The number of cancer diseases is steadily growing throughout the world every year, and the proportion of patients with malignant neoplasms can reach 1.4% of the country's population [1]. According to experts from the World Health Organization, in the next twenty years the number of cases of various types of cancer in the world will increase by 60% [2]. Today in Russia there are about 3.7 million people living with some kind of cancer, which is approximately 2.6 thousand cases per 100 thousand population [3].
Currently, an important indicator of the effectiveness of cancer treatment is improving the quality of life of patients. One of its components is timely dental care aimed at maintaining health and preventing oral diseases.
How cancer affects oral health
Oncology develops under the influence of both external and hereditary genetic factors. This pathology can affect any part of the body and does not depend on the age of the patient. It begins with changes in just one cell and leads to serious, often fatal consequences for human health and life.
With the development of cancer, the functions of the affected organs may be impaired. In addition, these pathologies lead to a general deterioration of the condition, decreased immunity, bad mood, depression, digestive dysfunction and anemia. Thus, malignant tumors have a complex effect on all systems and organs of the body, including the condition of the oral cavity.
What to do in case of memory and attention problems?
Taking chemotherapy drugs causes disruption of the nervous system and memory problems. If you experience dizziness, loss of balance, spasms and pain, or deterioration of the musculoskeletal system, tell your doctor about these conditions.
During chemotherapy, memory may be impaired and thinking may be inhibited. Sometimes, a condition called “chemo-brain” occurs, a disorder of cognitive processes associated with taking drugs that suppress cancer cells. If you experience problems with attention, memory, or confusion, talk to your doctor about overcoming these unpleasant symptoms.
What to do?
- get more rest;
- make a to-do plan and act on the list;
- ask your loved ones for help;
- create reminders in the form of notes or using an application on your phone;
- divide big things into small and specific tasks.
How cancer therapy affects oral health
Various, often intensive and aggressive methods of therapy are used to treat cancer. Each type of cancer typically requires a different treatment regimen, which may combine surgery with chemotherapy (drugs) and radiation therapy (targeted exposure to radiation). All of these treatments are aimed at suppressing the division, development and death of cancer cells. However, they are often accompanied by painful side effects, which are associated with the fact that radiation and chemotherapy have a detrimental effect on normal tissue cells and can also suppress the functioning of the immune system. Moreover, often the more effective the treatment method, the higher the degree of toxicity for the patient.
In addition, radiation and chemotherapy often have long-term consequences for health, including dental health. It is especially important to take this into account when treating children who have undergone these types of cancer therapy.
Among the side effects of radiation and chemotherapy that have a direct impact on oral health and its treatment are:
- deterioration of general condition, weakness, nausea;
- diseases of the mucous membranes, including the oral mucosa, most often manifested as inflammation - stomatitis;
- decreased immunity and anemia, which cause frequent local bleeding.
Treatment of malignant tumors of the oropharyngeal region at the present stage is based on the principles of a multidisciplinary approach, which makes it possible to reduce the volume of surgical interventions, and in some cases even avoid them [3]. The results of using an integrated approach in the treatment of tumors of this localization, obtained by most authors, are more effective than the results of isolated radiation, chemotherapy or surgical treatment methods [7].
Leading oncology clinics have sufficient experience in combined treatment of tumors of the oropharyngeal region, which makes it possible to evaluate long-term results and compare them [4]. However, to assess the effectiveness of treatment, it is important to study not only positive, but also negative effects, that is, complications and reactions. One of the most important criteria for the effectiveness of any treatment method is the reduction in the level of negative reactions and complications[1].
Material and methods
The material for this study was data from a prospective, longitudinal study of the results of treatment of 586 patients with malignant neoplasms of the oropharyngeal region. All patients were divided into 2 groups. The main group included 195 patients, the comparison group was formed of 391 patients. The selection of patients for the study was carried out in accordance with standard inclusion and exclusion criteria. Inclusion criteria included an established diagnosis of a malignant neoplasm, planned complex antitumor treatment, age from 18 to 84 years, and informed voluntary consent to participate in the study. Exclusion criteria were the refusal of patients to participate in the study, the presence of severe concomitant somatic pathology and mental illness. When forming groups for comparative analysis, we took into account the individuality of approaches to the treatment of malignant neoplasms depending on the location, stage, histological variant and features of the treatment program (Fig. 1).
Figure 1. Distribution of patients by groups.
Research results
Analysis of complications of the chemoradiation component of complex treatment.
Depending on the length of time after radiation and chemotherapy, local damage is divided into early and late. Early damage develops during radiation therapy or in the next 3 months after it (the deadline for recovery of sublethal cell damage). Late injuries are considered to be those that developed after the specified period, more often after several years [6].
Late chemoradiation damage is based on violations of more radioresistant structures, which are a consequence of the gradual accumulation of changes in small blood and lymphatic vessels, causing disruption of microcirculation and the development of hypoxia of irradiated tissues, which can subsequently cause fibrosis and sclerosis [2, 4].
