Orofacial Supportive Care in Cancer : A Contemporary Oral Oncology Perspective

This easy-to-use book equips clinicians and health care professionals with all the information that they will require in order to identify and manage orofacial complications of cancer therapy. Readers will find precise information on the presenting symptoms and signs associated with local or systemic complications associated with individual drugs or modes of therapy in cancer care. Guidance is provided whenever possible on the initial examinations to be performed in each circumstance and the investigations that can deliver a definitive diagnosis. The effective management of cancer complications are explained with the help of up to date clinical practice guidelines for the management of complications secondary to cancer therapy. In addition, an introductory section outlines contemporary principles of cancer management based on precision oral oncology principles. The text is supported by numerous highly informative clinical photographs, tables and a bibliography. Preface Contents Editors and Contributors About the Editor Contributors 1: Introduction to Modern Cancer Diagnosis and Survivorship 1.1 Cancer Control 1.2 Screening and Early Diagnosis 1.3 Survivorship 1.4 Opportunities for Precision Medicine and Oncology 1.5 Challenges in Cancer Supportive Care Bibliography 2: Hematologic Malignancies, Classification, and Update on Modern Interventions 2.1 Introduction 2.2 Classification 2.2.1 Leukemias 2.2.1.1 Clinical Features 2.2.1.2 Diagnosis 2.2.1.3 Management Acute Leukemia Chronic Leukemia 2.2.2 Lymphomas 2.2.2.1 Clinical Manifestations 2.2.2.2 Diagnosis 2.2.2.3 Staging 2.2.2.4 Treatment Indolent Lymphomas Aggressive Lymphomas Hodgkin Lymphoma (HL) 2.2.3 Myeloma 2.2.3.1 Diagnosis 2.2.3.2 Management 2.2.4 Myeloproliferative Neoplasms 2.2.4.1 Clinical Features 2.2.4.2 Treatment 2.2.5 Myelodysplastic Syndrome (MDS) 2.2.5.1 Clinical Features 2.2.5.2 Treatment CAR-T Cell Therapy Side Effects of Therapies Used in Hematologic Malignancies Oral Side Effects Bibliography 3: Solid Tumours and Update on Modern Medical Oncology Interventions 3.1 Introduction 3.2 The Evolution of Targeted and Immunotherapies 3.3 Targeted Therapies 3.4 Immunotherapies 3.5 Systemic Treatments to Manage Head and Neck Cancer 3.5.1 Neoadjuvant Chemotherapy 3.5.2 Primary Chemoradiotherapy 3.5.3 Adjuvant Therapy 3.6 Recurrent or Metastatic Head and Neck Cancer 3.7 Monoclonal Antibodies 3.7.1 Tyrosine Kinase Inhibitors 3.7.2 Angiogenesis Inhibitors 3.7.3 mTOR Inhibitors 3.7.4 Checkpoint Inhibitors and Other Immunotherapies 3.8 Conclusions Bibliography 4: Principles and Practice of Radiation Oncology and Modern Radiation Therapy Techniques 4.1 Introduction 4.2 Radiobiology 4.2.1 Radioprotection and Radiosensitization 4.3 Medical Imaging 4.3.1 Computer Science 4.3.2 Medical Physics 4.4 Goals of Radical Treatments 4.5 Goals of Palliative Treatments 4.6 Conclusion Bibliography 5: Oral Mucositis 5.1 Introduction 5.2 Epidemiology 5.2.1 Radiotherapy for Head and Neck Cancers (HNCs) 5.2.2 Chemotherapy 5.2.3 Hematopoietic Stem Cell