CANDIDIASIS (Thrush)

Candidiasis (thrush) occurs in about 70% of patients with advanced cancer.

It can cause:

•  Sore mouth

•  Dysphagia

•  Hoarseness

•  Misery!

It is particularly likely to occur if the patient has been on steroids or antibiotics, and is common after radiotherapy involving the buccal cavity.

Oral thrush – The mouth typically has white patches (pseudomembraneous variety) but may just look reddened (atrophic variety). Angular stomatitis is also common. The white patches are easy to diagnose, but can easily be missed if the mouth is not completely inspected, including the roof of the mouth, the inside of the cheeks and lips, and the back of the throat.

Treatment of oral thrush can be with nystatin suspension 1ml to 2ml every 6 hours, but this is a contact agent and needs to be swilled round the mouth, with no drinks for 30 minutes after. Dentures should be soaked in diluted Clorox (1 in 80). Alternatively, ketoconazole tablets 200mg per day can be given, which can clear even very severe thrush in 24 hours. (Ketoconazole is estimated to cause hepatitis in 1 in 15,000 individuals—an acceptable risk in a patient with advanced cancer.)

Esophageal thrush – Severe esophageal candidiasis can occur without any evidence of oral thrush. This usually causes painful dysphagia, and patients usually complain particularly of discomfort with hot drinks. Treat with ketoconazole 200mg per day which usually relieves the dysphagia within 24 to 48 hours.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.