Collectively, all cancers combined account for about one quarter of deaths in the United States, thereby placing cancer second only to heart disease as a leading cause of death.

Cancer is a major public health problem in the United States as well as worldwide. Concordant with improvements in health and medical care resulting in increased longevity, the prevalence of cancer has increased over the past 50 years. In 2015, the probability of developing cancer from birth to death in the United States in men was 43.3% and 37.8% in women.

Because patients diagnosed with cancer are experiencing increased survival rates as a result of improved diagnostics and advances in antineoplastic therapy, an increased likelihood exists of dentists treating patients in various phases of cancer therapy. For optimal oral health, the dentist should be an integral part of the cancer patient’s health care team. The characteristic clinical course, cancer progression status, treatment modalities, location of cancer therapy (hospital or outpatient facility), and likely outcome all will affect the dental treatment plan. Maintenance of proper oral hygiene is critical for limiting local and systemic complications associated with chemotherapy, radiation therapy, and bone marrow and stem cell transplantation. In addition, dentists have the unique opportunity to reduce the risk of cancer by providing advice regarding cancer screening and a healthy diet, counseling patients as appropriate regarding smoking cessation and risks associated with alcohol consumption, and performing cancer screening procedures.

This chapter focuses on common cancers that may affect patients who require dental care. No attempt is made here to include all cancers; instead, an overview of cancer is presented first followed by a discussion of common cancers, along with relevant considerations regarding oral care of patients with cancer. A discussion of lymphoma and leukemia can be found in Chapter 23 .

CRITICAL COMPLICATIONS: Patients for dental treatment with a risk of developing cancer or a history of cancer. The dentist must be aware of the type and extent of the cancer and prepare for complications such as adverse bleeding, side effects of drugs, and infection. These events could prove serious. The dentist must be able to detect these patients based on history and clinical findings, refer them for medical diagnosis and management, and work closely with the physician to develop a dental management plan that will be effective and safe for the patient.

Epidemiology

Fig. 26.1 indicates the most common cancers expected to occur in men and women in 2015. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for more than 56% of all newly diagnosed cancers. In women, the most common cancers are breast, lung, colon, and uterine. A total of 1,658,370 new cancer cases and 589,430 cancer deaths were projected to occur in the United States in 2015 ( Table 26.1 ). When deaths are aggregated by age, cancer has surpassed heart disease as the leading cause of death in those younger than age 85.

Ten leading cancer types in estimated new cancer cases and deaths, by gender, United States, 2015. Indicated are the most common cancers in men and women in 2015. Among men, cancers of the prostate, lung and bronchus, and colon and rectum account for more than 48% of all newly diagnosed cancers. Prostate cancer alone accounts for about 26% (220,800) of incident cases in men. Among women, cancers of the breast, lung and bronchus, and colon and rectum account for more than 50% of all newly diagnosed cancers. Breast cancer alone accounts for about 29% (231,840) of incident cases in women.

(From Siegel RL, Miller KD, Jemal A: Cancer statistics, 2016, CA Cancer J Clin 66:5-29, 2016 . © 2016 American Cancer Society.)

TABLE 26.1

Estimated New Cancer Cases and Deaths by Sex, United States, 2015 *

	ESTIMATED NEW CASES			ESTIMATED DEATHS
	Both Sexes	Male	Female	Both Sexes	Male	Female
All sites	1,658,370	848,200	810,170	589,430	312,150	277,280
Oral cavity and pharynx	45,780	32,670	13,110	8,650	6,010	2,640
Tongue	14,320	10,310	4,010	2,190	1,500	690
Mouth	12,920	7,750	5,170	2,120	1,200	920
Pharynx	15,520	12,380	3,140	2,660	2,010	650
Other oral cavity	3,020	2,230	790	1,680	1,300	380
Digestive system	291,150	163,050	128,100	149,300	86,540	62,760
Esophagus	16,980	13,570	3,410	15,590	12,600	2,990
Stomach	24,590	15,540	9,050	10,720	6,500	4,220
Small intestine	9,410	4,960	4,450	1,260	670	590
Colon †	93,090	45,890	47,200	49,700	26,100	23,600
Rectum	39,610	23,200	16,410
Anus, anal canal, and anorectum	7,270	2,640	4,630	1,010	400	610
Liver and intrahepatic bile duct	35,660	25,510	10,150	24,550	17,030	7,520
Gallbladder and other biliary	10,910	4,990	5,920	3,700	1,660	2,040
Pancreas	48,960	24,840	24,120	40,560	20,710	19,850
Other digestive organs	4,670	1,910	2,760	2,210	870	1,340
Respiratory system	240,390	130,260	110,130	162,460	89,750	72,710
Larynx	13,560	10,720	2,840	3,640	2,890	750
Lung and bronchus	221,200	115,610	105,590	158,040	86,380	71,660
Other respiratory organs	5,630	3,930	1,700	780	480	300
Bones and joints	2,970	1,640	1,330	1,490	850	640
Soft tissue (including heart)	11,930	6,610	5,320	4,870	2,600	2,270
Skin (excluding basal and squamous)	80,100	46,610	33,490	13,340	9,120	4,220
Melanoma of the skin	73,870	42,670	31,200	9,940	6,640	3,300
Other nonepithelial skin	6,230	3,940	2,290	3,400	2,480	920
Breast	234,190	2,350	231,840	40,730	440	40,290
Genital system	329,330	231,050	98,280	58,670	28,230	30,440
Uterine cervix	12,900		12,900	4,100		4,100
Uterine corpus	54,870		54,870	10,170		10,170
Ovary	21,290		21,290	14,180		14,180
Vulva	5,150		5,150	1,080		1,080
Vagina other genital, female	4,070		4,070	910		910
Prostate	220,800	220,800		27,540	27,540
Testis	8,430	8,430		380	380
Penis other genital, male	1,820	1,820		310	310
Urinary system	138,710	96,580	42,130	30,970	21,110	9860
Urinary bladder	74,000	56,320	17,680	16,000	11,510	4,490
Kidney renal pelvis	61,560	38,270	23,290	14,080	9,070	5,010
Ureter other urinary organs	3,150	1,990	1,160	890	530	360
Eye orbit	2,580	1,360	1,220	270	140	130
Brain other nervous system	22,850	12,900	9,950	15,320	8,940	6,380
Endocrine system	64,860	16,520	48,340	2,890	1,350	1,540
Thyroid	62,450	15,220	47,230	1,950	870	1,080
Other endocrine	2,410	1,300	1,110	940	480	460
Lymphoma	80,900	44,950	35,950	20,940	12,140	8,800
Hodgkin lymphoma	9,050	5,100	3,950	1,150	660	490
Non-Hodgkin lymphoma	71,850	39,850	32,000	19,790	11,480	8,310
Myeloma	26,850	14,090	12,760	11,240	6,240	5,000
Leukemia	54,270	30,900	23,370	24,450	14,210	10,240
Acute lymphocytic leukemia	6,250	3,100	3,150	1,450	800	650
Chronic lymphocytic leukemia	14,620	8,140	6,480	4,650	2,830	1,820
Acute myeloid leukemia	20,830	12,730	8,100	10,460	6,110	4,350
Chronic myeloid leukemia	6,660	3,530	3,130	1,140	590	550
Other leukemia ‡	5,910	3,400	2,510	6,750	3,880	2,870
Other and unspecified primary sites ‡	31,510	16,660	14,850	43,840	24,480	19,360

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