Materiały źródłowe

• #1 Oral mucositis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/1135

  Oral mucositis (OM) is an acute inflammation of the oral mucosa following systemic cancer therapy, particularly chemotherapy, and/or radiation therapy. Diagnosis is typically based on clinical history and physical exam. […] The clinical presentation ranges from a general erythematous oral mucosa to erosive lesions and, rarely, overt necrosis. […] Severe OM may necessitate an undesirable dose-reduction and/or a break in cancer therapy, thereby potentially impacting patient prognosis. […] Key diagnostic factors include history of intensive chemotherapy regimens, history of radiation therapy to the oral cavity, history of chemoradiation, erythema and/or ulceration of oral mucosa, and oral pain. […] Diagnostic tests include clinical diagnosis and tests to consider such as CBC with differential, blood cultures, superficial smear of lesion for microscopy, fungal culture, and viral culture or polymerase chain reaction (PCR).

• #1 Mucositis: Symptoms, causes, complications and treatment

  https://www.medicalnewstoday.com/articles/mucositis

  Symptoms of mucositis are often clear in the early stages of cancer treatment. A doctor may be able to diagnose mucositis as early as 12 weeks after radiation therapy or within 3 days of chemotherapy. […] First, the doctor will assess the persons symptoms and medical history. They will then ask about past or ongoing cancer treatment and examine the affected area. They may, for example, look for sores and swelling in the mouth.

• #1 FF #121 Oral Mucositis: Diagnosis and Assessment | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/oral-mucositis-diagnosis-and-assessment/

  FF #121 Oral Mucositis: Diagnosis and Assessment […] Background The term mucositis refers to the inflammatory response of the oral-pharyngeal mucosa typically resulting from systemic cancer therapy (e.g., chemotherapy) or from radiotherapy that includes the oral-pharyngeal mucosa within the radiation field. […] This Fast Fact discusses the diagnosis and assessment of mucositis; Fast Fact #130 discusses its prevention and treatment; Fast Fact #450 discusses multimodal strategies for cancer-related mucositis, and Fast Fact #430 provides pearls on the oral examination. […] Assessment A thorough assessment of the patient with mucositis should include: […] Complete oral examination: assessment for local fungal (see Fast Fact #147), bacterial, or viral infections.

• #1 Mucositis – diagnosis and treatment | NHSGGC

  https://clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-paediatric-guidelines/haematologyoncology/mucositis-diagnosis-and-treatment/

  The patients mouth should be regularly examined by a nurse/doctor/dentist using the otoscope/torch as part of routine assessment to observe any changes ie inflammation, ulcerated areas and candida plaques using the scoring chart below (see Appendix 1). External changes ie sore or vesicles on the lips should also be noted and bacterial/viral swabs taken where necessary. […] All findings (ie affected area, grading, pain scale) should be documented in the casenotes. […] Swabs should be sent for microscopy and bacterial and viral culture as appropriate. […] Appropriate pain control is recommended together with the continuation of good oral hygiene, as tolerated. The patient’s pain should be assessed using the assessment tool in Appendix 3. […] Recommendations for the Treatment of Oral Mucositis: Appropriate pain control is recommended together with the continuation of good oral hygiene, as tolerated. […] Pain associated with mucositis can be severe. Opiates are required for the control of such pain. […] Parents and patients should be informed for the importance of keeping the mouth clean and encouraged to practice good, basic oral hygiene.

• #1 Chemotherapy-Induced Oral Mucositis Workup: Approach Considerations, Histologic Findings

  https://emedicine.medscape.com/article/1079570-workup

  Diagnosis is primarily based on the clinical findings and the chronology of the development of lesions. […] There are no routine hematologic or blood chemistry laboratory investigations needed in the workup of a patient with chemotherapy-induced oral mucositis. […] Cultures (particularly for herpetic infection) should be performed if erythema and ulcers (or vesicles) are located on the keratinized tissues of the hard palate, the attached gingiva, or the dorsum of the tongue or if lesions persist after the period of profound neutropenia has passed. […] Particularly in hematopoietic cell transplantation (HCT) patients, biopsy is indicated if a deep fungal infection is suspected. […] There is no indication for ordering imaging studies in a patient with suspected chemotherapy-induced oral mucositis. […] Oral mucositis should be assessed routinely using a validated instrument. […] Of note, symptoms may precede objective findings by 1-3 days and therefore can serve as an important prognostic indicator.

• #1 Oral Mucositis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19378

  Oral mucositis is a frequent complication in patients receiving radiation therapy (RT) to the head and neck, chemotherapy for solid tumors or lymphoma, and high-dose myeloablative chemotherapy prior to hematopoietic cell transplantation. The incidence of oral mucositis varies amongst the different chemotherapy agents. Chemotherapeutic agents that affect DNA synthesis (S-phase), e.g., 5-fluorouracil, methotrexate, and cytarabine, have a high incidence of oral mucositis. […] The severity of mucositis is measured on a well-defined scale, and several different scales have been developed. […] Evaluating for oral mucositis is dependent upon clinical history and physical exam findings. Laboratory and radiography are not as helpful. If ulcers are present on the hard palate, attached gingiva, or tongue dorsum, cultures should be obtained to rule out viral or fungal etiology.

• #1 Mucositis – Wikipedia

  https://en.wikipedia.org/wiki/Mucositis

  Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer. […] Diagnosis is based on the symptoms the patient is experiencing and the appearance of the tissues of the mouth following chemotherapy, bone marrow transplants or radiotherapy. Red burn-like sores or ulcers throughout the mouth is enough to diagnose mucositis. […] The severity of oral mucositis can be evaluated using several different assessment tools. Two of the most commonly used are the World Health Organization (WHO) Oral Toxicity score and the National Cancer Institute Common Toxicity Criteria (NCI-CTC) for Oral Mucositis. […] Another scale developed in 1999, the Oral Mucositis Assessment Scale (OMAS) has been shown to be highly reproducible between observers, responsive over time, and accurate in recording symptoms associated with mucositis. The OMAS provides an objective assessment of oral mucositis based on assessment of the appearance and extent of redness and ulceration in various areas of the mouth.

• #1 Oral Mucositis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK565848/

  Oral mucositis is a severely debilitating condition characterized by erythema, edema, and ulcerations of the oral mucosa. It is a complication of radiation therapy (RT) to the head and neck, chemotherapy, chemoradiotherapy, and hematopoeitic stem cell transplantation (HSCT). […] This activity reviews the etiology, pathophysiology, history and physical, evaluation, and treatment of oral mucositis. […] Evaluating for oral mucositis is dependent upon clinical history and physical exam findings. Laboratory and radiography are not as helpful. If ulcers are present on the hard palate, attached gingiva, or tongue dorsum, cultures should be obtained to rule out viral or fungal etiology. […] The severity of mucositis is measured on a well-defined scale, and several different scales have been developed. […] The CTAE was developed by the National Cancer Institute (NCI) and is rated from 1 to 5. This scale is divided into two parts: a clinical exam and a functional/symptoms-based exam.

