If you have oral mucositis, it is very important that you have a good oral hygiene routine because it can reduce the severity of your symptoms and shorten the length of time that you have them for.
Below is some general advice to help you obtain a good level of oral hygiene. Always follow any advice your cancer treatment team gives you if it differs from the advice below.
- Brush your teeth every morning and evening and after every meal.
- Use a toothbrush with soft bristles.
- Allow the toothbrush to dry before storing it.
- Replace your toothbrush regularly. Most toothbrushes need to be replaced every three months.
- Floss your teeth at least once a day or as advised by your treatment team.
- Rinse your mouth five or six times a day using a bland rinse. A bland rinse is a mixture of water and sodium bicarbonate (baking soda) or a mixture of water and salt (to make a saline solution). Your treatment team will be able to advise you about the type of bland rinse that is suitable for you.
- Do not use a mouth rinse that contains alcohol.
- Avoid tobacco, alcohol and irritating foods, such as hot, spicy, acidic or rough foods.
- Use a water-based moisturiser to protect your lips.
- Make sure you drink plenty of fluids throughout the day. A minimum of 1.2 litres (2 pints) is the recommended daily amount. However, if you have diarrhoea, you will need to drink more than this to avoid becoming dehydrated.
In the past, sucking ice cubes or ice chips was often recommended as a way of providing relief from the symptoms of oral mucositis. However, sucking ice cubes can cause your blood vessels to narrow, which may result in the chemotherapy or radiotherapy not reaching the tissues that they are supposed to be treating. In some cases, ice cubes may also cause more damage to the lining of your mouth.
The healthcare professionals treating you will advise you about whether ice cubes could help you or not.
Oral mucositis is often painful but there are several kinds of painkillers available that you can try. You may be given painkillers in the form of a mouth rinse, gel or spray.
If the first painkiller you try is not effective, other medicines can be tried alongside it, or a stronger painkiller can be used. Worsening pain does not always mean that you will need to be admitted to hospital, and in most cases you can take the painkilling medication yourself at home.
You will usually be started on a simple painkiller, such as paracetamol. If this proves ineffective at controlling your pain, you may then be prescribed a stronger type of painkiller, such as codeine. If this is still not effective, a stronger opioid can be prescribed, such as morphine.
If you are in severe pain, you can be given morphine by a continuous drip through a narrow tube into a vein in your arm.
Non-steroidal anti-inflammatory drugs (NSAIDs) may provide pain relief for some people. However, if you are receiving platinum-based chemotherapy, NSAIDs could damage your kidneys and affect the way they work. For this reason, you should only take painkillers as advised by your treatment team.
Palifermin is a type of medication that has proved to be reasonably successful in treating people who are having a stem cell transplant (bone marrow transplant) and who are thought to be at considerable risk of developing oral mucositis.
Palifermin encourages the growth of new cells on the lining of the mucous membrane. This growth is thought to reduce the severity of your symptoms and encourage any ulcers to heal faster. Palifermin also stops sores forming, so it can be used to prevent, as well as treat, mucositis.
One small study found that people taking a single dose of palifermin before their chemotherapy also experienced less nausea and constipation than those who did not.
Palifermin is given by injection. You should receive an injection once a day for three days before your chemotherapy or radiotherapy, and then for three days afterwards, for a total of six doses.
Common side effects of palifermin include:
- skin rash, itchiness and redness
- an increase in the thickness of the lining of your mouth or tongue
- a change in the colour of your mouth or your tongue
- general swelling of the body
- aching joints
- altered taste
Less common side effects include swelling of the face or mouth.
The side effects should pass after you have completed the course of palifermin.
The use of palifermin during pregnancy is not recommended. This is because there has not been any testing to determine whether palifermin is safe to use during pregnancy. Therefore, you should tell your treatment team if:
- you are pregnant
- you think that you are pregnant
- you plan to get pregnant
Low-level laser therapy (LLLT)
Low-level laser therapy (LLLT) is another treatment that can reduce the severity of oral mucositis. It involves focusing low-energy lasers (beams of light) at affected tissue. LLLT is thought to work by stimulating certain cells that then help to speed up the healing process.
As LLLT requires specialist equipment and training, it may only be available at specialist cancer centres or clinics.
The mouth ulcers (sores) that mucositis causes can become infected. If this happens, your treatment team may prescribe medication for this. You may also be given a special mouth wash to use to prevent further infections.
