone marrow transplantation;
- frequent irritation of the mucosa by hot food and liquid;
- smoking.
Mucositis may also develop after taking certain medications. We already mentioned that taking antitumor drugs can lead to inflammation and ulceration of tissues. However, any cytostatics and immunosuppressants can provoke the appearance of mucositis. Such drugs are prescribed, for example, in autoimmune diseases. These agents weaken the body's defenses and reduce the amount of beneficial bacteria in saliva.
Mucositis usually occurs within 2-3 weeks after the start of medication. If within a month the patient has no symptoms in the mouth, then most likely the pathology will not develop.
ICD code
According to the International Classification of Diseases, oral mucositis refers to pathologies of the oral cavity, jaw and salivary glands (departments K00-K14). This disease is considered as a lesion related to stomatitis (code K12). The complete code of mucositis according to ICD-10 is K12.3.
This applies only to mucositis of the oropharynx. If the ulcerative process has already spread to the digestive tract, then a different code is used. The gastrointestinal mucositis code is K92.8. This disease is considered as one of the pathologies of the digestive system.
Symptomatology
The first sign of the disease is redness of the mucosa. Then, rashes resembling vesicles with herpes appear on the affected areas. Over time, they are ulcerated. Pathology is accompanied by other symptoms:
- redness of the mucosa;
- severe itching;
- dry mouth
- soreness while talking and eating;
- the appearance of white spots in the affected areas;
- a small but constant increase in temperature.
If a patient has dyspeptic disorders, then this may be the first sign of gastrointestinal mucositis. What it is? As already mentioned, the pathological process can spread to the digestive organs, this is considered a gastrointestinal form of pathology. The following symptoms indicate this complication:
- diarrhea;
- the appearance of bloody and mucous impurities in the feces;
- frequent abdominal pain.
With this clinical picture, the patient needs emergency care. In advanced cases, diarrhea is replaced by intestinal obstruction, and the patient may die from peritonitis.
With chemotherapy, gastrointestinal mucositis can develop as an independent disease. Not always pathology begins with the oral cavity. In some cases, inflammation and ulcers immediately form in the digestive tract, and oral lesions are not noted.
Stages of damage to the oral cavity
There are several stages of mucositis. What it is? The pathological process in the oral cavity develops in stages. The stage of the disease depends on the degree of tissue damage and the severity of the pain syndrome. Each stage of the development of pathology is characterized by its symptoms:
- Zero stage. This stage of the disease is considered an incubation period. Pathology is already developing, but the patient does not yet feel any symptoms.
- First stage. Redness of some areas of the oral cavity is noted. Single ulcers may be observed. Pain while eating is absent.
- Second stage. Multiple erosions appear in the mouth. During a meal, a person feels discomfort, but this does not prevent the patient from eating.
- Third stage. Ulcers increase in size, become deeper. Slight bleeding is sometimes noted. Large foci of inflammation form in the mouth. At first, a person experiences discomfort during a conversation. Then there are severe pain during eating. Because of this, the patient can only take liquid and mashed food. Eating solid foods becomes impossible.
- Fourth stage. Most of the mucosa is ulcerated and inflamed. The patient experiences pain even with fluid. Severe weight loss and dehydration are noted. Ulcers often bleed.
The neglected stages of mucositis of the oral mucosa pose a danger to human life and health. The patient may die from a lack of food and dehydration. In such cases, the patient is transferred to food through a probe.
The degree of damage to the digestive tract and toxicity criteria
Mucositis of the gastrointestinal tract mucosa also develops in stages. The following stages of the development of the pathological process can be distinguished:
- 1st stage. Pronounced symptoms of gastrointestinal lesions are absent. Occasionally, slight diarrhea may occur.
- 2 stage. There are abdominal pains. Stool becomes frequent (4-6 times a day) and liquid, in the feces blood and mucus appear.
- 3 stage. The frequency of the stool reaches 8 or more times a day. The patient is constantly worried about severe abdominal pain. The temperature rises sharply. In some cases, the initial signs of intestinal obstruction are noted.
- 4 stage. Dead sections appear on the gastrointestinal mucosa. Frequent bleeding is noted, in severe cases, perforation of the intestinal wall and the development of peritonitis are possible. Without emergency medical care, the patient dies.
Doctors also take into account the degree of toxicity with mucositis. What it is? If the ulcerative process has developed after taking cytostatics, it is necessary to assess the level of negative effects of the drugs on the organs. In this case, the main criterion is the severity of diarrhea:
- 1 degree. The amount of feces is from 500 ml to 2 liters per day.
- 2 degree. The volume of feces is more than 2 liters per day. Blood and mucus appear in the feces.
- 3 degree. Intestinal obstruction develops, which requires surgical intervention. There are signs of severe colitis with frequent bleeding.
