Oral complications of cancer and its management

Oral Complications of Cancer and its Management www.pdflobby.com This page intentionally left blank www.pdflobby.com Oral Complications of Cancer and its Management Edited by Dr Andrew N Davies Consultant in Palliative Medicine Royal Marsden Hospital UK Prof Joel B Epstein Professor of Oral Medicine Otolaryngology and Head and Neck Cancer University of Illinois at Chicago USA www.pdflobby.com Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York © Oxford University Press, 2010 The moral rights of the author have been asserted Database right Oxford University Press (maker) First published 2010 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Oral complications of cancer and its management / edited by Andrew Davies, Joel Epstein p ; cm Includes bibliographical references ISBN 978–0–19–954358–8 (alk paper) Mouth—Cancer—Complications I Davies, Andrew, 1963- II Epstein, Joel, Dr [DNLM: Neoplasms—complications Oral Manifestations QZ 202 O625 2010] RC280.M6O743 2010 616.99'431—dc22 Typeset by Glyph International, Bangalore, India Printed in Great Britain on acid-free paper by The MPG Biddles Group ISBN 978–0–19–954358–8 10 Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations The authors and publishers not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding www.pdflobby.com Preface Globally, oral and pharyngeal cancers are leading sites of disease, and overall they make up the eighth most common site in men In the United States of America, there are about 1.5 million new cases of cancer diagnosed each year, and more than 35 000 of these cancers involve the oral and pharyngeal sites In spite of advances in surgery, radiation therapy, and chemotherapy, the overall 5-year survival rate has not significantly improved over recent years (~59%) The reason for the relatively poor survival is the often advanced presentation of the disease, stemming from the often delayed diagnosis of the problem In an attempt to improve survival, treatments have become even more aggressive, frequently resulting in ever more complex and/or more severe oropharyngeal complications Similar issues of tumour control occur in cancers of other systems, and, not surprisingly, similar strategies have been adopted in the management of these cancers, i.e the use of more aggressive treatments in an attempt to improve survival rates Indeed, many patients with more common malignancies now undergo extremely toxic chemotherapy, and even a bone marrow or stem cell transplant, in an attempt to arrest or ‘cure’ the tumour Many of these systemic treatments can cause a variety of oral complications A common and critical adverse effect is oral mucositis, which is associated with physical problems (e.g pain, impaired nutritional intake), psychological problems, decreased quality of life, and at times can even be life threatening Furthermore, oral mucositis is associated with increased healthcare expenditure (e.g more medications, longer hospital stays) This unique book serves as an outstanding resource for the many oral complications of cancer and its treatment It is written by international authorities in their respective specialties, and includes contributions from all of the members of the multi-professional oncology team The book comprises 30 chapters, and includes extensive tables, figures, clinical photographs, and references to aid the understanding of the text It covers topics such as oral anatomy and physiology, oral assessment and oral hygiene, as well as the more common oral complications of cancer and its treatment Surgical, radiation therapy, and chemotherapy responses are detailed in overview chapters, whilst specific problems are discussed in detail in separate chapters (e.g oral mucositis, osteonecrosis of jaw bones) Other chapters focus on oral infections, and oral symptoms experienced by patients with cancer (e.g xerostomia, taste disturbance) Furthermore, there are chapters addressing the needs of specific groups of patients (paediatric patients, geriatric patients, patients with advanced cancer), and the health economic impact of oral complications It is envisaged that the availability of this comprehensive, evidence-based (when available), practical reference text will help facilitate all healthcare professionals involved in the care of patients with cancer to provide the most appropriate care for the oral complications of cancer and its treatment It is a welcome addition to the available resources in this area of practice Prof Sol Silverman Professor of Oral Medicine University of California, San Francisco, USA www.pdflobby.com This page intentionally left blank www.pdflobby.com Contents Contributors ix Introduction Andrew Davies and Joel Epstein The oral cavity 11 Anita Sengupta and Anthony Giles Oral assessment 21 Michael Brennan and Peter Lockhart Common oral conditions 27 Katherine Webber and Andrew Davies Pretreatment screening and management 35 Peter Stevenson-Moore, Debbie Saunders, and Joel Epstein Oral hygiene 