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Pathology · single question

For the same patient with severe chemotherapy-induced mucositis, which of the following is LEAST appropriate for symptomatic management?

  1. Topical viscous anesthetic before meals
  2. An alcohol-containing antiseptic mouthrinse
  3. Cryotherapy with ice chips during bolus chemotherapy infusion
  4. A bland rinse such as salt and sodium bicarbonate in water
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Correct answer: B. An alcohol-containing antiseptic mouthrinse

  • A. Topical anesthetics (viscous lidocaine, 'magic mouthwash') are appropriate to allow eating, used with caution because they blunt the gag reflex.
  • B. CORRECT — this should be avoided. ALCOHOL-CONTAINING rinses (and other harsh antiseptics) dehydrate and chemically irritate already-denuded mucosa, producing severe burning and worsening the injury. Commercial alcohol-based mouthwashes are contraindicated in mucositis.
  • C. Oral cryotherapy during bolus 5-FU or melphalan infusion causes local vasoconstriction, reducing drug delivery to the mucosa — an evidence-based preventive measure.
  • D. Bland saline/bicarbonate rinses are the standard first-line supportive measure — they soothe, debride lightly, and buffer.

Note: MASCC/ISOO guidance: bland rinses, cryotherapy for specific agents, benzydamine for radiation. Avoid alcohol-based and harsh antiseptics.

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