It is cancer of the mouth.
Oral cancer most frequently involves the lips or the tongue and it can also occur in:
· The lining of the cheeks.
· The floor of the mouth.
· The gums (gingiva)
· Roof of the mouth (palate)
Smoking and other uses of tobacco are associated to the majority of oral cancer cases Excess consumption of alcohol also increases the risk of oral cancer.
Other factors that can increase the risk of developing oral cancer are:
· Chronic irritation (caused for example by sharp edges of teeth, dentures, rough fillings).
· Human papillomavirus infection (HPV).
· Taking medicine that weakens the immune system (immunosuppressants).
· Deficient oral and dental hygiene.
Some cases of oral cancer start as a white plaque (leukoplakia) or as an oral ulcer.
Lesion, tumor or an ulcer:
· It can be a deep fissure with an indurated tissue border.
· It most frequently has a pale color, but can be dark or pigmented.
· It can be in the tongue, the lip or in another area of the mouth.
· It is generally painless at the beginning (it can produce a burning sensation or pain when the tumor is advanced).
Other symptoms that can occur in oral cancer are:
· Problems chewing.
· Oral ulcers.
· Pain while swallowing.
· Difficulty speaking.
· Difficulty swallowing.
· Inflammation of cervical lymph nodes.
· Tongue problems.
· Weight loss.
TESTS AND EXAMS
The doctor of the dentist will examine the area of the mouth. The exam can show:
· A wound in the lips, tongue or in another area of the mouth.
· An ulcer or bleeding.
The tests applied to confirm oral cancer are:
· Biopsy of the gums..
· Biopsy of the tongue.
X-rays and CT scans can be taken to determine whether the cancer has spread or not.
The surgical removal of the tumor is generally recommended if the tumor is small enough. Surgery can be used along with radiotherapy and chemotherapy for the bigger tumors. Frequently surgery is not done if the cancer has spread to the lymph nodes in the neck.
Other treatments can include: Speech language therapy or other therapies that improve movement, mastication, swallowing and speech.
Approximately more than half of the persons with oral cancer will live more than five years after receiving the diagnosis and treatment. If cancer is detected on time, before it has spread to other tissues, the cure rate is almost 90%. However, more than half of the oral cancers have already spread when they are detected. The majority have disseminated to the throat or the neck.
· Radiotherapy complications can include oral dryness and difficulty swallowing.
· Face, head and neck disfigurement after surgery.
· Cancer can disseminate (metastasis).
· Avoid smoking or the use of tobacco.
· Correct dental problems.
· Limit or avoid the consumption of alcohol.
· Practice good oral hygiene.
It can be called cancer of the mouth, oral cancer, squamous cell oral carcinoma, cancer of the head and neck.
Evaluation of patients with hematopoietic stem cell transplantation
Poor oral hygiene is often associated with increased incidence and severity of oral complications in patients with cancer; therefore it is necessary to adopt a proactive approach to achieve oral stabilization before treatment. The principal preventive measures such as an appropriate nutritional intake, effective oral hygiene and early detection of oral lesions are important interventions that should be done before treatment.
An oral evaluation and the management of patients who are undergoing myeloablative chemotherapy should occur as soon as possible prior to initiation of treatment (see list on the stabilization of oral disease before chemotherapy or the hematopoietic stem cell transplantation below). For maximum results, the oncology team should clearly advise the dentist of the patient’s medical status and oncology treatment plan. In turn, the dental team should delineate and communicate an oral disease management care plan for before, during and after the oncologic treatment.
Data provided by the dental providers to the oncology team:
Dental caries (number of teeth and severity, including the number of teeth that should be treated before the cancer treatment).
Teeth with pulp infections.
Teeth with periapical infections.
Periodontal disease state.
Number of teeth requiring extraction.
The need of any other urgent attention.
Time required for complete stabilization of the disease.
The overall objective is to determine a comprehensive oral care plan that eliminates or stabilizes oral disease that could otherwise produce complications during or after chemotherapy. Achieving this goal will most likely reduce risk of oral toxicities with resultant reduced risk for systemic sequelae.
Specific interventions are aimed at:
Dental caries and endodontic disease.
Anomalies of the Salivary Glands.
Evaluation of patients with hematopoietic stem cell transplantation
Oral complications are related to the current systemic and oral health, oral manifestations of underlying disease and oral complications of recent cancer treatments or other medical therapies. During this period, we must eliminate the possibility of trauma and clinically significant infections, including dental caries, periodontal disease and infection of the pulp.
Hypoactivity of the salivary glands or xerostomia secondary to anticholinergic drugs and the dysfunction of taste are initially detected at this stage, the toxicity typically resolves within 2 or 3 months.
Allogeneic transplant patients may present hyperacute graft versus host disease (GVHD) although this is not common it can result in significant impairment and inflammation of the oral mucosa that may complicate the patient’s oral course. The clinical presentation usually will not be different enough to diagnose the injury. Clinical assessment is usually based on the fact that the patient will have a more severe mucositis than expected; it will usually not heal within the normal recovery time for oral mucositis caused by chemotherapy.
The frequency and severity of acute oral complications typically begin to decrease about 3 or 4 weeks after cessation of chemotherapy. Healing of the oral mucositis in the context of the regeneration of the bone marrow contributes to this dynamic. Although immune reconstitution is developing, the immune defenses of the oral mucosa may not be in optimal condition. It has been generally established that immune reconstitution will take between 6 and 9 months in autologous transplant patients and between 9 and 12 months for allogeneic transplant patients who do not develop chronic GVHD. Thus, the patient remains at risk for certain infections, including yeast infection and herpes simplex virus infections.
Bacterial Mucositic infection occurs less frequently during this stage, unless there is a delay in the graft or if the patient presents acute GVHD, or if he is under treatment for GVHD. Most centers will use prophylaxis against systemic infection during this period (and many instances, even longer) to reduce the risk of infection in general, a practice that positively influences the rate and severity of both the oral and the systemic infection.
The patient with hematopoietic stem cell transplantation represents a unique cohort at this time. For example, the risk of acute oral GVHD arises characteristically during this phase in patients who received allogeneic graft.
IMMUNE RECONSTITUTION AND RECOVERY FROM OF SYSTEMIC TOXICITY.
Oral lesions are mainly related to a regimen of chronic conditioning (chemotherapy with or without radiation therapy) to the toxicity and in the allogeneic patient, GVHD. Late oral infections predominate and xerostomia. Bacterial infections of the mucosa are rare unless the patient remains neutropenic or has a severe chronic GVHD.
There is risk of graft failure, cancer recurrence and there is risk of secondary cancers appearing. The patient of hematopoietic stem cell transplantation may develop oral manifestations of chronic GVHD during this period.
LONG TERM SURVIVAL
Patients who have long term survival from cancer and were treated with high dose chemotherapy, alone or as chemo –radiotherapy, have in general, few significant permanent oral complications.
All other chronic complications induced by radiation are related to the total dose and the schedule of the radiation therapy. Regimens that incorporate total body irradiation may cause xerostomia or salivary gland hypofunction, which constitutes the oral complication from which we have gathered more information about. In autologous transplant patients in addition to the non autogenous, there may be permanent dysfunction of the salivary gland. Other significant complications include craniofacial growth and development anomalies in pediatric patients and the emergence of secondary tumors in the head and neck region.
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