Oral cancer which result in devastating effect on the general as well as mental health of the individual. Numerous factors directly or indirectly leads to the development of the oral cancer. Most of the people fail to notice it in earlier stage when it just appears as ulcer or white/red patch, which eventually grows into dangerous tumour causing difficulties in the functioning of the oral cavity.
Oral cancer is treated with different treatment modalities such as surgery, chemotherapy, and radiotherapy. Chemotherapy involves introduction of chemical agents whereas, radiotherapy involves high doses of radiation which is directed towards the tumour site to destroy cancer cells. These radiations along with beneficial effects also has negative effects. These effects bring post-operative complications in the oral cavity.
3MEDS-Cancer medicines provider in India, gives insight into the complications and their management.
Acute reactions: these are reactions which occurs within the short period of time after commencement of radiotherapy. It occurs in combination with chemotherapy due to direct tissue toxicity and possibly secondary bacterial irritation resulting in ulcerative mucositis.
Chronic reactions: these are late reactions to radiotherapy which occurs due to change in the vascular supply, fibrosis in connective tissue and muscle, change in cellularity of tissues. These complications take time to develop and are not instant. It usually occurs along with surgical treatment resulting in pain.
COMPLICATIONS:
Mucositis:
It is a painful and debilitating condition that is related to dose and rate of radiation causing toxicity. It comprises of severe pain, increased risk of oral local & systemic infection of virus and fungus, compromised oral & pharyngeal functions, & oral bleeding that ultimately affects the quality of life.
3MEDS recommends oral care measures like;
· Good oral hygiene maintenance
· Oral lozenges containing polymixin which can be availed at online pharmacy store in India
· Diluting agents, coating agents like lip lubricants (Vaseline), topical anaesthetic agents like lignocaine gel. Painkillers like ibuprofen. Amifostin drug for systemic use.
· Maintenance of adequate nutrition and hydration.
Hypo-salivation:
Radiation affects salivary glands resulting in fatty degeneration, fibrosis, acinar atrophy, & cellular necrosis. Saliva is reduced in amount and is thick & ropy in consistency. It induces xerostomia (dry mouth) which may sometimes reverse back to normal in 12 months.
3MEDS recommends patients to;
Frequently sip water & chew on sugarless gum to stimulate salivation. Salivary substitutes such as carboxymethyl cellulose can be used only after prescription from oncologist. Salivary stimulants such as pilocarpine hydrochloride & bethamechol can be used.
Candidiasis:
Radiotherapy reduces the resistance of the body against colonization of fungal infection resulting in its rise.
3MEDS recommends application of topical antifungal gel and systemic intake of azoles to inhibit this.
Radiation caries:
Due to the effect of the radiation on the salivary glands, alteration of chemical composition of saliva occurs along with reduction in amount of saliva produced. This results in development of caries/cavities in the cervical/neck portion of teeth followed by edges of teeth.
3MEDS encourages patients to maintain oral hygiene. Use 3% hydrogen peroxide rinse. Consult dentist for topical fluoride application.
Osteoradionecrosis:
Radiation affects blood vessels present in the oral cavity resulting in reduced blood supply which in turn causes hypo cellularity and finally hypoxic tissue. Individual complains of pain, foul taste, paraesthesia, & lymphadenopathy.
3MEDS recommends use of tetracycline or antiseptic rinses. In extreme cases, hyperbaric oxygen therapy is necessary.
Speech and mastication (chewing):
Radiotherapy along with surgery affect speech due to removal of structures and due to reduced salivation & fibrosis leading to abnormal speech.
3MEDS recommends speech therapy and prostheses to manage this complication.
Nutrition, taste & smell problems:
Taste may be affected directly due to effect on taste buds, or due to reduced salivation & secondary infection.
3MEDS suggests use of zinc supplements to restore taste.
Problems with mandible:
Radiation affects the muscles resulting in limited opening of the mouth.
3MEDS suggests mandibular stretching exercise & prosthetic aids along with pentoxifylline to overcome it.
Pain:
Often severe pain is present after surgery along with radiotherapy which lasts for 1-2 months.
3MEDS recommends use of painkillers to alleviate the pain.
CONCLUSION:
Management after radiotherapy is very important to decrease the severity of complications. One must follow prescribed measures to get rid of complications soon. Cancer is devastating even after treatment. Therefore care and support is necessary for cancer patients to defeat it and emerge stronger. All it requires it strong will power.