In our study, we observed xerostomia, radiation caries, and radiation osteoradionecrosis among chemoradiation injuries during complex treatment of oropharyngeal cancer.
Xerostomia
called a delayed complication, but in fact it begins to develop from the first day of radiation therapy. In addition, it is a serious lifelong complication that constantly haunts the patient and causes a feeling of dry, hard mucous membranes. In the first week of radiation therapy, there is a sharp decrease in salivation, which decreases by 90% within 2 weeks of treatment. With the accumulation of a cumulative radiation dose of 40 Gy, salivation decreases by 95% compared to the initial one, and irreversible damage to the salivary glands occurs. This typical decrease in salivation is closely related to the radiation dose. With chemotherapy, clinical hyposalivation is observed only during treatment and is reversible.
We observed 52 patients from the comparison group and 44 patients from the main group with xerostomia that occurred after chemoradiotherapy. All patients underwent sialometry at the time of hospitalization and after completion of the course of chemoradiation treatment according to the “Method for collecting mixed unstimulated saliva at rest.” The average sialometry (total unstimulated saliva) at the time of hospitalization was M=3.98±0.04. All patients received a radiation dose of at least 40 Gy. We carried out repeated examinations at the end of radiation treatment and then at 6-month intervals.
As a rule, there are three degrees of xerostomia, so we combined all patients and grouped them according to the severity of symptoms (Table 1).
Of course, the most difficult for the patient (and for correction) is grade III xerostomia. In cases of dysfunction of the salivary glands of the third degree (the function of the salivary glands is completely suppressed), patients are bothered by severe dry mouth, painful sensations in the salivary glands, pain when eating, disturbances in sleep and speech. There are phenomena of catarrhal glossitis, stomatitis, the oral mucosa is dry, hyperemic, often with cracks and erosions. Hyposalivation (sialometry - up to 2 ml), increased viscosity, acidity, foaminess of saliva. Lips are dry, flaky, and crusty. Xerostomia is often accompanied by multiple dental caries (Fig. 2, a).
Figure 2. Complications of chemoradiotherapy. a — xerostomia III degree, b — radiation caries.
The severity of xerostomia symptoms decreases over time, even in the absence of dental care. Thus, we examined patients in the comparison group (52 people) immediately after completion of radiation therapy and then with 6-month breaks. The dynamics of the dependence of xerostomia symptoms on the time elapsed since the end of chemoradiotherapy is presented in Table. 2.
Thus, symptoms corresponding to grade III were observed for 1.42±0.02 years and then tended to decrease, reaching their minimum after an average of 2.21±0.03 years.
In this case, there is a direct correlation between the severity of xerostomia and the total radiation dose (Table 3).
Thus, symptoms corresponding to stage III xerostomia appeared at SOD = 59 Gy. Preoperative radiation therapy SOD = 50 Gy resulted in grade I xerostomia. As can be seen from the data presented above, the symptoms of chemoradiation xerostomia are reversible, which indicates the absence of structural lesions of the salivary glands during chemoradiotherapy treatment. However, restoring the amount of saliva secreted is a rather lengthy and difficult process for the patient.
Radiation caries
(Fig. 2, b) occurs after exposure to ionizing radiation on tooth tissue during the treatment of malignant tumors of the head and neck.
Clinical signs of post-radiation dental damage are quite characteristic. Usually, 3-6 months after radiation exposure, tooth enamel loses its characteristic shine and becomes dull and grayish-faded in color. Fragility and wear of the chewing and vestibular surfaces of the teeth are noted. Against this background, areas of necrosis appear, initially local, and then as a circular lesion of the teeth. These lesions are usually dark in color, filled with loose necrotic mass, and painless. The absence of a pain symptom is a characteristic feature of radiation damage to teeth, indicating suppression of odontoblast function. Gradually, areas of necrosis expand and cover a significant part of the tooth. Removal of necrotic masses from the lesion is usually painless and therefore requires special care. If radical interventions are not used, then in 1-2 years more than 96% of the teeth will be affected. We examined patients 2 years after completion of complex treatment of tumors of the oropharyngeal region. All examined patients received radiation treatment of at least 40 Gy. During examination, radiation caries was diagnosed in 88% of cases (Tables 4, 5). In table 6
The correlation dependence of the development of radiation caries depending on the received total dose (SOD) is presented.
Radiation osteonecrosis, radionecrosis, radiation necrosis (radionecrosis)
— tissue necrosis (most often bone tissue or skin), due to inhibition of its regenerative ability after a course of antitumor radiotherapy. Trauma or surgery (for example, tooth extraction) after radiation can exacerbate the process of radionecrosis.
