What Is Oral Mucositis?
Patients newly diagnosed with cancer want to know about potential side effects of radiation and chemotherapy, and one question they may find themselves asking is, “What is oral mucositis?”
Mucositis is one of the most common and least pleasant potential side effects of cancer treatment. It is an inflammation of the mucous membranes that line the digestive tract, starting in the mouth and going all the way through the body. While mucositis can occur at any location in the digestive tract, it is most common in the mouth.
The Biology of Oral Mucositis
Oral mucositis is a frequent side effect for patients receiving chemotherapy or radiation, particularly of the head and neck. The purpose of chemotherapy and radiation is to kill cancer cells. However, it is not possible to target treatments to affect only cancer cells. Healthy cells are at risk, too, and the cells of the mucosa are delicate and particularly vulnerable.
When the mucosa are damaged, the potential for developing oral mucositis increases. All patients who receive cancer treatment have some risk of getting it, but the risk is particularly high for:
- Patients receiving high-dose chemotherapy (up to 40% develop oral mucositis)
- Patients who have received bone marrow transplants (75% to 85% develop oral mucositis)
- Patients receiving radiation to the head and neck (up to 50% develop oral mucositis)
Patients who receive a fractionated radiation dosage or full body irradiation are particularly susceptible to oral mucositis and may have a more difficult time overcoming it than patients receiving other treatments.
The symptoms of oral mucositis include:
- Inflammation of the gums and inside of the mouth, which may take on a red, shiny appearance
- Ulcers (open sores) on the mucosa
- The ulcers may become covered with a white clot called a pseudomembrane
- Pain and discomfort in the mouth
- Difficulty swallowing
- A thick coating of mucous on the tongue and insides of the mouth
In general, patients who are receiving chemotherapy or radiation should be aware of the symptoms so that they can notify their doctors when they appear.
Stages of Oral Mucositis
Oral mucositis, like many diseases, has distinct stages that indicate the severity of the inflammation. Typically, an infection that is at Stage 1 or Stage 2 will permit the patient to continue receiving treatments. Infections at Stage 3 or Stage 4 usually require the suspension of treatments until the mucositis has cleared up. Some scales refer to healing as Stage 5.
Here is a basic explanation of the four stages of oral mucositis.
Stage 1 -- Initiation
The first stage of oral mucositis is often asymptomatic. As radiation or chemotherapy begins, there is imperceptible damage to the mucosa cells, which begin to die as a result of the treatment. The dead cells are shed from the mucosa, which thins and becomes vulnerable.
Stage 2 – Primary Damage Response
In the second stage of oral mucositis, the process of inflammation begins. The radiation or chemotherapy treatments affect the DNA of the mucosa, changing and damaging the cells. This process causes the accumulation of active proteins in the submucosa, particularly something called inflammatory cytokines. The cytokines do two things: first, they damage the cells; second, they amplify the damage caused by radiation or chemotherapy, thus speeding the degeneration of mucosal cells.
At this stage, patients will usually become mildly symptomatic, with some obvious inflammation of the mucosa and associated pain.
Stage 3 – Signal Amplification
The third stage of oral mucositis represents a marked increase in the severity of symptoms. The pain and inflammation become acute. The presence of cytokines creates a positive feedback loop that greatly accelerates the damage to cells.
At this stage of oral mucositis, it is usually necessary to suspend chemotherapy or radiation to give the mouth a chance to heal.
Stage 4 – Ulceration
The fourth and most painful stage of oral mucositis involves ulceration of the mucosa. During this stage, the mucosal membranes have lost so much integrity that they become susceptible to the formation of painful sores called ulcers.
Because the ulcers are open wounds, they permit the entry of bacteria from the mouth into the mucosa and submucosa, which can lead to infection. Patients at this stage usually experience severe pain and discomfort, and may find it difficult or even impossible to swallow food. Patients with very advanced mucositis may not even be able to tolerate liquids, and thus may require intravenous feeding.
The stages of mucositis represent a natural, but debilitating progression as the cells of the mucosa are damaged by radiation or chemotherapy. It is dangerous to continue treatment when the infection is at Stage 3 or Stage 4, which is why treatment is suspended to allow healing.
Treatment of Oral Mucositis
Most patients who have oral mucositis begin the healing process as soon as radiation or chemotherapy treatments stop. The body’s natural ability to restore dead or damaged cells takes over. However, because the immune system can be compromised, it is also helpful to give the body some help in that regard.
L-glutamine is an amino acid, the most abundant in the human body. It plays an important role in the repair and regeneration of cells. Studies have shown that patients who receive radiation or chemotherapy treatments experience a deficiency of L-glutamine, which may be partially responsible for the increased risk of mucositis.
Talking a solution of L-glutamine orally has been proven to help boost the body’s ability to heal the mucosa. L-glutamine provides essential proteins that the body needs to aid with cell repair. Oral solutions of L-glutamine, such as Healios Glutamine Complex, do two things:
- When the glutamine suspension is in the mouth, it provides glutamine directly to the cells that most need it.
- When the glutamine suspension is swallowed, the remaining glutamine is processed by the body and can help correct the deficiency.
Healios Glutamine Complex has proven to be effective both as a mucositis prevention treatment, and as a way of alleviating symptoms and lessening the severity of an infection. To order your supply, please click here.