The chemotherapy treatment can be related to complications in the oral cavity, with a particularly negative impact on the quality of life of the person, since they interfere with fundamental activities such as eating and communicating, also causing invalidity.
The most frequent oral problem related to chemotherapy is mucositis (stomatitis), a condition corresponding to the appearance of strong inflammation and very painful lesions (mouth ulcers) in the mucous membranes of the mouth and throat, which can extend to the entire mucous membrane of the gastrointestinal apparatus. Mucositis may also develop during or after radiotherapy, especially when it is performed in the head-neck or chest district.
In 40% of cases, particularly in patients with acute myeloid leukaemia, oral mucositis is associated with oropharyngeal candidiasis: an infection of the mucous membranes of the mouth and throat caused by a fungus normally present harmlessly in the oral cavity, but which can become pathogenic and cause infections when the immune system weakens or in particular conditions. In most cases, the fungus Candida Albicans is the cause of oropharyngeal infections associated with mucositis while, more rarely, different microorganisms such as Candida tropicalis, Candida parapsilosis or of the genus Aspergillus may be involved.
Mucositis always involves damage to the mucous membrane of the oral cavity. Patients with invalidating mucositis are those who have undergone immunosuppressive therapy (myeloablative treatment), to prepare for the blood stem cell transplantation (hematopoietic).
The extent and severity of mucositis depend on the oncological therapy the patient is undergoing, but also on individual factors such as: age, sex, ethnicity, systemic impairment, level of oral hygiene, mucosal characteristics, nutritional status, type of neoplasia , drug-induced oral dryness, previous damage to the oral cavity, smoking and genetic predisposition.
In 50% of patients with mucositis, lesions significantly compromise quality of life and predispose them to subsequent infections from fungi, viruses and bacteria.
The first sign of mucositis is the redness (erythema) of the mucous membranes that can affect any area of the mouth, but which is often localized at the level of the internal surfaces of the cheeks and lips, soft palate, lateral and inferior surface of the tongue and floor of the mouth.
Stomatitis is manifested by an initial burning or tingling sensation at the oral level, followed by the onset of pain that can limit the intake of food and liquids, with the consequent need to follow a liquid diet or even switch to parenteral or enteral nutrition (intravenously or with gastric or duodenal probes).
The mucositis becomes clinically evident 4-5 days after the infusion of the chemotherapy drug and, generally, it has a peak after 7-14 days, with the appearance of the ulcers.
The diagnosis of mucositis is made on the basis of the symptoms and alterations of the mucosa found during the evaluation of the oral cavity.
The World Health Organization (WHO) has identified 5 levels of mucositis severity, indicated by numbers from 0 to 4.
Grade 0: no sign or symptom
Grade 1: presence of redness and / or irritation (slight discomfort)
Grade 2: erythema and mild ulcerations; the patient is still able to eat solid food
Grade 3: widespread ulceration and redness; the patient cannot swallow solid food (liquid diet)
Grade 4: extensive and painful ulceration; the patient cannot feed himself orally
In most patients, mucositis resolves spontaneously within three weeks after the end of chemotherapy, but in the most severe cases, the symptoms persist longer, with highly negative effects on the well-being and quality of life of the person concerned, hindering for years a complete physical recovery after cancer has been cured.
The treatment of mucositis is aimed at reducing symptoms and allowing easier feeding by mouth.
The first intervention useful to alleviate mucositis is good daily oral hygiene, associated with rinsing with disinfectant solutions in case of lesions.
For pain control, there are solutions containing anti-inflammatory or anaesthetic principles to be used for rinsing the entire mouth and gel formulations to be applied locally, directly on the ulcers, to protect them and limit discomfort and burning.
If the pain is very severe, the doctor can also prescribe a systemic analgesic therapy, based on anti-inflammatory or opiate drugs.
Oral candidiasis is an infection of the mouth, caused mainly by the fungus Candida albicans, which is very common in patients with immune systems weakened by chemotherapy or immunosuppressive therapy.
The typical symptom of oropharyngeal candidiasis is represented by the formation on the mucosa of the oral cavity, including the tongue, of white and painful plaques associated with:
The doctor or dentist can easily diagnose oral candidiasis by examining the inside of the mouth and finding redness and the characteristic whitish plaques. In some cases, to confirm the diagnosis and proceed with the appropriate therapy, it may be necessary to carry out a biopsy, i.e. the removal of a fragment from the plaques to verify the presence of fungi of the genus Candida under the microscope.
The treatment of oral candidiasis is based on the use of antifungal drugs that specifically counteract the growth and multiplication of fungi (mycetes).
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