Oral complications of cancer therapy

Question 1

How to pre-operatively assess pt with OSCC about to go in for surgery and post-op radiotherapy?

Question 2

General complications of cancer (pneumonic CANCER)

Answer 2

Cachexia and wating 
Anaemia and infection 
Nutrititonal deficiencies 
Cutaneous manifestations 
Endocrine Disorders 
Rare manifestations

Question 3

Oral mucosal changes due to functional disturbances in the body DUE TO CANCER (4) vs DUE TO RADIOTHERAPY (3)

Answer 3

1. pupura
2. bleeding
3. infections
4. anaemia

vs

1. erythema
2. mucositis
3. ulceration

Question 4

Oral complications of radiotherapy in different oral tissues
(mucosa, muscles and CT, glands, bone, teeth etc)

Answer 4

mucosa:
mucositis, ulcerations, erythema, candidiasis

salivary gland:
xerostomia
loss of taste

muscle and CT:
trismus

bone:
ORN of jaws
periodontal disease
craniofacial defects possible in younger patients

teeth:
radiation caries
dentinal hypersensitivity

Question 5

How to manage patient during radiotherapy? (5)***

Answer 5

1. discourage smoking and alcohol consumption
2. eliminate infections
3. relieve mucositis
4. saliva subsitutes
5. physiotherapy for trismus

basically alleviate symptoms, avoid secondary complications (esp dehydration and infection which can have dire effects)

Question 6

How to manage pt after radiotherapy? (6)

Answer 6

1. continue OH, preventative care
2. abx for infections
3. specialist referrals for exos and surgery
4. topical F
5. avoid mucosa trauma (poorly fitting dentures can cause ORN)
6. saliva subsitutes

Question 7

Oral complications of chemotherapy? (7)

Answer 7

infections 
ulcers and mucositis 
xerostomia 
perio 
lip cracking
bleeding 
delayed/abnormal development in children

Question 8

How must you manage patients BEFORE chemo?

Answer 8

• oral and dental assessment
• OH and prevention
• similar to radiotherapy pre tx

Question 9

How to manage patients during and after chemo?

Answer 9

ulcer management (folic acid - systemic or topical)
xerostomia management (water and sucking ice)
CHX MW (diluted to reduce pain)
nystatin for candidiasis
abx for infections
rmb: methotrexate (chemo drug) interacts with NSAIDS

after: 
OH and prevention
risk of anaemia/ bleeding 
risk of infections 
refer to mxfx for exos and try to time before next course of chemotherapy

Question 10

What are the signs of oral mucositis? (4)

Answer 10

widespread erythema
ulcerations
soreness
bleeding

Question 11

WHO Mucositis Scale

Answer 11

grade 1: soreness/erythema
grade 2: erythema/ulceration - can eat solids
grade 3: ulceration - can only consume liquids
grade 4: oral alimentation not possible

Question 12

Management of Mucositis

Answer 12

• PCA/opioids
  -avoid smoking, spirits, spices
  -oral cooling
  -OHI
  -Topical Analgesics