• #1 Oral Mucositis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK565848/

  The Oral Mucositis Assessment Scale (OMAS) is an objective scale that measures erythema and ulceration at nine sites within the oral cavity. A multi-center trial showed that this scale has high interobserver reproducibility and a strong correlation between the OMAS score and patient symptoms. […] Clinicians employ various options to manage oral mucositis in the setting of cancer therapy. […] Basic oral care (BOC) is suggested by the 2020 Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO) clinical guidelines for managing oral mucositis secondary to cancer therapy. […] Patients must be informed regarding the signs and symptoms of oral mucositis before starting chemotherapy or radiotherapy carrying oral mucositis risk, as early diagnosis and intervention will improve outcomes. […] The treating clinician should also refer patients at risk of oral mucositis to a dentist for a complete oral examination before starting cancer treatment.

• #1 Oral Mucositis | Causes | Symptoms | Diagnosis | Treatment

  https://www.icliniq.com/articles/dental-oral-health/oral-mucositis

  A universal complication that most cancer patients encounter during treatment is oral mucositis. […] Oral mucositis is an inflammation in the mucosa lining the mouth, presenting as redness, swelling, bleeding, and ulcers in the mouth, tongue, and throat. […] The severity of mucositis varies with the treatment type (chemotherapy or radiotherapy), the type of drug used in chemotherapy, the number of treatment cycles, the dosage of drug intake, and individual susceptibility. […] Various scales are used to grade mucositis based on its severity. World Health Organization (WHO) grading scale for oral mucositis is the simplest, and the grading goes as follows; […] The other standard grading scales include – The Eastern Cooperative Oncology Group (ECOG) scale, Radiation Therapy Oncology Group (RTOG) scale, National Cancer Institute Common Toxicity Criteria (NCI-CTC). […] Oral mucositis is a common and often painful complication of cancer treatment, particularly chemotherapy and radiation therapy. […] Early detection and proactive management are essential to minimize the impact of oral mucositis on patients’ quality of life during cancer therapy.

• #1 Chemotherapy-Induced Oral Mucositis Differential Diagnoses

  https://emedicine.medscape.com/article/1079570-differential

  Overall, candidiasis is the most frequent oral infection in patients who are myelosuppressed; recurrent herpes simplex virus (HSV)1 infection is the most frequent oral viral infection in these patients. […] HSV infection should be suspected when ulcers are noted extraorally on the lips and intraorally on keratinized sites (ie, tongue dorsum, gingiva, and hard palate); in immunocompromised patients, HSV may reactivate in nonkeratinized sites, and, in some cases, this can occur despite antiviral prophylaxis. […] A high index of suspicion of secondary or concomitant infection in lesions of oral mucositis is imperative. Cultures should be obtained to rule out such infections. Effective antimicrobial treatments are available for herpetic, fungal, and secondary bacterial infections. The failure to make the diagnosis and, therefore, to treat such conditions may lead to dissemination of infection or unnecessary and prolonged pain and suffering.

• #1 Biomarkers and non-invasive tests for gastrointestinal mucositis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5527064/

  Gastrointestinal mucositis is a complex inflammatory reaction of the mucous membranes, a side effect of both chemotherapy and radiotherapy. Currently, assessment scales are used to diagnose mucositis. However, a biomarker which would determine whether there is mucositis and thereby establish the severity objectively would be very useful. […] The estimation of the incidence is such a broad range, since there is no gold standard for diagnosis and assessment of the severity of mucositis. […] Therefore, clinical practice is in need of a test to diagnose and assess the severity of mucositis. An optimal test to diagnose mucositis and establish the severity will give the opportunity to evaluate studies, to determine risk factors and incidence, and if used in all studies, it will make it possible to compare them. Moreover, this optimal test will potentially improve management in for example prophylactic antibiotic use, or diet changes for nutritional support.

• #1 Biomarkers and non-invasive tests for gastrointestinal mucositis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5527064/

  Therefore, a biomarker which would determine whether there is mucositis and thereby establish the severity objectively would be very useful. […] In this review, we give an update including new studies from recent years concerning potential biomarkers in blood samples and fecal samples, and potential tests in breath samples and urine samples. […] In respect to mucositis, a biomarker should diagnose mucositis and should determine the severity of mucositis. […] To evaluate the usefulness of a biomarker or test in the diagnosis of a disease, three aspects should be included. First, the validity of the biomarker or test shows if the result matches the severity of the disease and whether it classifies the patient correctly. Second, the diagnostic accuracy determines the chance that a patient with a positive test or biomarker has the disease, and the chance that a patient with a normal biomarker of test has the disease. Finally, the applicability values if the biomarker or test is feasible and cost effective in the specific patient group.

• #1 Biomarkers and non-invasive tests for gastrointestinal mucositis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5527064/

  We conclude that citrulline is a biomarker of mucositis, based on the abovementioned definition. It correlates with the severity of mucositis and is sequentially detectable; therefore, the applicability and validity of citrulline seems good. However, we cannot draw any conclusions about the diagnostic accuracy, because more research is needed to answer these questions. […] In contrast, the markers I-FABP and I-BABP in blood samples are indeed potentially interesting biomarkers since they are released by dying mature enterocytes; therefore, I-FABP and I-BABP are potential markers of enterocyte loss in the small intestine. However, the determination of these markers is probably critically time dependent and only of value in combination with another biomarker like citrulline for example, but further research is needed.

• #1 Oral mucositis: the hidden side of cancer therapy | Journal of Experimental & Clinical Cancer Research | Full Text

  https://jeccr.biomedcentral.com/articles/10.1186/s13046-020-01715-7

  However, these aspects may not be enough, the main bias, indeed, is that none of them is a specific marker that characterizes mucositis process. They are, indeed, produced as consequence of different stresses. That aspect could compromise their feasibility as mucositis biomarkers. During antineoplastic treatment, the whole organism undergoes to several stresses that could either hide or mimic mucositis process. It could be helpful to find a marker that specifically identifies mucositis process development. Non-coding RNAs have been found to be more lineage-specific than protein coding genes, unveiling how their different expression might specifically determine cell phenotype. Accordingly, this may not be foolish the research of non-coding RNAs that are specifically involved in mucositis process, whose assessment could be used as mucositis biomarker.

• #1 Pretherapeutic Plasma Pro- and Anti- Inflammatory Mediators Are Related to High Risk of Oral Mucositis in Pediatric Patients with Acute Leukemia: A Prospective Cohort Study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0064918

  This prospective study evaluated clinical risk indicators as well as pro- and anti- inflammatory mediators at the time of malignancy diagnosis in relation to chemotherapy-related oral mucositis in pediatric population. […] The results imply that pretherapeutic high levels of inflammatory cytokines and low levels of pro-LL-37 in plasma might contribute to the high incidence of oral mucositis in patients with acute leukemia. […] Early identification of the patients with high risk of oral mucositis and understanding the predispositions are of clinical importance. […] In the current study, we showed that at the time of malignancy diagnosis, patients with acute leukemia, who had the highest risk of oral mucositis, showed high concentrations of both pro- and anti- inflammatory cytokines and low levels of pro-LL-37 in the plasma.

