Cancer and Oral Care of Patients With Cancer

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.

FIG 26.1
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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Sep 3, 2018 | Posted by in General Dentistry | Comments Off on Cancer and Oral Care of Patients With Cancer
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