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.
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.
|ESTIMATED NEW CASES||ESTIMATED DEATHS|
|Both Sexes||Male||Female||Both Sexes||Male||Female|
|Oral cavity and pharynx||45,780||32,670||13,110||8,650||6,010||2,640|
|Other oral cavity||3,020||2,230||790||1,680||1,300||380|
|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|
|Other digestive organs||4,670||1,910||2,760||2,210||870||1,340|
|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|
|Vagina other genital, female||4,070||4,070||910||910|
|Penis other genital, male||1,820||1,820||310||310|
|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|
|Brain other nervous system||22,850||12,900||9,950||15,320||8,940||6,380|
|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|