Inflammation of mucosal linings: stomatitis (mouth), esophagitis (esophagus)
Causes
- Cytotoxic: Fluorouracil, irinotecan, anthracyclines,
- Targeted: Multi-kinase inhibitors, mTOR inhibitors, EGFR inhibitors, VEGF inhibitors
- Radiation
Complications: pain, nutrition, infection
Risk Factors: poor oral health, tobacco and alcohol, females > Males, dehydration, chemotherapy regimen: especially high doses, radiation
Prevention
- Good oral hygiene
- Baking soda and salt rinses; saline rinses swish/spit 4x/day: 1 tsp salt, 2 tsp baking soda, 8 oz warm water
- MTOR inhibitors: Dexamethasone mouth rinse swish/spit 4x/day
- High dose melphalan: Cryotherapy
- Hematopoietic stem cell transplant with high dose chemo/XRT: Palifermin (keratinocyte growth factor) 60 mcg/kg/day IV for 3 days before and after transplant
- Radiation to head and neck: Amifostine 200 mg/m2 IV prior to radiation
Management
- Good oral hygiene
- Topical/systemic analgesics
- “Magic” mouthwash: viscous lidocaine, diphenhydramine, Maalox
- Anti-infectives (Candida or HSV)