MOUTH SORES ~Suggested helps 4 Mike & others taking chemo~be proactive & consistent~Keep mouth moist

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LorettaMarshall
LorettaMarshall Member Posts: 662 Member
in Esophageal Cancer #1

Dear Mike:

First of all, let me say how sorry I am to know that you’ve been diagnosed with Esophageal Cancer, but at least you have been diagnosed as a Stage III EC patient.  This leads me to believe that most likely surgery will be a possibility for you.  Since you were short on info, I will assume that this is “neo-adjuvant” chemo which means “pre-op” when surgery is anticipated. 

I am choosing to put this information on a separate forum line so that others who also have problems with mouth sores, as well as though who want to take all the precautions they can, may well benefit by my own experience.  So I will post your short letter here:

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https://csn.cancer.org/node/312804

-- “Excessive mouth mucous during last stages of chemo/radiation tx.

Nov 03, 2017 - 4:01 pm

I have stage 3 EC, and have had a lot of thick mouth mucous during this last week of 6 week treatment. It can gather around the tumor and cause distress and hiccups unless I spit it out. It seems to signal nausea onset but not always. Am taking Zofran and Promethazine gel. I hydrate PO and feeding tube often as I can. Any suggestions for relief..?  ”“Mike_Harrison392”

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My remarks continue here: 

First, I always want to share our own good news and say that my husband, William, was diagnosed with Adenocarcinoma @ the GastroEsophageal junction (GE) – Stage III (T3N1M0), at age 65.  He went through the pre-op radiation/chemo regimen and then had an Ivor Lewis Minimally Invasive Esophagectomy at the University of Pittsburgh Medical Center (UPMC) on May 17, 2003.  His thoracic surgeon was Dr. James D. Luketich, who pioneered this totally laparoscopic procedure during the mid 90’s.  And you will be happy to hear that we are still rejoicing that we are now in year 15 with no recurrence thus far.  Now this is the exception and not the rule for EC patients, but you always want to know who survived this dastardly diagnosis and how have they fared since.  So keep that in mind when a despondent day sets in and you’re not “feeling so hot!”  To be diagnosed with Esophageal Cancer has often been described as a getting on the “highway to H_E_L_L!”  But there are some that don’t “run out of gas” before they get to the “turning off point.”  There are survivors and we all hope to be one of those that make it through.  Some wish to say they’re “lucky”, I would prefer to give God the credit for allowing my husband to survive this far. Smile Now to be truthful, recurrence is always a possibility, but don’t dwell on that unless you arrive at that point.  There’s nothing on the front end that can guarantee there will never be a recurrence, but at the same time, there are many survivors still enjoying a cancer free life.  That’s a blessing.  “Lucky” is not a word in my vocabulary. 

Now with reference to mouth problems in particular, my husband did not have any mouth sores.  But as a Peritoneal Carcinomatosis/Ovarian Cancer patient myself, I did not fare as well as he did with his Carboplatin/5-FU plus radiation treatment.   

However, as for side effects with reference to “mouth sores” and oral care during chemotherapy, I never experienced a mouth sore.  I believe it was because of “pro-active/pre-emptive measures that helped me.  For one thing my doctor recommended an antiemetic called GRANISETRON hydrochloride Tablets USP 1 mg.   (KYTRIL)

He also prescribed me a “breakthrough prescription” called “PROCHLORPERAZINE” (10 Mg. Tab)

Once when my mouth was feeling real sensitive as though something like a mouth sore was starting, he also wrote a special prescription for a mouthwash called “CLACK’S SOLUTION – 150ml’s.   If you want to shop around at different drug stores, you will need to know the ingredients to compare prices.  So here is what is written on my bottle.  I believe it cost me about $39 for this bottle, but it is worth it to not have a mouth sore. 

These are the components:  Hydrocortisone  30mg, Lidocaine 50 ml, Nystatin 30 ml, Diphenhydramine 60 ml) – Instructions:  Swish & swallow 5 milliliters by mouth 4 X a day if needed for Mouth Sore Pain.