Transplantation (HSCT) 5.2.4 Targeted Therapy 5.3 Risk Factors 5.3.1 Age 5.3.2 Gender 5.3.3 BMI 5.3.4 Smoking 5.3.5 Genetic Factors 5.3.6 The Tumor 5.3.7 Oral Environment 5.3.8 Comorbidities 5.4 Pathogenesis 5.4.1 Five-Phase Model 5.4.2 Emerging Evidence 5.4.3 A New Era of Oral Complications 5.5 Clinical Presentation 5.6 Clinical and Economic Consequences 5.6.1 Outcome Assessment Measures 5.6.1.1 Clinician-Reported Outcome Measures 5.6.1.2 Patient-Related Outcome Measures 5.7 Treatment and Prevention 5.8 Summary Bibliography 6: Oral Bacterial, Viral, and Fungal Infections 6.1 Introduction 6.2 Bacterial Infections 6.2.1 Odontogenic Infections 6.2.2 Pericoronitis 6.2.3 Periodontitis 6.2.4 Prevention 6.2.5 Treatment 6.3 Fungal Infections 6.3.1 Oropharyngeal Candidiasis (OPC) 6.3.1.1 Risk Factors 6.3.1.2 Classification and Clinical Presentations 6.3.1.3 Diagnosis 6.3.1.4 Prevention 6.3.1.5 Treatment 6.3.2 Deep Fungal Infections 6.4 Viral Infections 6.4.1 Human Herpesvirus (HHV) 6.4.1.1 Herpes Simplex Virus (HSV) 6.4.1.2 Varicella-Zoster Virus (VZV) 6.4.1.3 Epstein-Barr Virus (EBV) 6.4.1.4 Cytomegalovirus (CMV) 6.4.1.5 Management of HHV Infections 6.4.2 Human Papillomavirus (HPV) Bibliography 7: Salivary Gland Diseases, Hyposalivation, and Xerostomia in Head and Neck Cancer Patients 7.1 Introduction 7.2 Normal Salivary Gland Function and Role of Saliva 7.2.1 Hyposalivation and Xerostomia 7.3 Impact of Cancer Therapy on Salivary Gland Function 7.3.1 Radiation Therapy 7.3.2 Chemotherapy 7.3.3 Radioactive Iodine Treatment 7.3.4 Conditioning Total Body Irradiation/Chemotherapy and Hematopoietic Stem Cell Transplantation 7.4 Management of Hyposalivation and Xerostomia 7.4.1 Prevention Strategies 7.4.1.1 Limiting Radiation Doses 7.4.1.2 Intensity-Modulated Radiation Therapy (IMRT) 7.4.1.3 Amifostine 7.4.2 Secretory Stimulants: Muscarinic Agonists 7.4.3 Gustatory and Masticatory Salivary Stimulants 7.4.4 Saliva Substitutes/Mucosal Lubricants 7.4.5 Alternative Management Options 7.4.5.1 Surgical Transfer of Submandibular Gland/Seikaly-Jha Procedure 7.4.5.2 Acupuncture 7.4.5.3 Hyperbaric Oxygen (HBO) Treatment 7.5 Discussion and Conclusion Bibliography 8: Soft Tissue and Hard Tissue Necrosis 8.1 Introduction 8.2 Definitions 8.3 Current Knowledge 8.4 Clinical Presentation 8.5 Classification 8.5.1 ORN Staging 8.5.2 MRONJ Stages 8.6 Guidelines for Soft Tissue and Hard Tissue Management 8.6.1 Management of ORN 8.6.2 Management of MRONJ 8.6.3 Specific Management Including Follow-Up and Referral Bibliography 9: Temporomandibular Joint Disorders and Trismus in Head and Neck Cancer Patients 9.1 Introduction 9.2 Implications of Trismus on Cancer Patients 9.3 Etiology of Trismus in Cancer Patients 9.3.1 Mechanical Impediment 9.3.2 Neuromuscular Reflectory Spasm 9.3.3 Radiation Therapy 9.3.4 Ablative Procedures 9.3.5 Prolonged Immobilization 9.3.6 Combined Toxicities 9.3.7 Jaw Fracture and Hardware Failure 9.4 Prevention of Trismus 9.5 Treatment of Trismus 9.5.1 Physical Therapy 9.5.2 Pharmacologic Therapy 9.5.3 Release Surgery 9.5.4 Miscellaneous 9.6 Summary Bibliography 10: Drug-Specific