• #1 Markers of intestinal mucositis to predict blood stream infections at the onset of fever during treatment for childhood acute leukemia | Leukemia

  https://www.nature.com/articles/s41375-023-02077-7

  Despite chemotherapy-induced intestinal mucositis being a main risk factor for blood stream infections (BSIs), no studies have investigated mucositis severity to predict BSI at fever onset during acute leukemia treatment. […] These findings underline the importance of disrupted intestinal integrity as a main risk factor for BSI and suggest that objective markers for monitoring mucositis severity may help predicting BSI at fever onset. […] Gastrointestinal mucositis constitutes a main risk factor for BSI due to translocation of bacteria through the disrupted epithelial barrier as supported by studies in patients undergoing hematopoietic stem cell transplantation. […] However, studies in this patient population are sparse and to date, no studies have evaluated mucositis severity at the onset of fever.

• #1 Oral mucositis: the hidden side of cancer therapy | Journal of Experimental & Clinical Cancer Research | Full Text

  https://jeccr.biomedcentral.com/articles/10.1186/s13046-020-01715-7

  Despite the expression levels of some proteins involved in the inflammation response, such as TNF-α or IL-1β, partially correlate with mucositis process, their presence does not exclude others mucositis-independent inflammation events. This strongly suggests the need to discover biomarkers that specifically feature mucositis process development. Non-coding RNAs might hold this potential. […] The opportunity to stratify cancer patients according to their risk to develop mucositis, as well as the possibility to identify mucositis development and its severity in an early phase represents an unmet need for researchers and clinicians. Identification of a standardized biomarker for mucositis assessment and/or early diagnosis might allow, indeed, a precision management of patient, thus reducing hospitalization, therapy termination and dosage re-modulation; ultimately reducing patient management cost.

• #1 Oral mucositis: the hidden side of cancer therapy | Journal of Experimental & Clinical Cancer Research | Full Text

  https://jeccr.biomedcentral.com/articles/10.1186/s13046-020-01715-7

  Inflammation response of epithelial mucosa to chemo- radiotherapy cytotoxic effects leads to mucositis, a painful side effect of antineoplastic treatments. About 40% of the patients treated with chemotherapy develop mucositis; this percentage rises to about 90% for head and neck cancer patients (HNC) treated with both chemo- and radiotherapy. […] Currently, several interventions and prevention guidelines are available, but their effectiveness is uncertain. This review comprehensively describes mucositis, debating the impact of standard chemo-radiotherapy and targeted therapy on mucositis development and pointing out the limits and the benefits of current mucositis treatment strategies and assessment guidelines. Moreover, the review critically examines the feasibility of the existing biomarkers to predict patient risk of developing oral mucositis and their role in early diagnosis.

• #1 Oral Mucositis: Update on Prevention and Management Strategies

  https://www.uspharmacist.com/article/oral-mucositis-update-on-prevention-and-management-strategies-12403

  Oral mucositis (OM) is one of the most commonly occurring adverse effects in patients with head-and-neck cancer receiving chemotherapy (CT) and radiotherapy (RT). […] Managing OM relies on the use of valid assessment scales, supportive care, symptom relief, and patient education. […] The severity of OM depends on various factors, including the anticancer treatment protocol, the patients age and diagnosis, the level of oral hygiene during therapy, and genetic factors. […] Patient-related factors such as age, gender, genetic factors (increased proinflammatory cytokine expression), preexisting poor oral hygiene, periodontal disease, nutritional status, RT- or drug-induced xerostomia, impaired salivary function, myelosuppression, tobacco use, and alcohol consumption have a major influence on the development, severity, and duration of OM.

• #1 Oral Mucositis: Update on Prevention and Management Strategies

  https://www.uspharmacist.com/article/oral-mucositis-update-on-prevention-and-management-strategies-12403

  Treatment-related risk factors that increase the probability of developing OM are the type of CT agent (dose and schedule) and type of RT (location, dose, schedule, concomitant CT). […] The most commonly used assessment scales for OM are summarized in TABLE 3. […] The severity of the condition is graded from 0 (no OM) to 4 (alimentation not possible; patient needs TPN). […] Cryotherapy is an inexpensive, readily available therapy that has been utilized for the prevention of OM in cancer patients. […] Palifermin (Kepivance), which was FDA-approved in 2004 for the management of OM, is a human recombinant keratinocyte growth factor that stimulates the development of cells on the surface of the gastrointestinal tract. […] Chlorhexidine, an oral broad-spectrum antibiotic rinse, is not recommended by the National Comprehensive Cancer Network (NCCN) for prevention of OM in patients with solid tumors of the head and neck who are undergoing RT. […] In January 2008, the NCCN updated its guidelines for the prevention and treatment of OM.

• #1 Mucositis in Cancer Patients: A Review

  https://www.uspharmacist.com/article/mucositis-in-cancer-patients-a-review

  Mucositis—the breakdown of epithelial cells in the gastrointestinal tract—is a common and painful side effect of treatment for many cancer patients. […] The diagnosis of mucositis is generally based on clinical findings. After a diagnosis has been made, two main grading scales are used by clinicians to assess severity: the World Health Organization’s (WHO) Oral Toxicity Scale and the National Cancer Institute’s (NCI) Common Toxicity Criteria. […] While mucositis is common, it is widely asserted that its true incidence in cancer patients is underreported. Mucositis of any degree is estimated to occur in approximately 40% of patients undergoing chemotherapy. […] The MASCC/ISOO guidelines also suggest the use of palifermin in this specific patient population. […] The main focus of mucositis treatment, however, should be adequate pain control and palliation of symptoms. […] If topical therapies fail, systemic analgesia should be added. The MASCC/ISOO guidelines specify the use of fentanyl and morphine for mucositis pain. […] The NCCN adds that, in order to facilitate maximum pain control, medications should be scheduled rather than administered as needed.

• #1 Oral toxicity associated with systemic anticancer therapy – UpToDate

  https://www.uptodate.com/contents/oral-toxicity-associated-with-systemic-anticancer-therapy

  Oral complications resulting from systemic anticancer therapy include mucositis, saliva changes, taste alterations, infection, and gingival bleeding. All of these complications can cause pain and/or impair nutrition. […] Mucositis, which reflects a short-term, self-limited adverse effect of treatment, can affect the entire alimentary tract. The range of symptoms includes oral ulcerations, dysphagia and odynophagia, esophagitis, gastritis, diarrhea, and malabsorption. […] Oral mucositis affects on average 20 to 40 percent of patients receiving conventional-dose cytotoxic chemotherapy. The frequency is higher (up to 80 percent) in those undergoing hematopoietic cell transplantation (HCT), particularly myeloablative allogeneic HCT, and in those who are prepared with radiation-containing regimens and with the use of methotrexate for graft-versus-host disease prophylaxis. […] The pathobiology underlying damage to the oral mucosal barrier is complex, and a series of stages has been described in patients treated with conventional cytotoxic chemotherapy agents.