I’ve also included a web link that is all about “BIOTENE”.  Once when I was at the dentist, he gave me a sample, and told me that I should use it during my chemo treatments.  I did and attribute part of my successful regimen relative to my mouth with the fact that I used it as a rinse often during the day.  Nope—I don’t own any stock in the company, but this product is one that I would recommend.  There is also a Biotene Gel  that can be rubbed on the gums that is designed to keep the mouth moist, and you could always carry a small bottle with you and use it no matter where you go.   

Perhaps my suggestions will be helpful in addressing your immediate concern in reference to “mouth maintenance.” 

I will give you some references below my name that will help you to know how I coped with during my own chemo regimens, of which I have had 3 separate regimens of Carboplatin/Paclitaxel (Taxol).  I am praying about taking only one more series in an attempt to keep the cancer knocked back just a bit longer.  Only 46% OC Stage IV patients ever live 5 years and November is my 5th anniversary.  With Stage IV Ovarian cancer, there isn’t a cure, unless the Lord allows a miracle.  So the next best thing is to ask for His guidance in where to go, and whom to see that knows the most about your particular cancer and how to best “treat” it.  In that context, one of the references below is a letter I wrote to “Brian from the North” who wanted to hear from others about how they best coped with their chemo, since his mother was about to undergo chemotherapy. 

Another thing my oncologist told me was to keep something “cold” in my mouth for the first 24 hours of each chemo treatment.  This sort of provides a “barrier” in the mouth, because the chemo can cause gum damage, and as a result cause teeth problems.  So ice chips, popsicles, ice cream, Jello, anything cold will help to cool the mouth. I also kept a bottle of baking powder and water solution in each bathroom, and anytime I went there during the day or night, I would rinse out my mouth.  Keeping the mouth moist at all times is ESSENTIAL. 

And as for the antiemetic measures, I took a bottle of water and my Granisetron tablet on the bedside table, and the first thing when I awoke each morning, I took that tablet.  Don’t wait until you feel nauseous to take your antiemetic. I learned this tip from another lady who was so helpful to me along the way. 

And so Mike, I wish for you the very best, and when your PET/CT scans are scheduled, it is always our prayer that it will show that the neo-adjuvant treatments were totally successful in wiping out the cancer.  Nevertheless, an Esophagectomy is always NECESSARY, due to the fact that sometimes there is residual cancer that wasn’t picked up on a scan.  And so it isn’t good enough to just say, “Hey—no problem—I’m cancer free so I’ll skip the surgery.”  That is most unwise. 

If I could only give a couple of tips—it would be always to have a SECOND opinion at a major medical facility that is known for their successful Gastrointestinal Surgery Department.  And by all means, if possible, select a thoracic surgeon thoroughly proficient at performing the totally laparoscopic esophagectomy commonly called the MIE.  (Ivor Lewis MINIMALLY INVASIVE ESOPHAGECTOMY!  All of us who have already traveled the road you are now on wish you the very best.  With that I will say goodnight.

Most sincerely

Loretta Marshall

P.S.  Trade name for Ondansetron is ZOFRAN.  Trade name for Granisetron is KYTRIL.

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1.      https://www.biotene.com/dry-mouth-products/

[My note:  I used these products all during my last series of chemo treatments.  Biotene liquid for Dry Mouth and Biotene Oral balance gel to keep mouth moist]

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2.      https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000032.htm

Dry mouth during cancer treatment –

“… Rinse your mouth 5 or 6 times a day for 1 to 2 minutes each time. Use one of the following solutions when you rinse:

  • 1 teaspoon of salt in 4 cups of water
  • 1 teaspoon of baking soda in 8 ounces of water
  • ½ teaspoon salt and 2 tablespoons baking soda in 4 cups of water…”

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3.      http://www.ncbi.nlm.nih.gov/pubmed/22081189

“Mymensingh Med J. 2011 Oct;20(4):680-8.

Ondansetron versus granisetron in the prevention of chemotherapy induced nausea and vomiting in children with acute lymphoblastic leukemia.

