Chemotherapy & Immune Suppression

• chemotherapy definition

  treatment that uses drugs to stop the growth of cancer cells, either by killing cells of stopping them dividing
• uses of chemotherapy

  curative:acute lymphoblastic leukaemia (ALL), Burkitt's Lymphoma

  adjuvant:with other type of treatment - surgery/radiotherapy

  maintenance:prolong remission or prevent relapse - lymphoma

  palliative:prolong life, relieve symptoms, improve quality of life
• types of chemotherapy

  anticancer drugs:

  cytotoxic chemotherapy

  hormone therapy

  targeted therapy

  immunotherapy
• cytotoxic chemotherapy

  exploits the fact that malignant cells divide more rapidly than normal cells

  other tissues with rapidly dividing cells eg, oral mucosa, hair follicles are affected
• acute side effects of chemotherapy

  weakened immune system

  hair loss

  fatigue

  nausea

  constipation/diarrhea

  bruising/bleeding
• hormonal therapy

  effect confined to target organ

  less systemic side effects

  used for breast and prostate cancer
• hormonal therapy oral side effects

  increased gingival inflammation

  gingival bleeding

  xerostomia

  oral burning
• targeted chemotherapy

  made to target specific areas:

  DNA changes limited to cancer cells

  protein only found in cancer cells

  proteins increased in cancer cells
• targeted chemotherapy mode of action

  trigger immune system to kill cancer cells

  stop blood vessels forming to feed the cancer

  carry toxins into the cancer cells

  eg. monoclonal antibodies, angiogenesis inhibitors, proteasome inhibitors, signal transduction inhibitors
• immunotherapy


  helps to boost immune system to destroy cancer cells
• immunotherapy examples

  immune check point inhibitors: boost action of immune system

  monoclonal antibodies - make cancer cells visible to immune system

  tumour vaccines - target tumour specific antigens

  immune system modulators - interferon/interleukins
• maintenance chemotherapy

  maintain remission or delay return of cancer

  long term

  extends life

  improves QoL

  commonly used for:

  ovarian, breast, lung, myeloma, leukaemia, lymphoma, sarcoma

  might include bisphosphonate with risk of jaw osteonecrosis
• metastatic spread to jaw

  breast, lung, kidney

  jaw bone involvement

  soft tissue swelling

  mandible molar region most common site

  numb chin
• acute dental side effects

  - mucositis

  - infection

  - bleeding

  - taste disturbance

  - dry mouth
• long term side effects

  oral cancer

  jaw osteonecrosis
• screening questions for maintenance patients

  Do you feel generally well

  Have you had any unusual infections

  Do you heal normally

  How often do you have to have blood tests

  Are your doctors concerned about you
• chemotherapy summary

  divide patients into acute treatment or maintenance

  - in acute group: mucositis, infection and bleeding are main issues

  - in maintenance group: metastatic spread, jaw osteonecrosis, secondary Ca are main issues
• immunodeficiency summary


  Oral manifestations of immunosuppression are common

  Be vigilant for Head and Neck Malignancy

  Remember the clinical screening questions

  Bisphosphonates may have been used