• #1 Hina Khan reveals mucositis diagnosis amid chemotherapy: Experts decode relief measures to alleviate symptoms – Hindustan Times

  https://www.hindustantimes.com/htcity/wellness/hina-khans-mucositis-diagnosis-amid-breast-cancer-chemotherapy-expert-opinions-on-pain-management-and-nutrition-101725612781548.html

  Hina Khan reveals being diagnosed with mucositis: What does symptom and pain management look like? […] The most recent development in this regard has been her mucositis diagnosis. In a social media post, Hina reached out to her followers, revealing that she is also contending with mucositis, „another side effect of chemotherapy”. […] As per a Cleveland Clinic report, mucositis is the „inflammation of the mucosa, the mucous membranes that line your mouth and your entire gastrointestinal tract”. […] The report also asserts that mucositis is a near-given side effect to deal with for those undergoing chemotherapy, affecting almost 50% of the demographic. […] Mucositis also impacts 80% to 100% of people receiving local or whole-body radiation therapy or stem cell transplants. […] Dr. Indu Bansal Aggarwal, Group Director And HOD of Radiation Oncology at Paras Health, Gurugram breaks it down for the layman. She explains, „Mucositis occurs when the rapid cell turnover in the mucous membranes is disrupted. Treatments like chemotherapy and radiation target fast-growing cancer cells, but they also affect healthy cells in the mouth and gastrointestinal tract. This leads to the breakdown of the mucous membranes”.

• #1 What is mucositis? 4 things to know about this cancer treatment side effect | MD Anderson Cancer Center

  https://www.mdanderson.org/cancerwise/what-is-mucositis–4-things-to-know-about-this-cancer-treatment-side-effect.h00-159774078.html

  Mucositis is a disruption in the mucosal lining of the gastrointestinal tract that causes inflammation. It is often accompanied by symptoms such as sores and ulcers in the mouth and throat. […] Mucositis is a common side effect of cancer treatment, but it is treatable. […] Mucositis can be caused by the following cancer treatments: Chemotherapy, Radiation therapy, Certain targeted therapy drugs, Stem cell transplants, which are used to treat blood cancers like leukemia and lymphoma. […] When we treat mucositis, our goal is to relieve the symptoms. This often includes practicing good oral hygiene. […] Let your doctor know if treatment is not helping your symptoms. They can make adjustments to the treatment, so that you’re able to get some relief. […] Typically, mucositis symptoms begin a few days after chemotherapy treatment. Symptoms may take a week or longer to start after radiation therapy. […] The good news is that mucositis does not last forever. Symptoms typically go away and your body heals after cancer treatment is completed. This usually happens anywhere from one to about six weeks after your last treatment.

• #1 Hina Khan reveals mucositis diagnosis amid chemotherapy: Experts decode relief measures to alleviate symptoms – Hindustan Times

  https://www.hindustantimes.com/htcity/wellness/hina-khans-mucositis-diagnosis-amid-breast-cancer-chemotherapy-expert-opinions-on-pain-management-and-nutrition-101725612781548.html

  Dr. Aggarwal lists good oral hygiene, cold therapy and rinses as potential lifestyle tweaks to incorporate. […] Regular, gentle brushing and the use of non-alcoholic mouthwashes can help prevent infection and promote healing. […] Staying hydrated can reduce discomfort and prevent dryness. […] Saline or baking soda rinses can soothe the mouth and promote healing. […] She concludes saying, These approaches can provide comfort while the mucosa heals, though a doctors guidance is essential for managing the condition effectively.

• #1 Mucositis: causes and treatment | CURAPROX

  https://curaprox.us/blog/post/treating-and-preventing-mucositis?srsltid=AfmBOoobi34mH5tyClAXszGKCBqaCFJWXRT8wlljGqdZN_yUkKrTeGQn

  Mucositis (or: mucositis) is when the mucous membranes become acutely inflamed. This often occurs in the oral cavity (oral mucositis), especially in cancer patients. […] Oral mucositis is often incorrectly labelled as stomatitis. However, this is incorrect. Oral mucositis is an acute inflammation of the mucous membranes that is mainly caused by chemotherapy and radiotherapy. […] If you google „oral mucositis” on the internet, you will find many images. However, the appearance of mucositis is not uniform – it depends on how advanced the inflammation is, for example. Ultimately, only a doctor can make a reliable diagnosis. […] Unfortunately, the treatment options for mucositis are limited. Here we show you how it can be treated – primarily symptomatically. […] As we already know, cancer patients in particular are at risk of developing oral mucositis. As the treatment options are clear, prevention is the best protection. This is especially true for cancer patients. […] Low-level laser therapy (LLLT) is recognised and proven to be effective in the prevention of radiogenic mucositis.

• #1 Mucositis explained | Blood Cancer UK

  https://bloodcancer.org.uk/understanding-blood-cancer/treatment/side-effects/mucositis/mucositis-explained/

  Mucositis is a condition which affects the gastrointestinal tract in your digestive system. The gastrointestinal, or GI, tract is a long tube that runs from your mouth to your anus. It includes your mouth, oesophagus (food pipe), stomach and bowels. […] Mucositis causes the lining of your GI tract to become thin, making it sore and causing ulcers. This can happen after chemotherapy or radiotherapy. Its painful, but it can be treated and gets better with time. […] Mucositis happens when cancer treatments kill healthy cells in the GI tract. The lining of the GI tract gets thinner and becomes inflamed (sore and swollen). […] The chance of getting oral or GI mucositis varies depending on the type of treatment you have and how intensive (concentrated) it is. Your genes and your general health also affect your likelihood of getting mucositis. Generally, mucositis affects: one or two out of five people (2040%) who have standard chemotherapy; four out of five people (80%) who have high-dose chemotherapy before a stem cell transplant, with or without total body irradiation (TBI). […] Mucositis may be less severe if its picked up early, so do tell your healthcare team if you have symptoms. There are also treatments and self-care strategies which can reduce the risk of getting mucositis and help with the symptoms.

• #1 Patients and Mucositis – Mucosamin

  https://mucosamin.com/patient-mucositis/

  Patients receiving high-dose chemotherapy or radiotherapy will commonly receive regular assessments for mucositis until their risk of developing the condition has passed. […] Healthcare professionals use a grading system to determine how serious the symptoms of OM are. There are several grading systems available, including systems presented by the World Health Organization Oral Toxicity Scale (WHO OTS).

• #1 Patients and Mucositis – Mucosamin

  https://mucosamin.com/patient-mucositis/

  Mucositis is an acute inflammatory and ulcerative complication of the mucosal membrane that commonly occurs during cancer therapy. It is one of the more significant side-effects of cancer treatment. It can result from systemic chemotherapy, from radiation therapy, or a combination of the two. […] The primary morbidity of OM is the intense pain, which is usually associated with ulcerative lesions. It can also cause dysphagia and impairment of the ability to talk, eat and swallow. […] Chemotherapy-induced OM is regarded as an acute condition, with ulceration normally occurring 1-2 weeks after treatment, and resolving within 3 weeks of treatment. Radiotherapy-induced OM normally occurs around 2 weeks into a 7-week treatment cycle, and resolves 3-4 weeks after treatment has ended. […] Oral Mucositis is usually diagnosed with a description of symptoms and a physical examination. Diagnosis is based on the clinical appearance, location, timing of oral lesions, and use of certain types of therapy known to be associated with OM.