Siddique R1, Hafiz MG, Rokeya B, Jamal CY, Islam A. - Author information

 Abstract

Effect of ondansetron and granisetron were evaluated in sixty (60) children (age 4-11 years) irrespective of sex, diagnosed case of acute lymphoblastic leukemia (ALL) who received high dose methotrexate and did not receive any antiemetic 24 hours prior to HDMTX. This was a prospective, randomized, double-blind, single center study. Of 60 children, 30 received oral ondansetron (4mg) and rest 30 Granisetron (1mg) half an hour before therapy. Drugs were randomly allocated with appropriate code.

The patients were followed up from day 1 to day 5 of therapy. Episodes of nausea and vomiting were recorded and scorings was done every 24 hours following chemotherapy. No significant difference was found between two groups according to acute emesis (Day-1) (p=0.053).

 In day two and day three it was significant (p<0.05).

In day four it was significant (p=0.002).

 Early chemotherapy induced nausea and vomiting (CINV) were controlled 90% in children who received granisetron and 70% in children who received ondansetron.

Delayed (Day 2-4) CINV were controlled in 80% of children who received granisetron and 43.4% who received ondansetron (p<0.05).

Granisetron group required additional doses only 3.3% cases and ondanseton group 30% cases on the second day (p<0.05).

Result was significant between two groups.

About 36.7% patients had episodes of nausea on day four of chemotherapy in ondansetron group and it was only 3.3% in granisetron group due to adverse effects of antiemetic drug itself (p=0.001).

Maximum episodes of vomiting were found on the second day in ondansetron group 33.3% and in granisetron group 3.3% (p=0.003).

Though adverse effects like headache, constipation, abdominal pain and loose motion were common in both group of children but their number was much less in children who received granisetron.

On second day of therapy score of nausea and vomiting was maximum in ondansetron and minimum in granisetron treated on day 4 and the result was significant.

So, to prevent acute and delayed CINV in children with ALL, oral graniseteron can be considered as more effective and well tolerated with minimum adverse effects compared with ondansetrons.”

4.    http://www.targetedonc.com/news/extendedrelease-of-granisetron-for-cinv-now-approved

Aug 11, 2016 ... Extended-Release of Granisetron for CINV Now Approved 

CINV stands for “chemo induced nausea vomiting”

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5.      https://www.ncbi.nlm.nih.gov/pubmed/26997579/

Future Oncol. 2016 Jun;12(12):1469-81. doi: 10.2217/fon-2016-0070. Epub 2016 Mar 21.

APF530 (granisetron injection extended-release) in a three-drug regimen for delayed CINV in highly emetogenic chemotherapy.

Schnadig ID1, Agajanian R2, Dakhil C3, Gabrail NY4, Smith RE Jr5, Taylor C6, Wilks ST7, Schwartzberg LS8, Cooper W9, Mosier MC10, Payne JY11, Klepper MJ12, Vacirca JL13. Author information

Abstract

AIM:

APF530, extended-release granisetron, provides sustained release for ≥5 days for acute- and delayed-phase chemotherapy-induced nausea and vomiting (CINV). We compared efficacy and safety of APF530 versus ondansetron for delayed CINV after highly emetogenic chemotherapy (HEC), following a guideline-recommended three-drug regimen.

METHODS:

HEC patients received APF530 500 mg subcutaneously or ondansetron 0.15 mg/kg intravenously, with dexamethasone and fosaprepitant. Primary end point was delayed-phase complete response (no emesis or rescue medication).

RESULTS:

A higher percentage of APF530 versus ondansetron patients had delayed-phase complete response (p = 0.014). APF530 was generally well tolerated; treatment-emergent adverse event incidence was similar across arms, mostly mild-to-moderate injection-site reactions.

CONCLUSION:

APF530 versus the standard three-drug regimen provided superior control of delayed-phase CINV following HEC. ClinicalTrials.gov : NCT02106494.

KEYWORDS:

chemotherapy-induced nausea and vomiting (CINV); extended-release granisetron; highly emetogenic chemotherapy (HEC)

PMID:26997579 DOI: 10.2217/fon-2016-0070 [Indexed for MEDLINE] Free full text”

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6.      http://csn.cancer.org/node/301646

My letter to Brian can be read at this link.

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