Radiation osteonecrosis is the death of bone tissue and is the most severe consequence of radiation therapy for head and neck cancer. In our case, 7 (9.3%) patients in the control group complained of pain and prolonged non-healing of the sockets after tooth extraction. The extractions were performed in dental institutions in the city within 7 to 12 months after the end of radiation therapy. In all cases, the diagnosis of osteoradionecrosis was made (Fig. 3).
Figure 3. Osteoradionecrosis. In all cases, osteoradionecrosis was characterized by a long course, with periods of exacerbation and the absence of clearly defined boundaries of sequestration demarcation. Surgical intervention was mainly aimed at preventing the development of abscesses and phlegmons of the maxillofacial area. In one case, the course of radionecrosis was combined with simultaneous tumor relapse.
Analysis of complications of the surgical component of complex treatment.
Subtotal and total jaw defects most often occur after the surgical stage of complex treatment of tumors of the oropharyngeal region [8]. Surgical treatment of malignant neoplasms of the oropharyngeal region in many situations is accompanied by resection of a significant amount of jaw bones. During resection of the upper jaw, the resulting postoperative communications between the oral cavity and the nasal cavity contribute to severe functional disorders: disturbances in the act of chewing, swallowing, breathing, speech and salivation [1]. Defects of the lower jaw lead to disturbances in chewing, speech and changes in the aesthetics of appearance. Scarring of the operating cavity leads to severe disfigurement of the patient's face. The cosmetic defect is especially pronounced during combined resection of the jaw bones with soft tissues of the face, bone structures of the orbit, and zygomatic bone [5]. All these circumstances and the uncertainty of the prognosis of the course of the disease and life, the violation of life plans and goals form various psychogenic reactions in patients, which manifest themselves in more than 90% of patients [6]. In this regard, the treatment and rehabilitation of patients with malignant neoplasms of the maxillofacial region are one of the most difficult tasks in an oncology clinic and require an integrated approach [7, 8].
We examined 73 patients with defects of the jaw bones: 54 (73.9%) cases - the upper jaw, 19 (26.1%) cases - the lower jaw.
Defects of the upper jaw were determined according to the classification of D. Okay et al. (2001), which divides flaws into 3 main classes and 2 subclasses.
In the lower jaw, to systematize possible variants of defects and deformations and draw up a plan of treatment tactics, we used the classification of L.V. Gorbaneva, B.K. Kostur and V.A. Minyaeva (1995), since this classification not only considers the specified pathology depending on the severity and severity of the defect or deformation, but also takes into account the nature of fusion or non-fusion of fragments of the lower jaw, as well as common variants of defects of the lower jaw formed after oncodental operations in as a result of disarticulation of half or complete removal of the lower jaw. The results obtained are presented in table. 7.
Complications of surgical treatment of malignant neoplasms of the oropharyngeal region also include: development of contractures, narrowing of the oral cavity (microstomy), limited mobility of the tongue, lips and cheeks.
Contracture
- limitation of joint mobility due to pathological changes in soft tissues, bones or muscle groups functionally associated with this joint.
All contractures that occur after complex treatment of tumors of the oropharyngeal region are of the extra-articular type. According to the degree of mouth opening, extra-articular contractures are divided into: severe (mouth opening up to 1 cm), moderate (mouth opening 1-2 cm) and mild (mouth opening 2-3 cm). We examined 391 patients who received surgical treatment (as part of the complex treatment scheme for cancer of the oropharyngeal region). The results of assessing the degree of development of contractures are presented in table. 8.
Discussion
The main dental complications that occur after chemoradiotherapy are xerostomia and radiation caries. These complications have a high incidence and, as a rule, do not go away without qualified dental care. Osteoradionecrosis, being a serious complication of radiation therapy, fortunately is not so widespread. The main complications of surgical treatment, of course, are defects of the jaw bones and soft tissues of the oropharyngeal region, which accompany each surgical intervention, as well as the resulting postoperative extra-articular contractures. All of these complications have a symptom of mutual aggravation, i.e. may complicate each other during complex antitumor therapy. All developed complications require dental correction. Dental care for such patients is provided immediately after discharge from an oncological institution; then, during the first year, a dental examination must be carried out every 3 months, which will be combined with oncological monitoring. After the first year, a dental examination is performed every 3-6 months, depending on individual factors: level of hygiene, degree of development of xerostomia, and the presence of restorative orthopedic structures.
conclusions
Our research allows us to draw the following conclusions.
1. A significant part of the undesirable effects of complex treatment of malignant tumors of the oropharyngeal region is associated with the chemoradiation component and is represented mainly by chemoradiation reactions. Of which, 34% are clinically significant radiomucositis, forcing breaks in treatment and, as a consequence, leading to a decrease in the effectiveness of the chemoradiation component.
2. Xerostomia as a complication of chemoradiotherapy develops from the first day of specialized antitumor therapy, and in the first week there is a sharp decrease in salivation, which, with the accumulation of a cumulative radiation dose of 40 Gy, decreases to 95% compared to the initial one, however, the severity of xerostomia symptoms decreases over time even in the absence of dental care.
