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Chemotherapy

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by

Kyle Fong

on 19 March 2014

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Transcript of Chemotherapy

What is radiotherapy?
Radiotherapy is the use of high energy x-rays and similar rays (such as electrons) to treat cancers.



Uses of Radiotherapy
Cure or shrink early stage cancer

Prevent cancer recurring in another area

Treat symptoms of advanced cancer

How does chemotherapy work?
The chemotherapy drugs target the fast dividing cells via the bloodstream, this kills the cancer cells and damages them so they cannot reproduce and spread.
ORAL side effects
Eat a
well-balanced diet
. Proper nutrition can help the body tolerate the stress of cancer treatment, maintain energy, fight infection and build tissue.

Good dental hygiene
helps prevent cavities, mouth sores and infections.

Have a complete
oral health exam
which will check for the following:
Mouth sores or infections
Tooth decay
Gum disease
Dentures do not fit well
Problems moving the jaw
Problems with the salivary glands

chemotherapy &
radiotherapy

Chemotherapy drugs
• Alkylating agents
• Anti-metabolites
• Anti-microtubules
• Anti-tumour antibiotics
• Cytotoxic antibiotics

How Does Radiotherapy work?
X-rays kill tumour cells by causing damage to their DNA

The rays cause breaks in the DNA and this makes it impossible for the cell to multiply.

Without tumour cell multiplication, the cancerous tumour cannot grow

What is chemotherapy?
Chemotherapy is a type of treatment for cancer where medicine is used to kill cancer cells.
Main aims of chemotherapy
• Tries to cure cancer completely
• To shrink tumours before surgery or radiation therapy
• Helps to make other treatments more effective
• Reduces the risk of the cancer returning after surgery or radiotherapy
• Relieves the symptoms

Learning outcomes
A brief history
Chemotherapy
Radiotherapy
Side effects of both therapies
Prevention
Management
Radiotherapy has the advantage of being able to be localised and focused at the treatment site. It works during cell division by damaging DNA causing cell death.
Radiotherapy is a local treatment
Radiation does not reach all parts of body

Only affects cells in and around cancer

Not as useful against cancer that has spread to distant parts of body

Sialadenitis

the inflammation of
a salivary gland




Xerostomia
medical term for the
symptom of dryness in the mouth


MUCOSITIS
Common complication of chemotherapy and radiotherapy

35- 40% patients receiving chemotherapy

30 – 60% patients receiving radiation, especially to head and neck

Break down of epithelial cells lining gastrointestinal tract

Leaves tissue open to ulceration and infection.



FUNGAL INFECTIONS
ORAL CANDIDIASIS  occurs in around 37% of chemotherapy and radiotherapy patients.

Caused by the fungus CANDIDA ALBICANS

Chemotherapy and medications like steroids can cause an overgrowth of this fungus

Growth of this fungus is not as easily regulated in immunocompromised patients such as those undergoing chemotherapy or radiotherapy.

Pseudomembranous and Erythematous candidiasis are the most common forms of intraoral candidiasis in oncology patients

BACTERIAL INFECTIONS
Herpes group viral infections can cause variety of disease ranging from mild to serious conditions in patients undergoing cancer treatment.

Correlating to degree of severity of immunocomprimisation

Herpes simplex virus (HSV), Varicella-zoster virus (VZV) and Epstein Barr Virus (EBV) can result from reactivation of latent virus

Haemorrhage
May occur in patients undergoing high dose chemotherapy or undergoing hematopoietic stem cell transplantation


Spontaneous gingival oozing may occur when platelet count drops below 20,000/mm³ especially when there is pre-existing gingivitis or periodontitis.
History : Chemotherapy
Prevention of oral complications
Chemotherapy
causes dry mouth by making saliva thicker, a temporary symptom , usually clears up 2 to 8 weeks after treatment ends.
Radiation
can often cause patients to experience some level of long term dry mouth
Xerostomia signs
and symptoms
Why is prevention of Oral
Complications important?

Sometimes treatment doses need to be decreased or treatment stopped because of oral complications. Patients with poor oral health before treatment begins may have more frequent and severe complications after treatment has started.

Problems such as
cavities, broken teeth, loose crowns and fillings, and gum disease
can get worse or cause problems during cancer treatment.

Patients receiving high-dose chemotherapy or radiation therapy should have an
oral care plan
in place before treatment begins.

It is important that patients who have head or neck cancer
stop smoking
. Continued smoking slows recovery and increases the risk that the
head or neck cancer
will recur or that a second cancer will develop.

Management of Oral Complications
Regular Oral Care
- Keep mouth clean
- Be gentle with the tissue lining the mouth
Brushing teeth:
• Use a soft-bristle brush
2-3 times a day
2-3 min

• Rinse the toothbrush in hot water every 15 to 30 seconds to
soften the bristles

• Use a fluoride toothpaste with a
mild taste

Flavouring may
irritate
the mouth



Alternative :
1/4 tsp Salt


1 cup water
Rinsing
Use a rinse every 2 hours to decrease soreness
1/2 tsp of salt
+
1/2 tsp of baking soda
+
1 cup of water.
Gum disease - Use antibacterial rinse
-2 to 4 times a day
-1-2 min
Floss gently once a day
Use lip care products to prevent drying and cracking
Brush and rinse dentures everyday

Avoid :
Acidic or spicy food
'Hard' food
Hot food/drinks
Oral Pain
Caused by :
Tumor
- affects nerves and causes inflammation.
Leukemias
and
lymphomas
- may affect sensitive areas in the mouth.
Multiple myeloma
can affect the teeth.
Cancer may
spread to the head and neck
from other parts of the body and cause oral pain.
Tumors of the nose, throat, and lungs can cause
referred pain
in the mouth or jaw.
- Topical treatments
- Opioids - Severe pain
- Muscle relaxants
- Medicine for
anxiety
depression
seizures
- Non-drugs therapy
Counseling
Hypnosis
Applying cold or heat
Food : chopped, ground, or blended

Eat between-meal snacks : add calories and nutrients.

