Hina Khan has mucositis: How to manage this common side effect of chemotherapy

“This condition affects almost 50 per cent of all breast cancer patients who are on chemotherapy” says Dr Ramesh Sarin, breast cancer oncologist at Indraprastha Apollo Hospitals, Delhi. Listen in.

What’s mucositis and why does it happen?

This is a common side effect caused by breast cancer chemotherapy drugs. It erodes the mucosal or protective lining of the gastro-intestinal tract, causing it to atrophy and break down, forming ulcers. Usually, you feel its impact on the seventh day of chemotherapy but gets over by the 14th day. So it has a short spell.

This usually happens with normal chemotherapy drugs, which destroy all rapidly increasing and dividing cells in the body, regardless of whether they are cancerous or normal. Mucosal cells fall in the rapidly dividing category as they shed, repair and regenerate all along the gastro-intestinal tract in normal times. As they are stripped and healing is not as fast during chemotherapy, our inner tissues are exposed and react to anything that we ingest. That’s why even hair and nails get affected because they have rapidly growing cells too. Mucositis is not seen in targetted therapy for cancer because it attacks only cancer cells.

Is this a serious condition?

This also has four stages. It begins with mild symptoms which if you manage, can reduce severity. Unmanaged, it can lead to severe pain in the fourth stage and cause localised infection.

What do patients go through?

There is oral pain, burning sensation, inflammation, irritation, ulcerations. Usually the person feels sore, mouth downwards and has difficulty eating, drinking, and speaking. The patient also finds it difficult to maintain oral hygiene routines. Sometimes there are white patches of soft pus.

How to manage mucositis?

The first stage in disease management begins with the oncologist, who must prepare the patient for the side effect. The patient, on their part, must immediately contact the oncologist at the slightest sign of irritation and inflammation. Here are what patients must do:

1) Continue to clean the mouth four times a day. Gargle with saline or antiseptic solutions like betadine.

2) Gargle with baking soda, anti-fungal and antibacterial solutions, swish and spit it out

3) Use a milder toothpaste, soft toothbrush or clean teeth by hand after washing it.

4) Suck on ice cubes or popsicles

5) Manage your diet: Have bland, soft, semi-solid and cold foods. Avoid acidic, spicy, salty, coarse and dry foods. Moisten the mouth cavity with sips of water.

What to do when mucositis goes bad?

One is advised strong painkillers then. We suggest dissolving Dolo in water, adding glycerine to it and painting the mouth cavity with it. For the stomach, we prescribe antacids. Sometimes patients get diarrhoea when the GI tract is badly ulcerated. Then medicines specific to that condition are given.