3. Radiation caries, which occurs after exposure to ionizing radiation on tooth tissue, is detected in up to 88% of cases with irradiation of 40 Gy and up to 96% of cases with irradiation of up to 70 Gy, causing damage to hard dental tissues in a period of 6 to 24 months.
4. Surgical complications in the complex treatment of cancer of the oropharyngeal region account for 20.2% and represent defects of the face and jaw bones; undesirable effects of photodynamic therapy are represented by nonspecific complications in the form of deformations of the oral cavity and the occurrence of communication with the nasal cavity and amount to 13.6%; correction of all these complications is possible only through the interaction of oncological surgeons and the dentist.
Dental treatment during chemotherapy and radiation therapy
Timely dental care can significantly improve the quality of life of a patient with cancer. Regular preventive examinations and treatment help get rid of pain and inflammation, help maintain chewing function in full, and prevent the development of pathological processes in the oral cavity.
However, when carrying out treatment, the dentist must take into account the side effects of the radiation and chemotherapy the patient receives, as well as the impact of toxic reactions on both the general condition of the patient and the health of his oral cavity.
Most often, diseases of the oral mucosa occur during radiation and chemotherapy. These are stomatitis , candidiasis, tongue papillomas, “geographic tongue” (an inflammatory disease that manifests itself as a bright pattern on the tongue and causes discomfort in the mouth) and other types of glossitis (inflammation of the tongue). The increased risk of developing such diseases is due to the fact that antitumor therapy is aimed, among other things, at suppressing the body’s immune function.
Another group of diseases, the risk of which increases with antitumor therapy, is periodontal disease. They occur in 69.5% of cases, while gingivitis is observed 2 times more often than periodontitis [1].
In addition, patients receiving radiation and chemotherapy may complain of discomfort in the mouth. Among them:
- dry mouth;
- formation of ulcers and abrasions;
- taste changes;
- inflammation, swelling, bleeding gums and others.
There are mainly three manifestations:
- ulcerative;
- catarrhal;
- aphthous.
Initially, patients complain of the appearance of redness and itching; subsequently, ulcers are observed on the affected areas, which subsequently burst, and in their place lesions with a diameter of up to 1 cm are formed.
stomatitis during chemotherapy on their own; it is accompanied by the following symptoms:
- salivation increases;
- observes an increase in temperature;
- decreased appetite;
- pain in the oral cavity.
If you do not contact specialists in time, bleeding ulcers may occur. Untimely intervention by specialists can lead to complications and the spread of infection, which will require longer treatment.
Features of the treatment of oral diseases during radiation and chemotherapy
It is important for the patient to undergo a preventive examination and consultation with a dentist in advance, before starting radiation or chemotherapy. This is due to the fact that mandatory examination of such patients should include an X-ray or tomographic examination of the condition of the bones of the jaws and teeth, which makes it possible to exclude the development of a pathological process in them.
If a patient requires oral surgery (such as tooth extraction) or dental prosthetics, treatment strategies should be discussed with the treating oncologist and dentist. As a rule, surgical interventions are recommended to be performed 2–3 weeks before the start of antitumor therapy. In addition, before starting the course of treatment, it is necessary to perform sanitation of the oral cavity (cure carious cavities), and it is also advisable to conduct a course of remineralization of the enamel.
Due to the increased risk of bleeding, poor wound healing, and the possibility of inflammation or infection when treating dental diseases in patients receiving radiation or chemotherapy, dentists must take a number of precautions.
- When examining the oral cavity, the doctor should pay attention to the condition of the gums and ask the patient about cases of inflammation or bleeding.
- All interventions must be carried out with monitoring of blood tests, in particular the level of leukocytes.
- All interventions, from local anesthetic injections to the canal depulpation procedure, must be performed in the most gentle and careful manner possible.
- Consultations between the dentist and the treating oncologist are advisable for a correct assessment of the patient’s condition.
- If necessary, a course of antibiotics is given before treatment, which reduces the risk of infection.
What to do if there is bleeding during chemotherapy treatment?
By attacking bone marrow cells, chemotherapy can reduce the number of platelets in the blood, the cells that are responsible for blood clotting. If chemotherapy drugs affect blood clotting, bruises on the body, frequent nosebleeds, and a small rash on the body may occur.
What to do if there is a risk of bleeding?
- handle cutting objects carefully;
- avoid too vigorous activity, in which there is a risk of bruises and cuts;
- use an electric razor instead of a razor;
- use a soft toothbrush and avoid dental floss;
- Avoid constipation.