Eat food high in calories and protein.

Take supplements to get vitamins, minerals, and calories.

Meet with nutrition counsellor

Diet
Mouth and Jaw Stiffness
- Caused by :

• Oral surgery.

• Late effects of radiation therapy - overgrowth of fibrous tissue in the skin, mucous membranes, muscle, and joints of the jaw

• Stress caused by the cancer and its treatment.

May lead to :


Malnutrition and weight loss

• Slower recovery

• Being unable to
clean the teeth and gums well.

•Unable to receive
dental treatments.

• Weakened jaw muscles

• Emotional problems – Less social contact

• Medical devices for the mouth.

• Pain treatments.

• Medicine to relax muscles.

• Jaw exercises.

• Medicine to treat depression.

Treatment :
- Pain during swallowing and dysphagia is common

- Dental team:
Replace missing teeth and damaged area of the mouth with artificial devices to help swallowing.


Swallowing Problems
Tissue and Bone Loss
- Radiation therapy can
destroy very small blood vessels
within the bone.

- This can
kill
bone tissue and lead to bone
fractures
or
infection.

-
Ulcers
may form, grow, and cause pain, loss of feeling, or infection.

• Eat a well-balanced diet.

• Wear removable dentures or devices as little as possible.

• Don't smoke.

• Don't drink alcohol.

• Use topical antibiotics.

• Use painkillers as prescribed.

• Surgery to remove dead bone or to rebuild bones of the mouth and jaw.


High Dose Chemotherapy
• Have brackets, wires, and retainers removed before high-dose chemotherapy begins.

• Take good care of dentures

• Continue your regular oral care 3 or 4 times a day

• If you have mouth sores, avoid using removable oral devices until the sores have healed.

Dental Treatments
- Regular dental treatments, including cleaning and polishing, should wait until the patient's immune system returns to normal.

- The immune system can take
6 to 12
months to recover after high-dose chemotherapy




- Supportive care before oral procedures :
Giving antibiotics or immunoglobulin G
Adjusting steroid doses
Radioprotectant Medication i.e
Amifostine

Saliva substitutes and mouth rinses
- Hyetellose
- Hyprolose
- Carmellose

Medications :
- Pilocarpine (Salagen)
- Cevimeline (Evoxac)

Sugar free candy, Sugar free gum

Management
Prevention
Visit a dentist at least 2 weeks before starting radiation treatment or chemotherapy
Drink sips of water throughout the day
Use
artificial saliva
to moisten the mouth
Improve oral care
Use a cool mist humidifier, especially at night
Rinse mouth especially after meals

Management:
Superficial oral candidiasis :
- Topical oral anti-fungal agents
(
Nystatin rinse
or
Clotrimazole troches
)

Persistant systemic infection or immunicompromised patients –
Systemic Fluconazole

Frequent cleaning of oral appliances i.e
soaking dentures overnight in the antifungal solution

Ensuring dentures or other oral appliances
fit correctly




Not uncommon for oncology patients to be told specifically not to use toothbrushes and dental floss when platelet count drops below 40,000/mm³ - generally poor advice except for extenuating circumstances.

Prevention
Foam brushes may be recommended by some practitioners – however some research shows not as adequate at plaque removal along gingival margins, thus promoting gingival infection and bleeding
Topical treatment
Wipe mouth and teeth gently with wet gauze dipped in saltwater to
remove pieces of food.
Painkillers
- if topical does not work
NSAIDS
should not be used by patients receiving chemotherapy because they increase the risk of bleeding.
Zinc supplements
for pain caused by mucositis as well as dermatitis (inflammation of the skin).
Povidone-iodine mouthwash
that does not contain alcohol may help delay or decrease mucositis
Management
• During World War II, naval personnel were exposed to
mustard gas
during military action.
• Mustard gas was found to have
toxic changes in the bone marrow cells
that develop into blood cells.
• During that same period, the US Army studied a number of chemicals related to mustard gas
• Found a compound called
nitrogen mustard that

killed rapidly growing cancer cells
by damaging their DNA.
History : Radiotherapy
• Very shortly after the European discovery of
X-rays and radium
in 1895 and 1898, scientists observed the effects of
hair loss
and
skin damage
from their rays.

• Both agents were then tried experimentally to
treat superficial skin diseases and unwanted hair.

• Physicians advanced from skin cancer to treating other superficial cancers like breast, head, and neck lymph nodes.

• Scarce and costly radium was used in
small tubes
for insertion directly into tumours or into body cavities containing cancer.

• Between World War I and II, physicists and biologists continued to discover how radiation works and how to measure the dose accurately.
Thanks for listening!
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