• #1 Oral Mucositis: A Complication of Chemotherapy & Radiotherapy

  https://www.healthline.com/health/oral-mucositis

  Some kinds of chemotherapy and radiation treatments can cause oral mucositis. […] About 40 percent of people undergoing regular cancer therapy will get oral mucositis. Up to 75 percent of people with high-dose chemotherapy and up to 90 percent of people getting both chemotherapy and radiation treatments may get this condition. […] Oral mucositis from chemotherapy or radiation treatment can last from 7 to 98 days. Variables such as the type of therapy and therapy frequency have an impact on oral mucositis symptoms, intensity, and length of time. […] After therapy is completed, sores from mucositis typically heal in two to four weeks. […] Your doctor may recommend one or a combination of several treatments for oral mucositis. […] Magic mouthwash is one prescription treatment that might be mixed by a pharmacist on-site with medications that address different aspects of the condition.

• #1 Patients and Mucositis – Mucosamin

  https://mucosamin.com/patients-mucositis/

  Mucositis is an acute inflammatory and ulcerative complication of the mucosal membrane that commonly occurs during cancer therapy. It is one of the more significant side-effects of cancer treatment. The oral cavity is the most common location for mucositis. Oral Mucositis is usually diagnosed with a description of symptoms and a physical examination. Diagnosis is based on the clinical appearance, location, timing of oral lesions, and use of certain types of therapy known to be associated with OM. Patients receiving high-dose chemotherapy or radiotherapy will commonly receive regular assessments for mucositis until their risk of developing the condition has passed. Healthcare professionals use a grading system to determine how serious the symptoms of OM are. There are several grading systems available, including systems presented by the World Health Organization Oral Toxicity Scale (WHO OTS). […] Oral mucositis can cause pain, restrict oral intake, act as a portal of entry for organisms, contribute to interruption of therapy, increase the use of antibiotics and narcotics, increase the length of hospitalization, and increase the overall cost of treatment.

• #1 Hina Khan reveals mucositis diagnosis amid chemotherapy: Experts decode relief measures to alleviate symptoms – Hindustan Times

  https://www.hindustantimes.com/htcity/wellness/hina-khans-mucositis-diagnosis-amid-breast-cancer-chemotherapy-expert-opinions-on-pain-management-and-nutrition-101725612781548.html

  Mucositis can cause significant discomfort, making it challenging to eat or swallow. […] To maintain proper nutrition, its essential to focus on small, frequent meals that are easy to consume. […] Additionally, incorporating high-calorie liquids and ensuring hydration with electrolyte-rich fluids can help maintain energy levels and prevent dehydration. […] Consultation with a dietitian to develop a personalized plan based on individual needs is highly recommended. […] For individuals with mucositis, it’s best to focus on soft, bland, and non-irritating foods that are easier to swallow and wont further aggravate the sensitive mucosal tissues. […] Now for the million dollar question. Is there a miracle food when it comes to dealing with this diagnosis? […] Ms. Bisht makes it clear that while no food in particular will actively aid one in reversing mucositis, certain foods with anti-inflammatory properties may go a long way in bringing some relief to the patient.

• #1 Hina Khan asks fans for 'useful remedies’ as she battles a side effect of chemotherapy

  https://indianexpress.com/article/lifestyle/health/hina-khan-breast-cancer-mucositis-chemotherapy-understand-the-issue-9553350/

  Dr Thakuria adds that mucositis occurs as a result of damage to the rapidly dividing cells that make up the mucosal lining. Chemotherapy, which targets fast-growing cancer cells, also affects the healthy cells in the mucous membranes, compromising their integrity. […] Mucositis presents several complications that can significantly affect a patient’s well-being. Pain is one of the most debilitating symptoms, often making it difficult to eat or swallow, which can lead to malnutrition and dehydration, Dr Thakuria says. […] The open ulcers created by mucositis increase the risk of bacterial infections, potentially leading to systemic infections that could require hospitalisation. […] If mucositis becomes severe, it can also result in treatment delays or reduced chemotherapy doses, which might compromise the effectiveness of cancer treatment.

• #1 Mucositis & Dry Mouth | Cancer Council NSW

  https://www.cancercouncil.com.au/cancer-information/managing-cancer-side-effects/mouth-health-and-cancer-treatment/mucositis-and-dry-mouth/

  Thick, sticky saliva or a dry mouth can make it harder to keep your teeth and mouth clean, which can increase the risk of tooth decay and mouth infections such as oral thrush. […] Dry mouth from radiation therapy to the head and neck area can last for many months after treatment. For some people, it can be permanent.

• #1 Mucositis | CCLG – The Children & Young People’s Cancer Association

  https://www.cclg.org.uk/information-professionals/outreach-information-resource/section-7-side-effects-and-supportive-care/mucositis

  Stomatitis is the term specifically used to describe inflammation of the mouth, however, it should be noted that both mucositis and stomatitis may be used interchangeably. Mucositis can make the tongue and inside of the mouth look pale and white and the tongue may have a scalloped appearance. On examination, patients may also have lip and / or mouth ulcers; therefore it is important to check all around the inside of the mouth, under the tongue, inside the cheeks and inside of lips when assessing toxicities. […] Following diagnosis, each patient will be reviewed by the dental team in their treatment centre to discuss a mouthcare plan, promote good oral hygiene and give advice on the importance of good dietary intake. […] Mucositis during cancer treatment cannot be avoided; however, in order to reduce the risk, good oral hygiene should be encouraged to keep the mouth clean, moist and free from infection. […] Taste alteration can result in a loss of appetite leading to reduced nutritional status. It is important that parents/carers are pre-warned this may happen so they can manage the situation, understanding that it is not the child or young person being fussy.

• #1 Biomarkers and non-invasive tests for gastrointestinal mucositis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5527064/

  In conclusion, mucositis is still challenging to diagnose, since the gold standard biopsy of the small intestine in not optional. Many different methods to establish the diagnosis and determine the severity of mucositis in both adult and pediatric clinical oncology settings are currently used. This makes any comparison about the diagnosis and thereby about the risk, the incidence, and the severity challenging. […] We are in need of a biomarker or test to be able to diagnose mucositis in the clinical setting and thereby determine the severity.

• #2 Oral mucositis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1135

  Oral mucositis (OM) is an acute inflammation of the oral mucosa following systemic cancer therapy, particularly chemotherapy, and/or radiotherapy. Diagnosis is typically based on clinical history and physical examination. […] The clinical presentation ranges from a general erythematous oral mucosa to erosive lesions and, rarely, overt necrosis. […] Severe OM may necessitate an undesirable dose-reduction and/or a break in cancer therapy, thereby potentially impacting patient prognosis. […] Key diagnostic factors include presence of risk factors, erythema and/or ulceration of oral mucosa, and oral pain. […] 1st investigations to order include clinical diagnosis.

