Cancer and Oral Complications to Cancer Therapy
You will receive 4 credit(s) of continuing education credit upon successful completion of this course.

This course will discuss the various types of cancer that occur in the United States.  The incidence, symptoms, risk factors, early detection, treatment, and survival of each cancer will be reviewed.  A discussion of common oral complications and treatment will also be examined.

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Gregory Naylor, DDS

Dr. Gregory D. Naylor is a native of western Massachusetts.  He graduated with honors from Springfield College in 1974 with a Bachelor of Science Degree in Biology.  He received a Doctorate in Dental Surgery from Georgetown University School of Dentistry in 1978 and was inducted into the Omicron Kappa Upsilon Honor Society.  After graduation from dental school, he received a commission in the United States Navy and served in the Navy for over 27 years.  His assignments in...

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Learning Objectives:

After completing this lesson, the reviewer will:


1.   Understand the different types, incidence, and symptoms of cancer.

2.   Understand the etiology and prevention of cancer.

3.   Understand the treatment and survival rates of patients with cancer.

4.   Understand the oral complications that result from cancer treatment.

5.   Understand how to treat these oral complications.


Cancer ranks among the leading causes of death in the world today.  As oral healthcare providers, we may be faced with the management of a patient who is undergoing cancer therapy.  While surgery, radiation therapy, and chemotherapy have decreased mortality rates of patients with cancer, the morbidity associated with the treatment can impair quality of life.  The goal of dental management for these patients is to prevent the development of oral complications.  As such, the oral health team needs to be involved with the patient’s treatment before the treatment begins and is a key contributor in the patient management during and after cancer therapy.  This discussion reviews various types of cancer, along with the incidence, symptoms, risk factors, early detection, treatment, and survival.  Also reviewed are the most common complications that occur from cancer treatment and the recommended management of those complications.


1.  Introduction

2.  Cancer Staging

3.  Types of Primary Cancer

      A.   Breast Cancer

      B.   Cervical Cancer

      C.   Childhood Cancer

      D.   Colon and Rectal Cancer           

      E.   Endometrial Cancer                                          

      F.   Kidney Cancer

      G.   Leukemia

      H.   Liver Cancer

      I.   Lung Cancer

      J.   Lymphoma

      K.   Oral Cancer

      L.   Ovarian Cancer

      M.   Pancreatic Cancer

      N.   Prostate Cancer

      O.   Skin Cancer

      P.   Thyroid Cancer

      Q.   Urinary Bladder Cancer

4.  Cancer Treatment

      A.   The Cell Cycle

      B.   Checkpoints for the Cell Cycle

      C.   Radiation Therapy

            1.   External Beam Radiation

            2.   Internal Radiation

            3.   Systemic Radiation

      D.   Chemotherapy Agents

            1.   Alkylating Agents

            2.   Antimetabolites Agents

            3.   Anti-tumor Antibiotic Agents

            4.   Steroid and Hormonal Agents

            5.   Plant Alkaloids

            6.   Newer Agents

5.  Oral Complications – these may change – lump into radiation and chemo check book

      A.   Mucositis

      B.   Infection

            1.   Bacterial Infections

            2.   Fungal Infections     

            3.   Viral Infections        

      C.   Hemorrhage

      D.   Xerostomia

      E.   Neurological Problems

      F.   Nutritional Problems

      G.   Radiation Caries

      H.   Osteoradionecrosis

      I.   Biophosphonate Associated Osteonecrosis

6.  Dental Management

      A.   Preventive and treatment options prior to treatment

      B.   Preventive and treatment options during treatment

            1.   Mucositis

            2.   Infections

                  a.   Bacterial Infections

                  b.   Fungal Infections

                  c.   Viral Infections

            3.   Hemorrhage

            4.   Xerostomia

            5.   Neurologic Problems

            6.   Nutritional Problems

            7.   Radiation Caries

            8.   Osteoradionecrosis

            9.   Biophosphonate Associated Osteonecrosis

      C.   Preventive and treatment options after treatment

7.  Conclusion

8.  References

9.  Examination


1.   Cancer Facts and Figures 2012. Atlanta: American Cancer Society: 2012.

2.   DeVita VT Jr. Principles of chemotherapy, In DiVita VTJr, Hellman S, Rosenberg SA (eds). Cancer; Principles and Practice of Oncology, 4th ed. Philadelphia,|: JB Lippincott, 1993;333-348.

3.   Naylor GD, Terezhalmy GT. Oral complications of cancer chemotherapy: prevention and management. Spec Care Dentist 1988;8:150-156.

4.   Huber MA, Terezhalmy GT. The medical oncology patient. Quintessence Int 2005;36:383-402.

5.   Shapiro GI, Harper JW. Anticancer drug targets: cell cycle and checkpoint control. J Clin Invest 1999;104(12);1645-1653.

6.   Lawrence TS, Ten Haken RK, Giaccia A. Principles of Radiation Oncology. In: DeVita VT Jr., Lawrence TS, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology. 8th ed. Philadelphia: Lippincott Williams and Wilkins, 2008.

7.   Taylor A, Powell ME. Intensity-modulated radiotherapy—what is it? Cancer Imaging 2004; 4(2):68–73.

8.   Veldeman L, Madani I, Hulstaert F. et al. Evidence behind use of intensity-modulated radiotherapy: A systematic review of comparative clinical studies. Lancet Oncology 2008; 9(4):367–375. Erratum in: Lancet Oncology 2008; 9(6):513.

9.   Noda SE, Lautenschlaeger T, Siedow MR, et al. Technological advances in radiation oncology for central nervous system tumors. Seminars in Radiation Oncology 2009; 19(3):179–186.

10.  Patel RR, Arthur DW. The emergence of advanced brachytherapy techniques for common malignancies. Hematology/Oncology Clinics of North America 2006; 20(1):97–118.

11.  Epstein JB, Schubert MM. Oropharyngeal mucositis in cancer therapy. Review of pathogenesis, diagnosis, and management. Oncology 2003;17:1667-1679.

12.  Sonis ST. Oral mucositis in cancer therapy. J Support Oncol 2004;2:3-8.

13.  Heimadahl A. Prevention and management of oral infections in cancer patients. Support Care Cancer 1999;7:224-228.

14.  Bottomley WK, Perlin E, Ross GR. Antineoplastic agents and their oral manifestations. Oral Surg, Oral Med Oral Pathol 1977;44:527-534.

15.  Sonis ST, Fazio RC, Fang L. Oral complications of cancer chemotherapy. In Sonis ST. Principles and Practice of Oral Medicine. Philadelphia: WB Saunders, 1995:426-454.

16.  Little JW, Falace DA, Miller CS, Rhodus NL. Dental Management of the Medically Compromised Patient. 8th ed. St Louis, MI: Mosby Elsevier; 2013.

17.  Markiewicz MR etal. Biophosphonate-associated osteonecrosis(BON) of the jaws: a review. J Am Dent Assoc 2005; 136:1669-1676.

18.  Ruggiero SL et al.  American Association of Oral and Maxillofacial Surgeons position paper on biophosphonate related osteonecrosis of the jaw – 2009 update, Aust Endod J 35:119-130, 2009.

19.  Silverman S Jr, Sollecito TP. Clinician’s Guide to Treatment of Common Oral Lesions, 5 ed. American Academy of Oral Medicine, 2001:11-12.

20.  Epstein J et al. Postradiation osteonecrosis of the mandible: a long-term follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83:657-662.

Release date: August 28, 2018
Review date: January 1, 2020
Expiration date: December 31, 2022
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