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Oral mucositis in head and neck cancer

Oral mucositis in head and neck cancer Significant advancements have been made in the management of patients undergoing cancer chemotherapy (CT) and radiotherapy (RT). Mounting evidence indicates that more aggressive regimens improve locoregional tumour control and survival in patients with head and neck cancer (HNC). The better treatment outcome, however, has come at the expense of increased patient morbidity in the form of many debilitating side effects such as nausea, vomiting, diarrhoea and mucositis. Such critical issues often delay or restrict the therapy and impede recovery. In general terms, mucositis is the inflammation of the mucous membrane lining of the digestive tract from the mouth on down to the anus. When such inflammation occurs in the mucous membrane of the oral and oropharyngeal region, it is termed as oral mucositis (OM). It is due to systemic effects of chemotherapeutic agents and from the local effects of radiation on the oral mucous membrane. OM is a major problem for cancer patients receiving head and neck radiotherapy, stem cell transplantation and myelosuppressive chemotherapy for solid tumours. Nowadays, majority of HNC patients are being treated by concurrent chemoradiotherapy as radical or adjuvant management, which in turn increases the probability of flaring up of mucosal inflammation. Virtually all patients with NHC develop some degree of mucositis during their treatment either by RT or CT. So, OM, if not detected or treated adequately, can lead to pain, discomfort and inability to tolerate food or fluids with increased propensity for opportunistic infections in the mouth and can worsen the patient's quality of life. Poorly managed OM is one of the leading causes for unplanned treatment interruptions and therefore increasing overall treatment time. Prolongation of overall treatment time adversely affects the tumour control probability. It also increases the overall cost of the treatment. To prevent or reduce the incidence and severity of mucositis, early diagnosis and effective treatment are needed. The better understanding of its pathologic basis has led to the development of targeted agents to combat mucositis. Several scoring systems like one from National Cancer Institute Common Toxicity Criteria (NCI–CTC) have been devised to assess the severity of oral mucositis ( National Cancer Institute 2009 ). The Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology advocate guidelines for the prevention and treatment of mucositis ( Keefe . 2007 ). The main aim of this module is to provide you with the knowledge and understanding of the risk factors, pathogenesis and development of OM. It will guide the reader for the early diagnosis and accurate management of OM in head and cancer patients undergoing treatment. The topic module can be accessed at http://www.onlinecancereducationforum.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Cancer Care Wiley

Oral mucositis in head and neck cancer

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References (2)

Publisher
Wiley
Copyright
© 2011 Blackwell Publishing Ltd
ISSN
0961-5423
eISSN
1365-2354
DOI
10.1111/j.1365-2354.2011.01243.x
pmid
21281368
Publisher site
See Article on Publisher Site

Abstract

Significant advancements have been made in the management of patients undergoing cancer chemotherapy (CT) and radiotherapy (RT). Mounting evidence indicates that more aggressive regimens improve locoregional tumour control and survival in patients with head and neck cancer (HNC). The better treatment outcome, however, has come at the expense of increased patient morbidity in the form of many debilitating side effects such as nausea, vomiting, diarrhoea and mucositis. Such critical issues often delay or restrict the therapy and impede recovery. In general terms, mucositis is the inflammation of the mucous membrane lining of the digestive tract from the mouth on down to the anus. When such inflammation occurs in the mucous membrane of the oral and oropharyngeal region, it is termed as oral mucositis (OM). It is due to systemic effects of chemotherapeutic agents and from the local effects of radiation on the oral mucous membrane. OM is a major problem for cancer patients receiving head and neck radiotherapy, stem cell transplantation and myelosuppressive chemotherapy for solid tumours. Nowadays, majority of HNC patients are being treated by concurrent chemoradiotherapy as radical or adjuvant management, which in turn increases the probability of flaring up of mucosal inflammation. Virtually all patients with NHC develop some degree of mucositis during their treatment either by RT or CT. So, OM, if not detected or treated adequately, can lead to pain, discomfort and inability to tolerate food or fluids with increased propensity for opportunistic infections in the mouth and can worsen the patient's quality of life. Poorly managed OM is one of the leading causes for unplanned treatment interruptions and therefore increasing overall treatment time. Prolongation of overall treatment time adversely affects the tumour control probability. It also increases the overall cost of the treatment. To prevent or reduce the incidence and severity of mucositis, early diagnosis and effective treatment are needed. The better understanding of its pathologic basis has led to the development of targeted agents to combat mucositis. Several scoring systems like one from National Cancer Institute Common Toxicity Criteria (NCI–CTC) have been devised to assess the severity of oral mucositis ( National Cancer Institute 2009 ). The Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology advocate guidelines for the prevention and treatment of mucositis ( Keefe . 2007 ). The main aim of this module is to provide you with the knowledge and understanding of the risk factors, pathogenesis and development of OM. It will guide the reader for the early diagnosis and accurate management of OM in head and cancer patients undergoing treatment. The topic module can be accessed at http://www.onlinecancereducationforum.com

Journal

European Journal of Cancer Care – Wiley

Published: Mar 1, 2011

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