• #2 Chemotherapy-Induced Oral Mucositis Workup: Approach Considerations, Histologic Findings

  https://emedicine.medscape.com/article/1079570-workup

  Diagnosis is primarily based on the clinical findings and the chronology of the development of lesions. […] There are no routine hematologic or blood chemistry laboratory investigations needed in the workup of a patient with chemotherapy-induced oral mucositis. […] Cultures (particularly for herpetic infection) should be performed if erythema and ulcers (or vesicles) are located on the keratinized tissues of the hard palate, the attached gingiva, or the dorsum of the tongue or if lesions persist after the period of profound neutropenia has passed. […] Particularly in hematopoietic cell transplantation (HCT) patients, biopsy is indicated if a deep fungal infection is suspected. […] There is no indication for ordering imaging studies in a patient with suspected chemotherapy-induced oral mucositis. […] Oral mucositis should be assessed routinely using a validated instrument. […] Of note, symptoms may precede objective findings by 1-3 days and therefore can serve as an important prognostic indicator.

• #2 Coding Oral Mucositis – A Painful Mouth Ulcer Condition

  https://www.outsourcestrategies.com/blog/documenting-and-coding-oral-mucositis-painful-mouth-ulcer-condition/

  Mucositis is a common condition that occurs when your mouth or gut becomes sore and inflamed. […] Oral mucositis is probably one of the most common and severe complications of cancer treatments. […] Diagnosis of the condition will be based on the timing of the symptoms relative to the therapy and the clinical appearance of the mouth. […] In most cases, a physician may be able to diagnose mucositis as early as 1–2 weeks after radiation therapy or within 3 days of chemotherapy. […] However, in some cases, a culture, or a scraping may be done to rule out the possible chances of an infection. […] Diagnosis and Treatment of Mucositis […] Treatment procedures administered by general physicians or other specialists must be documented using the right medical codes. […] ICD-10 diagnosis codes for oral mucositis include – K12.3 Oral mucositis (ulcerative). […] It is crucial for healthcare providers to remain updated about the associated ICD-10 codes to report oral mucositis correctly.

• #2 FF #121 Oral Mucositis: Diagnosis and Assessment – Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/oral-mucositis-diagnosis-and-assessment/?print=print

  Mucositis results from the destruction of rapidly dividing epithelial cells of the oral-pharyngeal mucosal epithelium and the secondary release of inflammatory mediators such as TNF-alpha and interleukin-1 beta. […] This Fast Fact discusses the diagnosis and assessment of mucositis; Fast Fact #130 discusses its prevention and treatment; Fast Fact #450 discusses multimodal strategies for cancer-related mucositis, and Fast Fact #430 provides pearls on the oral examination. […] A thorough assessment of the patient with mucositis should include: Pain assessment to include thorough review of analgesics used, effect and toxicities. Nutritional assessment. Quality of life assessment including screening for depression. Complete oral examination: assessment for local fungal, bacterial, or viral infections.

• #2 Chemotherapy-Induced Oral Mucositis Differential Diagnoses

  https://emedicine.medscape.com/article/1079570-differential

  Overall, candidiasis is the most frequent oral infection in patients who are myelosuppressed; recurrent herpes simplex virus (HSV)1 infection is the most frequent oral viral infection in these patients. […] HSV infection should be suspected when ulcers are noted extraorally on the lips and intraorally on keratinized sites (ie, tongue dorsum, gingiva, and hard palate); in immunocompromised patients, HSV may reactivate in nonkeratinized sites, and, in some cases, this can occur despite antiviral prophylaxis. […] A high index of suspicion of secondary or concomitant infection in lesions of oral mucositis is imperative. Cultures should be obtained to rule out such infections. Effective antimicrobial treatments are available for herpetic, fungal, and secondary bacterial infections. The failure to make the diagnosis and, therefore, to treat such conditions may lead to dissemination of infection or unnecessary and prolonged pain and suffering.

• #2 Oral Mucositis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19378

  The Oral Mucositis Assessment Scale (OMAS) is an objective scale that measures erythema and ulceration at nine sites within the oral cavity. A multi-center trial showed that this scale has high interobserver reproducibility and a strong correlation between the OMAS score and patient symptoms. […] The CTAE was developed by the National Cancer Institute (NCI) and is rated from 1 to 5. This scale is divided into two parts: a clinical exam and a functional/symptoms-based exam.

• #2 Oral Mucositis: Update on Prevention and Management Strategies

  https://www.uspharmacist.com/article/oral-mucositis-update-on-prevention-and-management-strategies-12403

  Treatment-related risk factors that increase the probability of developing OM are the type of CT agent (dose and schedule) and type of RT (location, dose, schedule, concomitant CT). […] The most commonly used assessment scales for OM are summarized in TABLE 3. […] The severity of the condition is graded from 0 (no OM) to 4 (alimentation not possible; patient needs TPN). […] Cryotherapy is an inexpensive, readily available therapy that has been utilized for the prevention of OM in cancer patients. […] Palifermin (Kepivance), which was FDA-approved in 2004 for the management of OM, is a human recombinant keratinocyte growth factor that stimulates the development of cells on the surface of the gastrointestinal tract. […] Chlorhexidine, an oral broad-spectrum antibiotic rinse, is not recommended by the National Comprehensive Cancer Network (NCCN) for prevention of OM in patients with solid tumors of the head and neck who are undergoing RT. […] In January 2008, the NCCN updated its guidelines for the prevention and treatment of OM.

• #2 Mucositis – European Association of Oral Medicine

  https://eaom.eu/education/eaom-handbook/mucositis/

  Mucositis is scored in four grades, I, II, III, and IV, for evaluation of treatment strategies and for communication purposes between oncologists. […] The diagnosis of grade I mucositis is based on the presence of asymptomatic mucosal erythema, evaluated on clinical grounds, and need no treatment. […] Grade II mucositis, with small foci of ulcers, is also diagnosed upon the clinical presentation, while it has to be differentiated from an early intraoral herpetic infection or from a superimposed candidosis. […] The most distressing grade III and IV mucositis is diagnosed upon its clinical presentation of superficial ulcerations covered by pseudomembranes, that are very painful to be rubbed off. […] Severe mucositis is important to be differentiated from the, often clinically identical, herpes simplex virus-1 reactivation and infection in neutropenic patients.

• #2 Biomarkers and non-invasive tests for gastrointestinal mucositis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5527064/

  Therefore, a biomarker which would determine whether there is mucositis and thereby establish the severity objectively would be very useful. […] In this review, we give an update including new studies from recent years concerning potential biomarkers in blood samples and fecal samples, and potential tests in breath samples and urine samples. […] In respect to mucositis, a biomarker should diagnose mucositis and should determine the severity of mucositis. […] To evaluate the usefulness of a biomarker or test in the diagnosis of a disease, three aspects should be included. First, the validity of the biomarker or test shows if the result matches the severity of the disease and whether it classifies the patient correctly. Second, the diagnostic accuracy determines the chance that a patient with a positive test or biomarker has the disease, and the chance that a patient with a normal biomarker of test has the disease. Finally, the applicability values if the biomarker or test is feasible and cost effective in the specific patient group.