Mucositis after chemotherapy is especially dangerous. After all, the patient’s body is greatly weakened by cancer and the use of cytostatics. Without treatment, advanced forms of pathology often lead to death.
Diagnostics
The dentist is engaged in the treatment of this disease. If the pathology arose as a result of chemotherapy, then it is necessary to report the occurrence of unwanted symptoms to the treating oncologist. With damage to the digestive tract, a consultation with a gastroenterologist is required.
Mucositis in its manifestations resembles many other dental pathologies, for example, aphthous stomatitis, which is also accompanied by the appearance of ulcers. For the purpose of differential diagnosis, the following examinations can be prescribed to a patient:
- examination of the oral cavity;
- blood test for white blood cell and ESR;
- a smear from the mouth for bacterial inoculation;
- MRI or CT scan of affected tissue.
Therapy
Treatment of mucositis must necessarily be comprehensive. Not only medication is needed. It is very important to carefully care for the oral mucosa, otherwise the infection can get into the ulcers. The patient experiences great difficulties during eating, so you need to organize sparing food for him.
With a lesion of the mouth, the following groups of drugs are prescribed:
- Antiseptics: Chlorhexidine solution, Oralsept and Tantum Verde sprays. These medicines are used for rinsing and irrigation. They reduce pain and also prevent bacteria from entering the wounds.
- Aloe ointment. They are used for compresses and applications. Aloe has wound healing and anti-inflammatory properties. It is an effective and safe remedy.
- Amino acids. Glutamine-based drugs are prescribed. This substance stimulates the formation of protein and promotes the healing of ulcers. These medicines are available in pill form.
- Protein preparations: Filgrastim, Kepivans. These drugs are administered intravenously or subcutaneously. They can only be used in a hospital. They promote healing and tissue repair.
- Corticosteroid ointments and solutions. Most often, agents with dexamethasone are prescribed. Local steroid hormones can quickly relieve inflammation. However, such funds should be used with caution, as they reduce immunity.
- Local anesthetics: Lidocaine, Trimecaine. Assign for severe pain.
If the patient has signs of damage to the digestive tract (diarrhea, abdominal pain), then the following drugs are indicated:
- Antibiotics and antiprotozoal drugs: Vancomycin, Ciprofloxacin, Trichopol. These remedies help prevent the development of infection in the intestines.
- The drug "Sulfasalazine". This medicine has a strong anti-inflammatory effect.
- Antacid "Omez". The drug stops pain.
- Adsorbents. The most effective drug is Neointestopan. It quickly reduces diarrhea and removes harmful substances from the body.
Conservative methods help only in the early stages of gastrointestinal mucositis. If the patient has severe bleeding and intestinal obstruction, then surgical intervention is indicated.
Diet
During the treatment of oral mucositis, it is very important to follow a sparing diet. The patient experiences severe pain while chewing food. Therefore, all annoying types of food should be excluded from the diet:
- solid food;
- alcohol;
- spicy and sour dishes;
- too hot and excessively cold food;
- high-calorie foods.
Light foods that are quickly digested should be preferred. It is recommended to include steamed vegetables and meat on the menu. They need to be eaten in pureed form. Food should be at room temperature.
If it is difficult for the patient to consume even sparing food, then nutrition through a probe or parenteral administration of solutions is indicated. Such procedures are carried out in a hospital.
Oral care
Mucositis is often complicated by bacterial inflammation. Mouth sores are the gateway to pathogens. Therefore, it is very important for the patient to observe the following hygiene rules:
- Use a brush with very soft bristles to clean the teeth.
- Temporarily stop wearing dentures, as they injure the oral cavity even more.
- Rinse your mouth with antiseptics several times a day.
- Teeth must be cleaned of plaque and food debris after each meal.
- Treat lip skin with special moisturizing balms. This will help prevent cracking.
In addition, during treatment you should try to drink plenty of clean water (at least 2 liters per day). This will help remove toxins from the body. If the patient is difficult to swallow, then you need to drink the liquid in small portions, but as often as possible.
Prevention
How to prevent the occurrence of unpleasant manifestations of mucositis? If the patient has to undergo chemotherapy, then it is necessary to conduct treatment of caries in advance. It is also very important to carefully monitor the cleanliness of the oral cavity while taking cytostatics. Any neglect of personal hygiene while taking anticancer drugs can cause an inflammatory and ulcerative process.
During chemotherapy, trauma to the oral cavity should be avoided. Do not gnaw hard chunks of food, eat hot food and drinks, or use sharp toothpicks. Damage to the mucosa during the course of treatment can lead to ulcers and the development of mucositis. During treatment with cytostatics, it is necessary to inform the doctor of any inflammation or discomfort in the oral cavity.