Cancer Treatment

COPING WITH CHEMOTHERAPY: Stomatitis and Esophagitis

Chemotherapy, a medication used to attack and kill malignant cancer cells, is an effective method to treat cancer. However, these drugs are very powerful and usually cause some undesirable side effects, including nausea, vomiting, hair loss, fatigue, low blood counts, and sore throat & mouth. These side effects do not occur all at once and can appear in varying degrees at different times within the treatment cycles. Here is some helpful information on managing a sore mouth and throat following your chemotherapy treatment at Cancer Care Northwest.

 

What is stomatitis and esophagitis?

Stomatitis and esophagitis are quite simply defined as inflamed soft tissues in the mouth and throat. Symptoms usually begin when your blood counts are at their lowest, about seven to fourteen days after treatment (nadir period). During this time, sore mouth and throat may be caused by the chemotherapy drugs themselves, the overgrowth of bacteria in your mouth, or other factors unrelated to chemotherapy.

 

How does it happen?

Chemotherapy drugs and radiation therapy to the head and neck can alter the lining of the mouth and throat, causing initial symptoms of soreness and inflammation. The soreness and inflammation can progress to painful open sores inside your mouth, on your tongue, and in your esophagus (the tube leading from the mouth down the throat).

During the nadir period your white blood cells are at their lowest; these cells keep bacteria inside your mouth and throat at normal levels. A decrease in white blood cells allows bacteria to flourish, causing infection. If you notice difficulty swallowing or eating, tender or red spots, white patches, or bleeding gums, call your doctor as soon as possible during office hours. Do not wait until you can’t eat or drink.

Sometimes soreness and inflammation are due to factors unrelated to chemotherapy, such as dental problems. A call to your doctor can confirm the cause of your symptoms.

 

What can I do to prevent it?

If you have low white blood cell counts you are more susceptible to infection and mouth sores. You can do several things to decrease the severity or possibly prevent stomatitis and esophagitis: increase your liquid intake, practice good mouth care and use a salt/soda mouth rinse at least five times daily (1 tsp. salt and 1 tsp. baking soda mixed in 1 qt. of water). If you wear dentures, it is best to remove them when using the salt/soda mouth rinse so the rinse can reach all areas of the gums. Avoid alcohol and tobacco because they too can alter the lining of your mouth and throat, leaving it susceptible to infection.

 

What can I do for stomatitis and esophagitis?

Be aware of any tenderness, swelling, dryness, or mild burning in your mouth and throat. These are early symptoms of stomatitis and esophagitis that can make eating, drinking, and general mouth care painful and frustrating.

It is very important that you continue to eat well and take care of your mouth even though it may be difficult. The following tips will help you continue to eat as normally as possible which will in turn keep up your strength and aid in your recovery.

• CHEWING AND SWALLOWING — Certain foods (hard, spicy, too hot, too cold, etc.) can irritate your sore mouth. Try eating soft foods and taking small bites. You can also mix foods with gravy, butter or sauce, or you can puree them to make swallowing easier. If you continue to have difficulty with chewing and swallowing, call your doctor. The doctor can prescribe anesthetic medications or sprays to numb your mouth and throat long enough to eat meals. Remember that using a straw to drink can make drinking and swallowing easier.
• TASTE CHANGES — Sometimes your sense of taste may change as a result of cancer treatment. Usually this is a short-term problem, but there are ways to improve the flavor of foods to help with this side effect. Ask your nurse for suggestions.
• MOUTH CARE — It is very important to take good care of your mouth and teeth regularly, not just cleaning, but moisturizing your mouth as well. Rinse your mouth with a salt/soda solution at least five times daily. It may be more comfortable to soften your toothbrush with hot water or use a disposable foam stick or cotton swab with a non-irritating cleanser such as baking soda. Remember to use gentle action, whether brushing, flossing, or rinsing, and use mouthwashes that do not contain alcohol. You also will want to protect your lips by applying lip salves, petroleum jelly, or vitamin E oil and avoid licking your lips as this increases dryness and chapping. Remember to drink plenty of water to keep your mouth from drying out. Because chemotherapy and radiation alter the lining of your mouth, dental problems such as tooth decay can result. Plan to visit your dentist before you have your first treatment (at least 14 days prior). If you are receiving radiation therapy, especially to the head or neck, you may need to see your dentist more often. Be sure to check with your CCNW doctor before making any follow-up dental appointments.
• DRY MOUTH — Chemotherapy and/or radiation can reduce the flow of saliva which is a natural mouth rinse. Saliva carries away bacteria and particles that stick to your teeth. Dry mouth makes it harder to chew and swallow and can even change the way foods taste. Antihistamines (i.e. benadryl, Claritin) can also cause dry mouth. Discuss all medications with your doctor. Rinsing your mouth with a salt/soda solution five times daily and carrying a bottle of water to drink often can soothe your mouth and prevent dryness. If the problem of dry mouth is severe, your doctor can prescribe medicines to produce artificial saliva or anesthetics that you can apply directly to sores and lesions. Remember to use caution in chewing and swallowing when using these agents.

Your CCNW doctor or nurse can give you more ideas about relief of stomatitis and esophagitis, so be sure to ask if you have any questions or concerns. Talking to someone who understands will help you keep a positive

 

We’re here for you

Be sure to ask your CCNW doctor or nurse if you have any questions or concerns. Side effects from your cancer treatment can be successfully managed with open communication between you and your CCNW oncologist. Because you and CCNW are a team — we are here for you and want to help in any way we can.