Complications of dental development during radiation and chemotherapy
Treatment of malignant neoplasms in childhood significantly affects dental development. It is important to understand that the development of teeth is one of the longest processes in the human body, because teeth are fully formed only by the age of 21–22 [4]. Tooth buds contain embryonic tissues that have the properties of intensively dividing and developing. If a child or teenager receives radiation or chemotherapy aimed at suppressing active cell growth, this inevitably affects the development of teeth. In particular, the impact manifests itself as follows:
- the resistance of teeth to cariogenic factors decreases;
- the constancy of the composition (homeostasis) of the oral fluid changes, including its cleansing properties, the protective function and content of trace elements and minerals involved in the remineralization of enamel and others decreases;
- teething is delayed;
- the risk of developing dental anomalies increases, for example, underdevelopment of tooth roots, microdentia, impaired enamel formation, and the formation of cavities;
- the rudiments of teeth die, which leads to their absence, while the likelihood of tooth loss is especially significant when chemotherapy is administered before the age of 9 years [4].
Children who have undergone chemotherapy should be routinely examined by a dentist at an early age (optimally at the age of 6 years, when the buds of all teeth are normally well mineralized and visible on radiographs, and for older children - after completion of chemotherapy) for timely diagnosis of edentia and prevention secondary deformation of the dental arches
Korolenkova M. V., Ph.D., pediatric dentist, Central Research Institute of Dentistry and Maxillofacial Surgery[4]
Causes of stomatitis after chemotherapy
Stomatitis is a special case of mucositis.
Mucositis is an inflammatory reaction of the mucous membrane of the upper gastrointestinal tract from the mouth to the abdomen (mouth, lips, throat) and surrounding soft tissues.
- Stomatitis refers to inflammation in the mouth.
- Esophagitis refers to inflammation of the esophagus.
- Mucositis applies to all mucous membranes.
This type of complication is caused by the use of certain chemotherapy drugs, individual reaction, radiation therapy and/or surgery. This reaction can progress into painful sores and infections, interfering with eating, speaking, tasting, chewing or swallowing and often lasting several days.
Features of oral hygiene in cancer patients
Given the side effects of radiation and chemotherapy for cancer and the development of possible complications, oral hygiene is of particular importance for patients. It allows you to prevent the development of many diseases and prevent the deterioration of the mucous membrane of the oral cavity and teeth.
It is important for the patient to especially carefully follow all the rules of oral hygiene. First of all, hygiene procedures for cancer patients should include:
- brushing your teeth twice a day, using a toothbrush with soft bristles, which will help avoid injury to the gums, as well as fluoride-containing toothpaste ;
- careful and gentle cleaning of interdental spaces with dental floss (if gums are bleeding, painful areas should be avoided);
- rinsing your mouth with water will help relieve dryness and prevent irritation of the oral mucosa.
During antitumor therapy, it is not recommended to use rinses containing alcohol, as it can cause unpleasant and painful sensations in the oral cavity and increase dryness of the mucous membrane. In addition, the dentist may recommend the use of saliva substitutes to eliminate dryness, discomfort and prevent caries and inflammation. Another remedy to help cope with dry mouth is chewing gum, which stimulates saliva production. Patients undergoing radiation or chemotherapy are advised to use sugar-free chewing gum.
In addition, it is important for the patient to independently examine the oral cavity (gums, tongue and mucous membranes) daily, paying special attention to pain, bleeding, abrasions and wounds. Regular examinations by a dental specialist who can promptly detect a possible problem and select the necessary treatment are also becoming critically important. In addition, it is very important to visit your dentist before starting radiation or chemotherapy.
List of sources
- Features of dental status in patients with cancer, Uspenskaya O. A., Fadeeva I. I. // Problems of dentistry. 2022. No. 1. - URL: https://cyberleninka.ru/article/n/osobennosti-stomatologicheskogo-statusa-u-patsientov-s-onkologicheskimi-zabolevaniyami (date of access: 09/06/2020).
- WHO outlines measures to save 7 million lives from cancer // WHO, News Release February 4, 2020, Geneva. — URL: https://www.who.int/ru/news-room/detail/04-02-2020-who-outlines-steps-to-save-7-million-lives-from-cancer (access date: 09/06/2020).
- Statistics of oncological diseases in the Russian Federation // Kommersant newspaper No. 28 dated 02/15/2020, p. 2. - URL: https://www.kommersant.ru/doc/4258255 (date of access: 09/06/2020).
- Korolenkova M.V. Dental malformations in children after chemoradiotherapy // Vestn. RONC named after. N. N. Blokhin RAMS. 2015. No. 1. - URL: https://cyberleninka.ru/article/n/poroki-razvitiya-zubov-u-detey-posle-himioluchevogo-lecheniya (date of access: 09/06/2020).
Consultation with an oncologist and chemotherapist at the Vitamed clinic
To identify cause-and-effect relationships in the process of treating the disease, the help of highly specialized specialists may be required, since the disease was provoked by chemotherapy .
It is not difficult to remove the active impact of the disease on the oral cavity; it is necessary to identify the causes of its manifestation, what drugs provoked stomatitis during chemotherapy . This approach to treatment will allow you to avoid its occurrence in the future, since it is of a recurring nature.
