Oral mucositis is an acute inflammation of the oral mucosa following systemic cancer therapy and/or radiotherapy. Diagnosis is typically based on clinical history and physical examination.
Clinical presentation varies from erythema to patchy or confluent ulceration with a superficial pseudomembranous membrane or, rarely, overt necrosis.
If severe, may warrant an undesirable dose-reduction and/or a break in cancer therapy.
Lesions are often very painful. Treatment is symptomatic and includes oral hygiene and pain control.
Preventive treatments include palifermin (during hematopoietic stem cell transplantation), low-level laser therapy, and use of ice-chips during chemotherapy infusion therapy.
Oral mucositis secondary to cancer therapy is an acute inflammation of the oral mucosa in response to systemic oncology therapy and/or radiation to fields involving the oral cavity. The clinical presentation ranges from a general erythematous oral mucosa to erosive lesions and overt ulceration. Lesions are often very painful, may compromise nutrition and oral hygiene, and can increase the risk of local and systemic infection. Furthermore, severe oral mucositis may necessitate an undesirable dose-reduction and/or a break in cancer therapy. Therefore, mucositis is a highly significant complication of cancer therapy, with a potential impact on patient prognosis.
History and exam
Key diagnostic factors
- presence of risk factors
- erythema or ulceration of oral mucosa
- oral pain
Other diagnostic factors
- dietary impairment
- intensive chemotherapy regimens
- radiotherapy to the oral cavity
- genetic polymorphisms in drug metabolic enzymes
1st investigations to order
- clinical diagnosis
Investigations to consider
- FBC and differential
- blood cultures
- superficial smear of lesion for microscopy
- fungal culture
- viral culture or polymerase chain reaction (PCR)
undergoing haematopoietic stem cell transplant: preventive measures
receiving bolus fluorouracil: preventive measures
receiving radiotherapy to oral cavity: preventive measures
established oral mucositis
- Oral candidiasis
- Herpes simplex virus infection
- Graft-versus-host disease
- Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation
- MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy
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