Orofacial Complications of Novel Anti-cancer Therapies 10.1 Introduction 10.2 Targeted Therapy: MABs and TKIs 10.2.1 Introduction 10.3 Angiogenesis 10.3.1 Introduction 10.4 The Epidermal Growth Factor Receptor Family 10.5 Monoclonal Antibodies Targeting EGFR 10.6 Tyrosine Kinase Inhibitors Targeting EGFR/HER2 10.7 Targeting the BRAF Mutation 10.8 Immune Checkpoint Inhibitors 10.9 Other Agents in Current Use 10.9.1 Multi-kinase Inhibitors 10.9.2 ALK Inhibitors 10.9.3 Poly (ADP-Ribose) Polymerase Inhibitors 10.10 Drugs Targeting the Cell Cycle 10.11 Examples and Management of Specific Orofacial Complications 10.11.1 Stomatitis 10.11.1.1 Background 10.11.1.2 Management 10.11.2 mTor Inhibitor-Associated Stomatitis (MIAS) 10.11.2.1 Background 10.11.2.2 Management 10.11.3 Dysgeusia and Xerostomia 10.11.4 Immune-Related Adverse Events 10.12 Conclusion Bibliography 11: Dysphagia in Head and Neck Cancer 11.1 Introduction 11.2 Assessment 11.3 Pathophysiology 11.3.1 Tissue Loss 11.3.2 Tissue Damage 11.4 Impact 11.4.1 Weight Loss and Feeding Tube Placement 11.4.2 Nutritional Deficiency 11.4.3 Stricture 11.4.4 Aspiration 11.4.5 Treatment Delays and Interruptions 11.4.6 Psychosocial Impact 11.5 Prevalence of Dysphagia 11.5.1 Baseline 11.5.2 Acute and Early Recovery 11.5.3 Late Post-treatment Dysphagia 11.6 Odynophagia 11.6.1 Mucositis-Associated Odynophagia 11.6.1.1 Site-Specific Considerations 11.6.1.2 Technique-Specific Considerations 11.6.1.3 Time Course of Oral Mucositis 11.7 Mucosal Sensitivity 11.8 Management: The Need for a Systematic Team Approach 11.8.1 Pharmacological Therapy 11.8.2 Surgical Considerations 11.8.3 The Role of the Radiation Oncology Team, Including Radiation Dosimetrists and Medical Physicist 11.8.4 The Role of the Speech and Language Pathologist 11.8.4.1 Education 11.8.4.2 Assessment of Swallow Function 11.8.4.3 Rehabilitation: Compensatory Measures and Swallow Exercises 11.8.4.4 Dietary Recommendations 11.8.4.5 Barriers to Care 11.8.4.6 Telemedicine: Cost-Effectiveness and Alternative Models of Care Delivery 11.9 Summary Bibliography 12: Chemosensory Dysfunction in Head and Neck Cancer Patients 12.1 Introduction 12.2 Anatomy of Smell and Taste 12.3 Impact of Chemosensory Dysfunction 12.4 Measurement of Taste and Smell 12.5 Causes of Chemosensory Dysfunction 12.6 Head and Neck Cancer-Specific Causes of Chemosensory Dysfunction 12.6.1 Tumor-Induced Nerve Damage 12.6.2 Surgery-Induced Chemosensory Dysfunction 12.6.3 Radiation-Induced Injury 12.7 Chemotherapy-Induced Chemosensory Dysfunction 12.8 Intervention Strategies for Chemosensory Dysfunction 12.9 Prevention of Taste Dysfunction 12.9.1 Cytoprotection 12.9.2 Radiation Dosimetry and Xerostomia-Related Dysgeusia 12.10 Conclusions Bibliography 13: Orofacial Supportive Care in Paediatric Cancer 13.1 Introduction 13.2 Paediatric Cancer 13.2.1 Acute Leukaemias 13.2.2 Hodgkin’s Disease 13.2.3 Non-Hodgkin’s Lymphoma 13.2.4 Ewing Sarcoma 13.2.5 Rhabdomyosarcoma 13.2.6 Neuroblastoma 13.3 Current Knowledge 13.4 Clinical Presentation 13.5 Complications 13.5.1 Early Complications 13.5.1.1 Oral Mucositis 13.5.1.2 