You can contact us right now and make an appointment with a specialist who will help you overcome the disease as soon as possible.
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Radiotherapy treatment
Radiation therapy for oral cancer can be remote and contact - brachytherapy, when the radiation source is not in a particle accelerator, but directly in the patient’s body. External beam radiation therapy is used in three variations:
- Independently on the primary lesion and regional lymph nodes in case of small size of the tumor and the impossibility of surgical treatment.
- Adjuvant radiation therapy is carried out after surgical treatment of cancer of the oral mucosa in its later stages. It is recommended to begin postoperative radiation therapy within 6 weeks after the procedure.
- As part of adjuvant chemoradiotherapy for incomplete removal of the tumor, germination of the lymph node capsule and some other unfavorable factors in the later stages of the process.
During this brachytherapy, special needles are installed into the tumor - intrastats, through which radioactive cobalt or iridium (sometimes other elements) are supplied through hoses from the container. Brachytherapy allows you to deliver a high dose of radiation directly to the tumor, minimally affecting healthy tissue, but has several disadvantages that limit its use. These include the need for surgical intervention and fairly complex preparation. The procedure is absolutely contraindicated in case of tumor infiltration into bone tissue and large vessels, as well as active infection at the site of intrastat installation.
Prevention methods
- Get a dental exam. Visit your dentist before starting cancer treatment to take care of any unresolved dental problems, such as gum disease, tooth decay, or teeth that need to be removed. Any pain or infection in your mouth will only get worse as you begin treatment.
- Tell your doctor if you already have mouth ulcers.
- In some cases, medications can prevent ulcers from occurring during chemotherapy. For example, people who suffer from canker sores due to the herpes simplex virus can take antiviral medications to prevent such complications during treatment. Mouth rinsing with the drug dexamethasone may help avoid stomatitis in people receiving the targeted drug everolimus.
- Take care of your teeth. Get into the habit of brushing your teeth and rinsing your mouth several times a day. Check the labels on mouthwashes and avoid products that contain alcohol.
- Stop smoking. If you smoke, quit. Smoking during treatment will make it difficult for your mouth to heal.
- Eat a diet rich in fruits and vegetables. You will need vitamins and nutrients to help your body fight infections during treatment.
Surgery
Depending on the location and extent of the oncological process, various operations are used for the surgical treatment of oral tumors, which can involve the underlying bone tissue. In addition, sometimes reconstructive interventions are also required. At the first and second stages, surgical treatment is usually prescribed alone, and at later stages it is combined with radiation or chemoradiotherapy. During the operation, in addition to intervention on the primary lesion, if necessary and technically possible, the affected regional lymph nodes are removed. An alternative to surgery in the early stages may be a scheme combining external beam radiation therapy with brachytherapy, which involves placing a source of radioactive radiation directly into the affected tissue.
Dietary recommendations if cancer is diagnosed
You should limit your intake of simple sugars or replace them with aspartame, acesulfame, sorbitol or xylitol. Consumption of foods with spicy spices that irritate the mucous membrane should be limited. Preferred food is warm and with mild aromas, with minimal amounts of spices. Avoid fruit juices, particularly sour fresh fruits, both because they taste too strong and because of the risk of enamel erosion. Reduce consumption of coffee, tea and thirst-causing foods (dry biscuits, crackers, chips). Alcohol in any form should be excluded from the diet.
It should be borne in mind that maintaining a balanced diet in patients undergoing chemotherapy and/or radiation therapy poses specific difficulties. There is a change in taste, difficulty swallowing, and nausea and vomiting may occur. In addition, drugs recommended during treatment have an adverse effect on some food ingredients, drugs such as neomycin reduce the absorption of vitamins K and D, methotrexate, in general, affects the metabolism of vitamins, in particular, it reacts with folic acid and most drugs can lead to anorexia.
Nutritional compositions available in pharmacies, in liquid form, containing a set of vitamins, microelements and amino acids that provide calories and nutrients, should complement the daily diet of cancer patients.
In the case of stomatitis, the most effective drugs are oil-based keratoplasties - aecol, vitamin A, E. But their healing effect is not high, these drugs are nothing more than vitamins.
There is a need to use more advanced and effective specialized drugs.
EGF Epidermal growth factor. Belongs to the group of polypeptides. Only a few of its forms are approved for use in Russia; in particular, it is offered by the Moscow company REPLERY in the form of a spray for application to the mucous membrane or skin. The wound healing effect is very high, as is the cost of the drug. It is still used in medicine to a limited extent, but is very widely represented in cosmetology and is included in many cosmetic preparations.
Palifermin is a recombinant human keratinocyte growth factor, a drug close to EGF, certified and used in the European Union
SUMMARY
Prevention of stomatitis in every patient with cancer should be part of therapy. It has a chance of success only due to the proper motivation of the patient himself, his desire and self-discipline. Of course, if a person has cancer, if the doctor sees symptoms of cancer in the mouth, then a request to replace a filling or install prosthetics causes a sarcastic smile in the patient. In addition to unpleasant sensations, there are also expenses, and cancer treatment itself is not cheap.
