Mucositis Grading — MFDS Part 1 MCQ

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ModerateOral MedicineMucositis GradingMFDS Part 1

A patient receiving systemic chemotherapy develops extensive oral erythema and ulceration. Because of the mucositis, the patient can take liquids but cannot swallow solid food. Which assessment system classifies this presentation as grade 3 oral mucositis?

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Correct answer: D — WHO oral mucositis grading scale

The correct answer is D. The WHO scale combines clinical mucosal findings with functional oral intake. Grade 3 is characterised by oral ulceration, often with extensive erythema, that prevents intake of solid food; the patient is limited to liquids. Grade 4 is reserved for mucositis so severe that alimentation is not possible. CTCAE also assesses treatment toxicity but uses different symptom- and intervention-based definitions. OMAS records erythema and ulceration at specified oral sites rather than assigning the WHO functional grade described here. RTOG criteria were developed principally for acute radiation morbidity, while the OAG is a broader oral-health assessment covering domains such as lips, tongue, saliva and swallowing. The original statement that WHO grade 4 requires bleeding was inaccurate because bleeding is not a defining WHO criterion.

Reference: Royal Cornwall Hospitals NHS Trust. Prevention and Treatment of Oral Mucositis for Patients Receiving Systemic Anti-Cancer Treatment (SACT): Clinical Guideline V6.0, sections 2.11.5–2.11.6, 2025. https://doclibrary-rcht.cornwall.nhs.uk/DocumentsLibrary/RoyalCornwallHospitalsTrust/Clinical/CancerServices/PreventionAndTreatmentOfOralComplicationsAndOralMucositisForPatientsReceivingSystemicAntiCancerTreatmentSACTClinicalGuideline.pdf