Mucositis - Treating mucositis

There's no single treatment for mucositis, as it largely depends on which type of mucositis you have and exactly what caused it.

For example, effective treatments for oral mucositis caused by radiotherapy may not be helpful if you have gastrointestinal mucositis caused by high-dose chemotherapy.

Oral mucositis

Self-care

If you have oral mucositis, it's very important you have a good oral hygiene routine, because it can reduce the severity of your symptoms and how long you experience them.

Ideally, you should be assessed by a dentist before starting radiotherapy to the head or neck, or receiving high-dose chemotherapy before a stem cell transplant.

Below is some general advice on good oral hygiene. However, always follow any advice your cancer treatment team gives you if it differs from the advice below:

• Brush your teeth every morning and evening, and after every meal. 
• Use a toothbrush with soft bristles.  
• Replace your toothbrush regularly. Most toothbrushes need to be replaced every three months.
• Floss your teeth at least once a day or as advised by your treatment team.
• Rinse your mouth five or six times a day using a bland rinse. A bland rinse is a mixture of water and sodium bicarbonate (baking soda) or a mixture of water and salt (to make a saline solution). Your treatment team can advise you on the type of bland rinse suitable for you.
• Don't use a mouth rinse containing alcohol.
• Avoid tobacco.
• Chew gum to help you produce more saliva.
• Use a water-based moisturiser to protect your lips.
• Make sure you drink plenty of fluids throughout the day to avoid dehydration.

Eating

If your mouth is sore because of radiotherapy or chemotherapy, you may need to change your eating habits. The following tips may help you to avoid making your symptoms worse:

• eat moist or soft food, because dry food may scratch your mouth – for example, add gravy or sauce to make food easier to swallow
• eat plain food
• eat warm rather than hot food

Avoid certain foods and drinks including:

• acidic fruits – such as oranges and lemons
• alcohol
• spicy or salty food
• garlic and onions
• vinegar

If you're unable to eat or drink because of mucositis, you may need to be admitted to hospital to receive nutrition.

Ice cubes

Sucking ice cubes or ice chips is sometimes recommended as a way of providing relief from the symptoms of oral mucositis.

The healthcare professionals treating you will advise on whether ice cubes could help you.

Pain relief

Oral mucositis is often painful, but there are several kinds of painkillers available to try. You may be given painkillers in the form of a mouth rinse, gel or spray.

If a painkiller is not effective, other medicines can be tried alongside it, or a stronger painkiller can be used. Worsening pain does not always mean you'll need to be admitted to hospital, and in most cases you can take the painkilling medication yourself at home.

If a simple painkiller such as paracetamol doesn't work, you may be prescribed a stronger type of painkiller, such as codeine. If this still isn't effective, a stronger opioid can be prescribed, such as morphine.

Non-steroidal anti-inflammatory drugs (NSAIDs) may provide pain relief for some people. However, if you're receiving some types of chemotherapy, NSAIDs could damage your kidneys and affect the way they work. For this reason, only take painkillers as advised by your treatment team.

Palifermin

Palifermin is a type of medication that has proved successful in treating people having a stem cell transplant (bone marrow transplant). This procedure usually includes chemotherapy or radiotherapy.

Palifermin encourages the growth of new cells on the lining of the mucous membrane. This growth is thought to reduce the severity of your symptoms and encourage any ulcers to heal faster. Palifermin also stops sores forming, so can be used to prevent, as well as treat, mucositis.

Palifermin is given by injection. You should receive an injection once a day for three days before your chemotherapy or radiotherapy, and then for three days afterwards, for a total of six doses.

Common side effects of palifermin include:

• skin rash, itchiness and redness
• an increase in the thickness of the lining of your mouth or tongue
• a change in the colour of your mouth or tongue
• aching joints
• altered taste

Less common side effects include swelling of the mouth or face.

The side effects should pass after you have completed the course of palifermin.

Low-level laser therapy (LLLT)

Low-level laser therapy (LLLT) is another treatment that can reduce the severity of oral mucositis. It involves focusing low-energy lasers (beams of light) at affected tissue. LLLT is thought to work by stimulating certain cells that then help to speed up the healing process.

As LLLT requires specialist equipment and training, it may only be available at specialist cancer centres or clinics.

Infected ulcers

The mouth ulcers (sores) that mucositis causes can become infected. If this happens, your treatment team may prescribe medication for this. You may also be given a special mouth wash to use to prevent further infections. 

Mucositis may increase the risk of oral thrush, which can be treated with antifungal medicines.

Read more about treating oral thrush.

Diarrhoea

Gastrointestinal mucositis can sometimes lead to diarrhoea, which can be treated in a number of ways, including:

• drinking plenty of fluids
• oral rehydration solutions
• antidiarrhoeal medicines

In severe cases, hospital treatment may be required to administer fluids and nutrients directly into a vein.

Read detailed information about treating diarrhoea.

Rectal bleeding and ulcers

Some people who have high-dose radiotherapy to treat a cancer in their pelvic region may experience rectal bleeding, as well as inflammation and ulceration of the anus and rectum (proctitis).

If these symptoms become severe, they can be treated using medicines such as cinchocaine hydrochloride (proctosedyl) suppositories or hydrocortisone acetate (colifoam). They are both inserted into your bottom and can help relieve pain and inflammation. They contain both a local anaesthetic to numb the area and a corticosteroid to reduce swelling.

Although there's no conclusive evidence to support its use, a medication called sucralfate can be taken for mucositis affecting the upper gastrointestinal tract, such as ulcers developing in your stomach or intestines.

Sucralfate is used to create a protective coating over any ulcers. This may help to prevent further damage and speeds up the healing process. Side effects of sucralfate tend to be mild and short-lasting. They include constipation or diarrhoea, indigestion and nausea.

If you develop a rash or swelling around your face or neck, or shortness of breath, it may indicate that you are allergic to sucralfate. If this happens, you should stop taking the medication and contact your treatment team as soon as possible.