And then these dentists start the old boring song about the need to have clean teeth. But it should be recalled that dental problems are one of the provoking factors for the occurrence of cancer. Those. Many ended up at the oncologist precisely because of untreated teeth.
And in our practice, we have encountered similar cases. In particular, I remember a case when we diagnosed a patient with cancer that developed under an old removable denture. This was malignancy of the area of the mucous membrane under the prosthesis with deep ulceration and reaction of the regional lymph nodes, classic leukoplakia. Our diagnosis was subsequently confirmed.
But even if the disease does appear, oncologists have developed effective treatment regimens and practice has shown that they are successful in most cases. But oncologists themselves admit that it is not always possible to fully carry out therapy due to the occurrence of complications associated with concomitant diseases.
Any therapy for cancer, and indeed all tumors, is based on one basic principle. Tumor cells are in the stage of constant, avalanche-like division and in this state they have one vulnerability - they are sensitive to X-rays and cytostatic drugs.
Unfortunately, epithelial cells of the gastrointestinal tract and oral cavity are also renewed very intensively. In therapy, they also become targets, although to a lesser extent. There is a chance to keep them intact, eliminating damaging factors.
In conclusion, I would like to warn people against mistakes. The proposed methods of treatment and prevention of complications were found through much trial and error. Medicine is not omnipotent and will never be omnipotent - even if humanity learns to treat all known diseases, they will simply be replaced by new ones and everything will repeat all over again.
But in medicine there are truisms and laws, unshakable axioms. Their fulfillment serves the purpose of recovery. Another thing is that the disease may turn out to be stronger, this is how this world works.
Attempts to reinvent what has already been created and tested by practice are constantly being made; people are ready to believe in a fairy tale, because only a fairy tale always gives hope.
Kerosene with vodka, treating cancer with soda, experiments with excrement - this makes a healthy person smile. But consciousness changes if a formidable illness holds you by the throat. If the doctor sets you up for a difficult and difficult path, then you want to go faster and faster.
If only diseases could be cured so easily, simply by discovering a method.
At the same time, if this is just the beginning of the disease, and the treatment is carried out vigorously and correctly, complete recovery occurs. Diseases are also not omnipotent.
GLOSSARY.
Erythema. Redness of the skin or mucous membranes due to hemostasis in the capillaries.
Erythroplasia (erythroplakia). Red papular or macular lesions of the mucous membrane. Malignancy may occur.
Etiology. Study of the causes of the disease. On the other hand, the cause of the disease.
Scab. A structure formed on tissue caused by cauterization or the application of some destructive substance.
Estrogen. General term for naturally occurring steroid hormones containing the core estrone, estriol estadiol, etc. secreted from the testes, ovaries and placenta; stimulates anabolic protein actions and has a positive effect on nitrogen balance.
Exogenous. Due to external reasons; not occurring in the body.
Fibroblasts. Connective tissue cells; a flattened, irregularly branched cell with a large oval nucleus, which is responsible, in part, for the production and remodeling of the extracellular matrix.
Fibroblast growth factor. A family of growth factors with mitogenic properties for fibroblasts and mesodermal cell types.
Fibronectin. High molecular weight (450 kDa) glycoprotein, consisting of two polypeptides connected by disulfide bonds; the functional domains of the molecule have an affinity for cells and components of the extracellular matrix; found on the surface of cells, in connective tissue, in the blood,
Fibrosis. Fibrous changes in the mucous membranes, especially the gums, resulting from chronic inflammation. Fibrous gums may appear healthy in appearance, masking the underlying disease.
Flow cytometry. Measuring the physicochemical characteristics of individual cells as they move past optical or electronic sensors; can be used to detect specific cells in a mixed population; used to determine the effects of drugs, hormones, chemicals.
General anesthesia. Drug-induced switching off of consciousness, during which patients do not respond to stimulation, even painful stimulation. The ability to independently maintain respiratory function is often impaired. Patients require assistance in maintaining airway function.
Glucocorticoids. A group of corticosteroids secreted from the adrenal cortex (such as cortisol or dexamethasone) that are involved in the metabolism of carbohydrates, proteins, and fats; which regulate the level of glycogen in the liver and blood sugar levels by changing gluconeogenesis.
Glycosaminoglycan. A polysaccharide chain consisting of hexosamines alternating with another carbohydrate residue. proteoglycan component.
GRAFT GRAFT. Any allograft in the form of granules or xenograft granular material placed for the purpose of increasing bone volume or regenerating a bone defect.
Gram stain. A method of classifying bacteria into two groups based on the color of their cell wall, after they are stained either violet (positive) or pale red (negative). Accordingly, bacteria are divided into gram-positive and gram-negative
Growth factors. A diverse group of polypeptides that play an important role in regulating the growth and development of various organs.