Treatments for diarrhoea
It is very important that you drink plenty of fluids if you have diarrhoea. This is because repeated bouts of diarrhoea can cause you to become dehydrated very quickly. Take small, frequent sips of water and drink as much as you can.
For people who are more vulnerable to the effects of dehydration, such as the elderly, oral rehydration salts may be recommended. Oral rehydration salts are available in sachets from pharmacies. You dissolve them in water and they replace salt, glucose and other important minerals that your body loses through dehydration.
If you have a kidney condition, certain types of oral rehydration salts may not be suitable for you. Ask your pharmacist or GP for advice about this.
Hospital treatment will be required for more serious cases of dehydration because fluids and nutrients will need to be administered intravenously (directly into a vein).
Changing your diet
One way to prevent and treat diarrhoea is to make some changes to your diet. Your treatment team may suggest a low-residue diet. This is a diet that is designed to reduce the amount and frequency of the stools that you pass.
Foods that can be eaten as part of a low-residue diet include:
- enriched refined white bread
- breakfast cereals, such as cornflakes
- white rice
- refined pasta
- cooked vegetables
- lean meat and fish
You should not make any significant changes to your diet without first consulting your treatment team.
A medicine called loperamide is known to help relieve the symptoms of diarrhoea. It is available over the counter (OTC) at pharmacies and you do not need a prescription to buy it. However, while you are still receiving treatment, you should only take loperamide on the advice of your treatment team.
Common side effects of loperamide include constipation and dizziness. Rarer side effects of loperamide include cramps, drowsiness, skin rashes and bloating.
Loperamide is not suitable for people with colitis (inflammation of the colon) or pregnant women. However, it can be used safely by breastfeeding women.
If your symptoms of diarrhoea fail to respond to loperamide, you may be given an alternative medicine called octreotide. Octreotide is a synthetic (man-made) hormone that has proved useful in treating diarrhoea caused by chemotherapy.
Octreotide is usually given twice a day by injection (intravenously). After receiving treatment, you may experience symptoms of pain, redness and swelling at the site of the injection. These symptoms should pass within 15 minutes.
Side effects of octreotide are uncommon but can include:
- loss of appetite
- nausea (feeling sick)
- vomiting (being sick)
- abdominal (tummy) pain
- flatulence (wind)
- changes in blood sugar levels
The side effects of octreotide can be minimised by injecting the medication between meals or before bed.
Rectal bleeding and ulcers
Some people who have high-dose radiotherapy to treat a cancer that is in their pelvic region may experience inflammation and ulceration of the anus and rectum and rectal bleeding. Proctitis is a medical term that is used to describe inflammation of the lining of the rectum (the lower section of the large bowel).
If these symptoms become severe, they can be treated using medicines such as proctosedyl suppositories or colifoam. Proctosedyl suppositories are inserted into your rectum and can help to relieve pain and inflammation. They contain both a local anaesthetic to numb the area and a corticosteroid to reduce swelling.
Colifoam also contains a corticosteroid to hep reduce inflammation and is a foam that is inserted into your rectum once or twice a day. Your treatment team will explain how to use colifoam or the patient information leaflet that comes with the medication will provide details.
If ulcers and inflammation affect your digestive system higher up, they can be treated using a medicine called sucralfate. Sucralfate works by creating a protective coating over any ulcers. This helps to prevent further damage and speeds up the healing process. Sucralfate can be taken for mucositis that affects the upper gastrointestinal tract, such as ulcers that develop in your stomach or intestines.
Side effects of sucralfate tend to be mild and short-lasting. They include:
- constipation or diarrhoea
- dry mouth
If you develop a rash or swelling around your face or neck, or shortness of breath, it may indicate that you are allergic to sucralfate. If this happens, you should stop taking the medication and contact your treatment team as soon as possible.
If your mouth is sore because of radiotherapy or chemotherapy , you may need to change your eating habits. The following tips may help you to avoid making your symptoms worse:
- eat moist or soft food because dry food may scratch your mouth
- eat plain food and avoid spicy flavours
- eat warm rather than hot food
If you are unable to eat or drink because of mucositis, you may need to be admitted to hospital so that you can receive nutrition in one of the following ways.
- with a nasogastric feeding tube: where a tube is inserted into your nose and down into your stomach
- with a gastrostomy: where a tube is inserted directly into your stomach
- intravenously: where a tube is inserted directly into a vein