43 Petrina Sweeney and Andrew Davies Oral cancer 53 Crispian Scully and Jose Bagan Other tumours of the oral cavity 65 Barbara Murphy, Jill Gilbert, and Anderson Collier III Overview of complications of oral surgery 79 Antonia Kolokythas and Michael Miloro 10 Overview of complications of radiotherapy (radiation therapy) 89 Kate Newbold and Kevin Harrington 11 Trismus 99 Pieter Dijkstra and Jan Roodenburg 12 Post-radiation osteonecrosis (osteoradionecrosis) of the jaws 117 Fred Spijkervet and Arjan Vissink 13 Overview of complications of systemic chemotherapy 123 Douglas Peterson and Rajesh Lalla 14 Oral complications of haematopoietic stem cell transplantation 129 Sharon Elad, Judith Raber-Durlacher, and Michael Y Shapira 15 Oral mucositis 141 Stephen Sonis and Nathaniel Treister 16 Bisphosphonate-related osteonecrosis of the jaws 151 James Sciubba and Joel Epstein 17 Oral infections – introduction 163 Susan Brailsford and David Beighton www.pdflobby.com viii CONTENTS 18 Oral fungal infections 171 Lakshman Samaranayake and Mohaideen Sitheeque 19 Oral bacterial infections 185 Anthony Chow 20 Oral viral infections 195 Deborah Lockhart and Jeremy Bagg 21 Salivary gland dysfunction 203 Andrew Davies 22 Taste disturbance 225 Carla Ripamonti and Fabio Fulfaro 23 Halitosis 233 Stephen Porter 24 Orofacial pain 241 Paul Farquhar Smith and Joel Epstein 25 Miscellaneous oral problems 253 Andrew Davies 26 Oral care in paediatric cancer patients 261 Alessandra Majorana and Fulvio Porta 27 Oral supportive care and the geriatric oncology patient 271 Ira R Parker, Joanne E Mortimer, and Joel Epstein 28 Oral care in advanced cancer patients 279 Andrew Davies 29 Quality of life and health economics 291 Jennifer Beaumont, David Cella, and Joshua Epstein 30 Sources of information 301 Andrew Davies and Joel Epstein Index 305 www.pdflobby.com Contributors Dr Jose Bagan Professor of Oral Medicine, Valencia University, Valencia, Spain Prof Jeremy Bagg Professor of Clinical Microbiology, University of Glasgow Dental School, Glasgow, UK Dr Anderson Collier III Assistant Professor of Pediatric Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, USA Dr Andrew Davies Consultant in Palliative Medicine, The Royal Marsden Hospital, Sutton, UK Dr Jennifer Beaumont Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA Prof Pieter Dijkstra Professor of Clinical Epidemiology, University Medical Center Groningen, Groningen, The Netherlands Prof David Beighton Professor of Oral Microbiology, KCL Dental Institute, London, UK Dr Sharon Elad Department of Oral Medicine, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel Dr Susan Brailsford Consultant in Epidemiology and Health Protection, NHS Blood and Transplant, London UK Prof Joel Epstein Professor of Oral Medicine, Otolaryngology and Head and Neck Cancer University of Illinois at Chicago, Chicago, USA Dr Mike Brennan Department of Oral Medicine, Carolinas Medical Center, Charlotte, USA Prof David Cella Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, USA Prof Anthony Chow Division of Infectious Diseases (Faculty of Medicine), University of British Columbia, Vancouver, Canada Dr Joshua Epstein Manager Medical Outcomes Research and Economics, Baxter Bioscience, Westlake Village, USA Dr Paul Farquhar-Smith Consultant Anaesthetist, The Royal Marsden Hospital, Sutton, UK Dr Fabio Fulfaro Department of Surgery and Oncology, University of Palermo, Palermo, Italy www.pdflobby.com (a) (b) (c) Fig 3.3 a) Normal appearance of teeth and periodontal tissues; b) example of amalgam restorations; c) example of gold crown Fig 4.1 Racial pigmentation Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford www.pdflobby.com Fig 4.2 Oral varicosity Source: Reproduced with permission from MP Sweeney and J Bagg (1997), Making Sense of the Mouth Partnership in Oral Care, Glasgow Fig 4.3 Fissured tongue Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford Fig 4.4 Geographic tongue Source: Reproduced with permission from MP Sweeney and J Bagg (1997), Making Sense of the Mouth Partnership in Oral Care, Glasgow www.pdflobby.com Fig 4.5 Black hairy tongue Source: Reproduced with permission from MP Sweeney and J Bagg (1997), Making Sense of the Mouth Partnership in Oral Care, Glasgow Fig 4.6 Recurrent minor aphthous ulceration Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford Figure 7.1 Squamous cell carcinoma of lip www.pdflobby.com Figure 7.2 Squamous cell carcinoma of tongue CTV1 - high dose region; CTV2 - elective dose region Fig 10.1 Axial image of IMRT plan for a right base of tongue tumour with sparing of both parotid glands Fig 12.1 Post-radiation osteonecrosis (osteoradionecrosis) of the mandible www.pdflobby.com Fig 12.3 Cutaneous fistula secondary to post-radiation osteonecrosis Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford Fig 14.1 Acute graft-versus-host disease of oral cavity Fig 14.2 Mucocoeles complicating chronic graft-versus-host disease www.pdflobby.com Initiation (I) Primary damage response and signal