• #2 Oral mucositis: the hidden side of cancer therapy | Journal of Experimental & Clinical Cancer Research | Full Text

  https://jeccr.biomedcentral.com/articles/10.1186/s13046-020-01715-7

  Despite the expression levels of some proteins involved in the inflammation response, such as TNF-α or IL-1β, partially correlate with mucositis process, their presence does not exclude others mucositis-independent inflammation events. This strongly suggests the need to discover biomarkers that specifically feature mucositis process development. Non-coding RNAs might hold this potential. […] The opportunity to stratify cancer patients according to their risk to develop mucositis, as well as the possibility to identify mucositis development and its severity in an early phase represents an unmet need for researchers and clinicians. Identification of a standardized biomarker for mucositis assessment and/or early diagnosis might allow, indeed, a precision management of patient, thus reducing hospitalization, therapy termination and dosage re-modulation; ultimately reducing patient management cost.

• #2

  https://link.springer.com/article/10.1186/s13046-020-01715-7

  However, these aspects may not be enough, the main bias, indeed, is that none of them is a specific marker that characterizes mucositis process. […] Non-coding RNAs have been found to be more lineage-specific than protein coding genes, unveiling how their different expression might specifically determine cell phenotype.

• #2 Pretherapeutic Plasma Pro- and Anti- Inflammatory Mediators Are Related to High Risk of Oral Mucositis in Pediatric Patients with Acute Leukemia: A Prospective Cohort Study | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0064918

  The higher concentrations of pretherapeutic inflammatory cytokines could reasonably be expected to contribute to the high risk of oral mucositis in patients with acute leukemia. […] Thus, a pretherapeutic low level of pro-LL-37 may render the oral mucosa more vulnerable to the destruction caused by commensal or pathological oral bacteria. […] In conclusion, the current study shows that at the time of malignancy diagnosis, patients with acute leukemia, who had highest risk of oral mucositis, presented high concentrations of inflammatory cytokines and low levels of pro-LL-37 in the plasma.

• #2 Markers of intestinal mucositis to predict blood stream infections at the onset of fever during treatment for childhood acute leukemia | Leukemia

  https://www.nature.com/articles/s41375-023-02077-7

  The aim of this study was to determine intestinal mucositis severity during febrile episodes based on the hypothesis that more severe intestinal mucositis constituted an increased risk of BSI and that objective markers of mucositis could serve as a diagnostic approach, regardless of the presence of neutropenia. […] We found significant differences in citrulline, REG3, and CCL20 in patients with BSI, indicating more severe intestinal mucositis in BSI-related fever episodes, emphasizing the serious implications of bacterial translocation through an injured intestinal epithelium. […] These results not only validate previous findings in both pediatric and adult patients with hematological cancer, suggesting that citrulline and CCL20 could be valuable in identifying individuals at higher risk of developing BSI during chemotherapy, but more importantly, they also propose that markers of mucositis can serve as predictive indicators for BSI when patients are admitted with fever. […] Our results further indicate that a dysregulated intestinal barrier is a significant risk factor for invasive infections and that monitoring intestinal mucositis by quantitative markers may serve as a potential diagnostic approach to detect BSI-related fever episodes.

• #2

  https://link.springer.com/article/10.1186/s13046-020-01715-7

  The World Health Organization (WHO) scale for oral mucositis (OM) evaluation accounts for objective criteria, such as the presence of either erythema or ulceration. […] The Eastern Cooperative Oncology Group (ECOG) mucositis scale is reported in the common toxicity criteria guide in which mucositis severity is differently classified based on the anatomic site of development. […] Similarly, the National Cancer Institute (NCI) provides in the Common Terminology Criteria for Adverse Event (CTCAE) mucositis severity measure scale based on anatomic site of development and on the kind of treatment, either chemo or radiotherapy. […] The opportunity to stratify cancer patients according to their risk to develop mucositis, as well as the possibility to identify mucositis development and its severity in an early phase represents an unmet need for researchers and clinicians.

• #2 Oral Mucositis: Update on Prevention and Management Strategies

  https://www.uspharmacist.com/article/oral-mucositis-update-on-prevention-and-management-strategies-12403

  Oral mucositis (OM) is one of the most commonly occurring adverse effects in patients with head-and-neck cancer receiving chemotherapy (CT) and radiotherapy (RT). […] Managing OM relies on the use of valid assessment scales, supportive care, symptom relief, and patient education. […] The severity of OM depends on various factors, including the anticancer treatment protocol, the patients age and diagnosis, the level of oral hygiene during therapy, and genetic factors. […] Patient-related factors such as age, gender, genetic factors (increased proinflammatory cytokine expression), preexisting poor oral hygiene, periodontal disease, nutritional status, RT- or drug-induced xerostomia, impaired salivary function, myelosuppression, tobacco use, and alcohol consumption have a major influence on the development, severity, and duration of OM.

• #2 Oral mucositis: the hidden side of cancer therapy | Journal of Experimental & Clinical Cancer Research | Full Text

  https://jeccr.biomedcentral.com/articles/10.1186/s13046-020-01715-7

  Inflammation response of epithelial mucosa to chemo- radiotherapy cytotoxic effects leads to mucositis, a painful side effect of antineoplastic treatments. About 40% of the patients treated with chemotherapy develop mucositis; this percentage rises to about 90% for head and neck cancer patients (HNC) treated with both chemo- and radiotherapy. […] Currently, several interventions and prevention guidelines are available, but their effectiveness is uncertain. This review comprehensively describes mucositis, debating the impact of standard chemo-radiotherapy and targeted therapy on mucositis development and pointing out the limits and the benefits of current mucositis treatment strategies and assessment guidelines. Moreover, the review critically examines the feasibility of the existing biomarkers to predict patient risk of developing oral mucositis and their role in early diagnosis.

• #2 Oral Mucositis: A Complication of Chemotherapy & Radiotherapy

  https://www.healthline.com/health/oral-mucositis

  To a certain degree there does appear to be some promising research that may soon provide definitive guidelines for prevention of mucositis caused by chemotherapy or radiation therapy. Studies have been done involving keratinocyte growth factor medications, anti-inflammatory medications, antimicrobial medications, laser therapy, and cryotherapy. In each of these categories, some studies have found ways to decrease the incidence of mucositis while undergoing cancer treatment. More research must be done to come up with reliable recommendations. […] Your doctor may recommend other treatments or a combination of treatments for oral mucositis.

• #2 Mucositis | CCLG – The Children & Young People’s Cancer Association

  https://www.cclg.org.uk/information-professionals/outreach-information-resource/section-7-side-effects-and-supportive-care/mucositis

  Stomatitis is the term specifically used to describe inflammation of the mouth, however, it should be noted that both mucositis and stomatitis may be used interchangeably. Mucositis can make the tongue and inside of the mouth look pale and white and the tongue may have a scalloped appearance. On examination, patients may also have lip and / or mouth ulcers; therefore it is important to check all around the inside of the mouth, under the tongue, inside the cheeks and inside of lips when assessing toxicities. […] Following diagnosis, each patient will be reviewed by the dental team in their treatment centre to discuss a mouthcare plan, promote good oral hygiene and give advice on the importance of good dietary intake. […] Mucositis during cancer treatment cannot be avoided; however, in order to reduce the risk, good oral hygiene should be encouraged to keep the mouth clean, moist and free from infection. […] Taste alteration can result in a loss of appetite leading to reduced nutritional status. It is important that parents/carers are pre-warned this may happen so they can manage the situation, understanding that it is not the child or young person being fussy.

