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ROCHMAN MUJAYANTO, DRG., SP.PM
DEPARTEMEN IPM FKG UNISSULA
TREATMENT ORAL CANCER
The level and the type of toxicity of the treatment greatly depend on :
the overall immune status of the patient prior to and during
chemotherapy,
the regimen it self,
the frequency and the dosage of the treatment,
the route of administration,
the type of tumor
Oral mucositis is an iatrogenic condition The initial condition is often described as
of erythematous inflammatory changes a burning or tingling sensation making
which tends to occur on buccal and the mouth hypersensitive to foods.
labial surfaces, the ventral surface of the
tongue, the floor of the mouth, and the
soft palate of patients receiving the condition progresses, eating,
chemotherapy swallowing, and talking become
increasingly difficult
The acute efects usually develop early in the radiation treatment period
and persist 2-3 weeks ater completion of treatment, whereas the late
efects may become evident at any time after treatment completion,
ranging from weeks to years
Xerostomia is perhaps the most commonly reported oral squela among
patients receiving radiotherapy for head and neck cancers.
Ionizing radiation may cause saliva becomes “scant, sticky, and viscous.”:
irreversible damage to glandular tissue and loss of salivary luid secretion;
The progressive glandular atrophy and fibrosis and the reduction in salivary
outlow occur shortly ater the initial exposure to radiation and intensify
there after
Xerostomia is associated with as little as two or three doses of 2Gy
each, whereas doses greater than 30Gy can usually result in
permanent or semipermanent xerostomia
Dryness of the mucosa may put the patient
at risk of oral infections
dificulties in speech, chewing, and swallowing,
increase the susceptibility to dental caries
compromise the mucosal integrity
Dysgeusia can occur at a rapid rate and be exacerbated at up to an
accumulated dose of 30Gy, then the progress of taste deterioration
would slow down as perception for all four tastes, that is, salty, sweet, sour,
and bitter, approaches zero
Mucositis :
Analgetic & anastetikum mouthwash
ice chips to the mouth every 30 minutes for prevention and
treatment of oralmucositis in patients undergoing
chemotherapy.
Bacterial infection :
a combination of penicillin and metronidazole, followed by routine dental
procedures if necessary
Oral hygiene practice by gentle brushingwith a sot bristle tooth brush and losing
using an antimicrobial mouthwash a chlorhexidine-containingmouthwash is
generally recommended
Candidiasis : systemic fluconazole (100–
200mg/day for 2 weeks) for the
topical antifungal agents are
management of moderate to
commonly prescribed for their
severe infections
lower risk of side efects and drug
interactions
Clotrimazole troches and nystatin fluconazole resistant cases,
pastilles are the irst line drugs for itraconazole capsules (200mg/day
mild oropharyngeal candidiasis for 2–4 weeks) or itraconazole oral
solution (200mg/day for 2 weeks)
Viral Infections HSV
Oral prophylaxis can be accomplished with acyclovir at the dose of
200 - 800mg thrice a day or valacyclovir at the dose of 500mg twice a
day
http://screening.iarc.fr/atlasoral.php
Epstein_et_al-2012-CA__A_Cancer_Journal_for_Clinicians.pdf
Lalla et al, Management of Oral Mucositis in Patients with Cancer, Dent
Clin North Am. 2008 January ; 52(1): 61–viii
Yardimci G, Kutlubay Z, Engin B, Tuzun Y. Precancerous lesions of oral
mucosa. World J Clin Cases 2014; 2(12): 866-872
Cancer / editors, Hellen Gelband, Prabhat Jha, Rengaswamy
Sankaranarayanan, Susan Horton. 2015
https://www.hindawi.com/journals/tswj/2014/581795/
Refference