Oral Infections 13.5.1.3 Salivary Gland Dysfunction 13.5.1.4 Taste Dysfunction 13.5.1.5 Oral Haemorrhage 13.5.2 Long-Term Complications 13.5.2.1 Dental Developmental Abnormalities 13.5.2.2 Dental Caries 13.5.2.3 Oral GvHD 13.6 Guidelines for Management 13.6.1 Oral Mucositis 13.6.2 Infections 13.6.3 Oral Haemorrhage 13.6.4 Xerostomia 13.6.5 Trismus 13.6.6 Oral GVHD 13.6.7 Taste Dysfunction 13.7 Specific Management Including Follow-Up and Referral 13.7.1 Role of Paediatric Dentistry: Oral Care 13.7.2 Oral Hygiene Measures and Management 13.7.3 Role of Parents Bibliography 14: Oral Graft-Versus-Host Disease 14.1 Introduction 14.2 Epidemiology and Pathobiology of GVHD 14.3 Acute Graft-Versus-Host Disease 14.4 Oral Acute GVHD 14.5 Chronic Graft-Versus-Host Disease 14.6 Oral Chronic Graft-Versus-Host Disease 14.7 Management of Oral GVHD 14.8 Long-Term Complications of Oral GVHD Bibliography 15: Dental Diseases and Management 15.1 Introduction 15.2 Definitions 15.3 Current Knowledge 15.3.1 Radiation Caries 15.3.2 “cGVHD-Related Caries” 15.3.3 Effect of Radiation Therapy on the Periodontium 15.4 Clinical Presentation 15.4.1 Radiation Caries 15.4.2 cGVHD-Related Caries 15.4.3 Periodontitis 15.5 Prevention and Specific Management 15.5.1 Radiation Caries 15.5.2 Hygiene 15.5.3 Dietary and Other Considerations 15.5.4 Fluoride 15.5.5 Dental Restorations 15.5.6 Silver Diamine Fluoride 15.5.7 “cGVHD-Related Caries” 15.5.8 Periodontitis Bibliography 16: Interpretation of Investigations 16.1 Introduction 16.2 Supportive Care 16.3 Tests at Diagnosis 16.3.1 Fine Needle Aspiration 16.4 Clinical Investigation, Endoscopy, and Biopsy 16.4.1 Staging Scans 16.4.2 Radiographs or X-Rays 16.4.3 Ultrasound 16.4.4 Computed Tomography (CT) Scan 16.4.5 Magnetic Resonance Imaging (MRI) 16.4.6 Positron Emission Tomography (PET) or PET-CT 16.5 HPV- and EBV-Associated Head and Neck Cancers 16.5.1 HPV 16.5.2 EBV 16.6 Investigations for Supportive Care 16.7 Investigating Nutritional Status 16.7.1 Oral Health 16.7.1.1 Swallowing 16.7.1.2 Pain 16.8 Measuring Distress 16.8.1 Psychological Well-Being 16.8.2 Spiritual Well-Being 16.9 Financial Toxicity 16.10 Investigations Associated with Systemic Therapy 16.10.1 Chemotherapy 16.10.2 Immunotherapy and Targeted Agents 16.11 Conclusions Bibliography 17: Photobiomodulation and Light Therapy in Oncology 17.1 Introduction 17.2 Photobiomodulation or Low-Level Laser Therapy 17.2.1 Mechanisms of Action of PBM 17.2.2 PBM Parameters 17.3 Potential Effects of PBM on Cancer Cells and Tumors 17.3.1 Effects on Molecular Pathways and Tumor Cells In Vitro 17.3.2 Can PBM Make Cancer Worse in Animal Models? 17.3.3 Can PBM Directly or Indirectly Attack Cancer? 17.3.4 Is There Evidence of Clinical Efficacy Using PBM for Cancer in Humans? 17.4 Clinical Applications of PBM for Cancer Therapy Side Effects 17.4.1 Oral Mucositis 17.4.2 Dermatitis 17.4.3 Dysphagia 17.4.4 Hyposalivation and Xerostomia 17.4.5 Taste Alterations 17.4.6 Trismus 17.4.7 Soft Tissue Necrosis and Osteoradionecrosis 17.4.8 Head and Neck Lymphedema 17.4.9 Voice and Speech Alterations 17.5 Conclusion Bibliography