• #3 Mucositis – WikEM

  https://wikem.org/wiki/Mucositis

  Diagnosis is typically clinical, based on history and exam. […] Grading system: National Cancer Institute Common Terminology Criteria for Adverse Events(CTCAE). […] Grade 1 – Aysymptomatic or mild symptoms, no intervention needed. […] Grade 2 – Moderate pain or ulcer that does not interfere with oral intake, modified diet indicated. […] Grade 3 – Severe pain, interfering with oral intake. […] Grade 4 – Life threatening consequences; urgent intervention indicated. […] Grade 5 – Death. […] Typically clinical diagnosis.

• #3 FF #121 Oral Mucositis: Diagnosis and Assessment | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/oral-mucositis-diagnosis-and-assessment/

  FF #121 Oral Mucositis: Diagnosis and Assessment […] Background The term mucositis refers to the inflammatory response of the oral-pharyngeal mucosa typically resulting from systemic cancer therapy (e.g., chemotherapy) or from radiotherapy that includes the oral-pharyngeal mucosa within the radiation field. […] This Fast Fact discusses the diagnosis and assessment of mucositis; Fast Fact #130 discusses its prevention and treatment; Fast Fact #450 discusses multimodal strategies for cancer-related mucositis, and Fast Fact #430 provides pearls on the oral examination. […] Assessment A thorough assessment of the patient with mucositis should include: […] Complete oral examination: assessment for local fungal (see Fast Fact #147), bacterial, or viral infections.

• #3 Mucositis – diagnosis and treatment | NHSGGC

  https://clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-paediatric-guidelines/haematologyoncology/mucositis-diagnosis-and-treatment/

  The patients mouth should be regularly examined by a nurse/doctor/dentist using the otoscope/torch as part of routine assessment to observe any changes ie inflammation, ulcerated areas and candida plaques using the scoring chart below (see Appendix 1). External changes ie sore or vesicles on the lips should also be noted and bacterial/viral swabs taken where necessary. […] All findings (ie affected area, grading, pain scale) should be documented in the casenotes. […] Swabs should be sent for microscopy and bacterial and viral culture as appropriate. […] Appropriate pain control is recommended together with the continuation of good oral hygiene, as tolerated. The patient’s pain should be assessed using the assessment tool in Appendix 3. […] Recommendations for the Treatment of Oral Mucositis: Appropriate pain control is recommended together with the continuation of good oral hygiene, as tolerated. […] Pain associated with mucositis can be severe. Opiates are required for the control of such pain. […] Parents and patients should be informed for the importance of keeping the mouth clean and encouraged to practice good, basic oral hygiene.

• #3 Mucositis – Wikipedia

  https://en.wikipedia.org/wiki/Mucositis

  Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer. […] Diagnosis is based on the symptoms the patient is experiencing and the appearance of the tissues of the mouth following chemotherapy, bone marrow transplants or radiotherapy. Red burn-like sores or ulcers throughout the mouth is enough to diagnose mucositis. […] The severity of oral mucositis can be evaluated using several different assessment tools. Two of the most commonly used are the World Health Organization (WHO) Oral Toxicity score and the National Cancer Institute Common Toxicity Criteria (NCI-CTC) for Oral Mucositis. […] Another scale developed in 1999, the Oral Mucositis Assessment Scale (OMAS) has been shown to be highly reproducible between observers, responsive over time, and accurate in recording symptoms associated with mucositis. The OMAS provides an objective assessment of oral mucositis based on assessment of the appearance and extent of redness and ulceration in various areas of the mouth.

• #3 Patients and Mucositis – Mucosamin

  https://mucosamin.com/patient-mucositis/

  Patients receiving high-dose chemotherapy or radiotherapy will commonly receive regular assessments for mucositis until their risk of developing the condition has passed. […] Healthcare professionals use a grading system to determine how serious the symptoms of OM are. There are several grading systems available, including systems presented by the World Health Organization Oral Toxicity Scale (WHO OTS).

• #3 Oral mucositis: the hidden side of cancer therapy | Journal of Experimental & Clinical Cancer Research | Full Text

  https://jeccr.biomedcentral.com/articles/10.1186/s13046-020-01715-7

  However, these aspects may not be enough, the main bias, indeed, is that none of them is a specific marker that characterizes mucositis process. They are, indeed, produced as consequence of different stresses. That aspect could compromise their feasibility as mucositis biomarkers. During antineoplastic treatment, the whole organism undergoes to several stresses that could either hide or mimic mucositis process. It could be helpful to find a marker that specifically identifies mucositis process development. Non-coding RNAs have been found to be more lineage-specific than protein coding genes, unveiling how their different expression might specifically determine cell phenotype. Accordingly, this may not be foolish the research of non-coding RNAs that are specifically involved in mucositis process, whose assessment could be used as mucositis biomarker.

• #4 FF #121 Oral Mucositis: Diagnosis and Assessment – Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/oral-mucositis-diagnosis-and-assessment/?print=print

  Mucositis results from the destruction of rapidly dividing epithelial cells of the oral-pharyngeal mucosal epithelium and the secondary release of inflammatory mediators such as TNF-alpha and interleukin-1 beta. […] This Fast Fact discusses the diagnosis and assessment of mucositis; Fast Fact #130 discusses its prevention and treatment; Fast Fact #450 discusses multimodal strategies for cancer-related mucositis, and Fast Fact #430 provides pearls on the oral examination. […] A thorough assessment of the patient with mucositis should include: Pain assessment to include thorough review of analgesics used, effect and toxicities. Nutritional assessment. Quality of life assessment including screening for depression. Complete oral examination: assessment for local fungal, bacterial, or viral infections.

• #4 Oral Mucositis | Causes | Symptoms | Diagnosis | Treatment

  https://www.icliniq.com/articles/dental-oral-health/oral-mucositis

  A universal complication that most cancer patients encounter during treatment is oral mucositis. […] Oral mucositis is an inflammation in the mucosa lining the mouth, presenting as redness, swelling, bleeding, and ulcers in the mouth, tongue, and throat. […] The severity of mucositis varies with the treatment type (chemotherapy or radiotherapy), the type of drug used in chemotherapy, the number of treatment cycles, the dosage of drug intake, and individual susceptibility. […] Various scales are used to grade mucositis based on its severity. World Health Organization (WHO) grading scale for oral mucositis is the simplest, and the grading goes as follows; […] The other standard grading scales include – The Eastern Cooperative Oncology Group (ECOG) scale, Radiation Therapy Oncology Group (RTOG) scale, National Cancer Institute Common Toxicity Criteria (NCI-CTC). […] Oral mucositis is a common and often painful complication of cancer treatment, particularly chemotherapy and radiation therapy. […] Early detection and proactive management are essential to minimize the impact of oral mucositis on patients’ quality of life during cancer therapy.

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