Humoral immunity. The immune response is mediated by the secretion of immunoglobulins (antibodies) produced by activated B cells (plasma cells) against antigens.
Hyperkeratosis. Excessive formation of keratin in epithelial cells.
Hypermineralization. The presence of unusual amounts of mineral elements in calcified tissue.
Hyperkeratosis. An abnormal increase in the thickness of the epithelial layer (stratum corneum) of the epithelium.
Hyperostosis. Localized bone overgrowth. See also exostosis.
Hyperplasia. An increase in the size of the tissue structure due to an increase in the number of cells.
Hypophosphatasia. Hypophosphatasia: An inborn error of metabolism characterized by a deficiency of alkaline phosphatase in serum and bone tissue, resulting in the formation of defective bone and cementum.
Hypoplasia. Defective or incomplete development.
There is a flap on the leg. Any flap that is mobilized to a new location using lateral incisions but retains its natural connection at the base to preserve its blood supply.
Autograft graft. Bone chips from the donor site to the recipient site within the same individual. Also known as autogenous graft.
Block graft. Graft. An autogenous or allogeneic bone graft in the form of a block, used to augment bony areas.
Foreign body. an unusual substance in the tissues or body cavity.
Foreign body reaction. Granulomatous reaction around foreign material in a tissue or organ; often characterized by the appearance of giant cells. This can manifest as acute or chronic inflammation of the gums and can lead to inflammation or purulent lesions.
Bridle. A fold of mucosal tissue that attaches the lips and cheeks to the alveolar mucosa (and/or gingiva) and underlying periosteum.
Fistula. Stoma. A pathological canal connecting the cavities of two hollow organs or into an organ cavity with the surface of the body.
Hydroxyapatite (HA). An inorganic compound, CA(P04)6(OH)2, found in the matrices of bones and teeth, which provides rigidity to these structures. Synthetic forms are used in medicine to replace intraosseous defects, as well as to coat dental implants.
Hemostatic instrument. A tool that can be used to stop bleeding. Clamps, clips.
Stages of cancer
Staging, as with other carcinomas, is carried out according to the TNM system, where T is the spread of the primary tumor, N is metastases to regional lymph nodes, M is distant metastases. The value “0” after the letter designation indicates the absence of the attribute.
| Stage | TNM | Explanation |
| I | Т1 N0 M0 | T1 - localized tumor less than 2 cm in size |
| II | Т2 N0 M0 | T2 - localized tumor measuring 2 to 4 cm |
| III | T3 N0 M0 T1-3 N1 M0 | T3 - localized tumor more than 4 cm N1 - involvement of one node on the affected side with its enlargement up to 3 cm. |
| IVA | Т1-3 N2 М0 Т4a N0-2 М0 | T4a - germination into bones, maxillary sinus, skin, muscles. N2 - involvement of one node on the affected side with its increase from 3 to 6 cm, or in several nodes < 6 cm, or on the opposite side < 6 cm |
| IVB | Т4b N0-3 М0 Т0-4b N3 М0 | T4b - growth into the base of the skull, pterygopalatine space, base of the skull, carotid artery. N3 - damage to nodes with their enlargement over 6 cm |
| IVC | Any T and N at M1 | M1 - distant metastases |
When treated in the early stages, the 5-year survival prognosis is more than 85% for the first stage and 60-80% for the second. In later stages, this indicator is worse (20 - 50%), and the patient requires combined treatment.
Efficacy of antiemetic therapy
Treating complications of chemotherapy, such as nausea and vomiting, can be beneficial. The arsenal of drugs that provide the prevention and treatment of nausea and vomiting is very large. Their combined use can prevent the appearance of these symptoms in 90% of cases.
Full control: no vomiting after administration of antiemetic drugs,
mild nausea
Partial control: one episode of vomiting or mild nausea
Using Probiotics
The microflora of the oral cavity, like the intestinal flora, is divided into beneficial, pathogenic and opportunistic. Accordingly, for successful treatment of stomatitis after chemotherapy, the number of beneficial bacteria must be sufficient to suppress harmful microorganisms that can aggravate the course of the disease. Probiotics are found both in food products (fermented milk, fermented) and in special preparations. Among the drugs, it is worth choosing liquid ones, which contain live strains of bacteria that can quickly begin their work.
Consult your doctor; for some types and complications of cancer, probiotics are not recommended for use.
Risk factors for developing nausea and vomiting
There are various causes that predispose to nausea and vomiting. First of all, these are the characteristics of the drug used or their combination.
The individual characteristics of the patient are of great importance:
- Age under 50
- Female
- Tendency to motion sickness in transport
- Presence of morning sickness during pregnancy
- Having had nausea and vomiting during a previous chemotherapy cycle
- Rare alcohol consumption
Chemotherapy is most difficult for women and patients under 30 years of age.