amplification (II/III) Normal Ulceration (IV) Healing (V) Epithelium Radiation/ Chemotherapy Proliferating basal cells Pseudomembrane (fibrin, dead cells, and bacteria) Basal cell Reactive oxygen species (ROS) Pro-inflammatory cytokines, proteins Anti-inflammatory cytokines Nuclear factor kappa-B (NFκB) Tumor necrosis factor (TNF) Interleukin (IL)-6, IL-1 Ceramide synthase Submucosa Basal membrane Blood vessel Macrophage Fibroblast Normal Initiation (I) DNA inside Cytoplasm nucleus Primary damage response and signal amplification (II/III) Pathway mediator Radiation adiation ROS Generation of ROS Macrophage NFκB Basal epithelium cell Fibroblast Macrophage Lethal Nonlethal Pathw Pathway thway DNA damage DNA damage ROS indu induction (Clonogenic cell death) IκB Chemothe apy Chemotherapy Healing (V) Bacteria Pseudomembrane Macrophage Threshold of cell death results in ulcer TNF NFκB TNF activates more NFκB Surface receptors Pathway mediators Blood vessel Ulceration (IV) Production of NFκB activated DNA damage, pro-inflammatory injury and NFκB by ROS, cytokines activates death radiation TNF Production of TNF, proteins Tissue injury and cell death Macrophage Production of cytokines Production of ceramide synthase inducing apoptosis in submucosal cells ROS Lethal DNA damage Macrophage Signals from the extracellular matrix direct basal epithelial cells to migrate, proliferate, and differentiate Bacteria present in ulcer pseudomembrane activate macrophages in submucosa to produce more cytokines resulting in more inflammation Fig 15.1 The pathobiology of mucositis Source: Reproduced with permission from Sonis ST (2007) Pathobiology of oral mucositis: novel insights and opportunities J Support Oncol, 5(9 Suppl 4), 3–11 www.pdflobby.com Fig 15.2 Early mucositis with generalized erythema and spotty ulceration in a patient undergoing radiation therapy for carcinoma of palate Fig 15.3 Advanced mucositis with confluent ulceration of the lower lip in a patient undergoing induction chemotherapy for acute lymphoblastic leukaemia (ALL) Fig 16.3a Patient with bisphosphonate-related osteonecrosis of the jaws (BRON) at presentation: clinical photograph shows two sites of exposed alveolar bone (Stage BRON) www.pdflobby.com Fig 16.4a Same patient four months after presentation: clinical photograph shows increased area of exposed alveolar bone Fig 16.5a Same patient fourteen months after presentation: clinical photograph shows the sequestrum Fig 18.1 Pseudomembranous candidosis Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford www.pdflobby.com Fig 18.2 Denture stomatitis Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford Fig 18.3 Angular cheilitis Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford Fig 18.4 Median rhomboid glossitis Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford www.pdflobby.com Fig 19.1 Early dental caries Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford Fig 19.2 Advanced dental caries Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford Fig 19.3 Simple gingivitis Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford www.pdflobby.com Fig 19.4 Necrotizing gingivitis Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford Fig 20.1 Primary herpes simplex virus infection (primary herpetic gingivostomatitis) Source: Reproduced with permission from MP Sweeney and J Bagg (1997), Making Sense of the Mouth Partnership in Oral Care, Glasgow www.pdflobby.com Fig 20.2 Secondary herpes simplex virus infection (herpes labialis) Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford Fig 20.3a Secondary herpes simplex infection in immunocompromised patient Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford www.pdflobby.com Fig 20.3b Secondary herpes simplex infection in immunocompromised patient Source: Reproduced with permission from MP Sweeney and J Bagg (1997), Making Sense of the Mouth Partnership in Oral Care, Glasgow (a) (b) Fig 20.4 Secondary varicella zoster infection ((a) facial and (b) oral components) www.pdflobby.com Fig 20.5 Oral hairy leukoplakia Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford Fig 20.6 Kaposi’s sarcoma Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford www.pdflobby.com Fig 20.7 Oral wart (HPV infection) Source: Reproduced with permission from Davies A and Finlay I (2005), Oral Care in Advanced Disease Oxford University Press, Oxford Fig 26.6 Enamel hypoplasia following chemotherapy www.pdflobby.com .. .Oral Complications of Cancer and its Management www.pdflobby.com This page intentionally left blank www.pdflobby.com Oral Complications of Cancer and its Management Edited by Dr Andrew... Management The standard of care in the management of cancer, and the management of cancer- related oral problems, involves the utilization of multi-disciplinary teams (MDTs) and the adoption of. .. for the oral complications of cancer and its treatment It is a welcome addition to the available resources in this area of practice Prof Sol Silverman Professor of Oral Medicine University of California,