Care After Tumour Treatment

Patients who have been subjected to radiotherapy for a malignant disease in the head and neck region are often afflicted by xerostomia in spite of measures taken to avoid irradiation of salivary gland parenchyma when planning the dose. In recent years modern technique has made it possible to limit the harmful effects on the salivary glands. The aforesaid notwithstanding, many patients feel their greatest problem after the treatment is - xerostomia. To objectively register the degree of xerostomia the secretion rate for chewing stimulated saliva is measured 1-2 months after conclusion of the radiotherapy. The National Social Insurance Board in Sweden recommends that an irradiated patient is to be considered to have xerostomia when the rate of secretion in chewing stimulated saliva is less than 0.5 ml/min at repeated tests.

There is a number of remedies on the market, e g V6 chewing gum, Salivin sucking tablets, Saliva Orthana, saliva replacement MAS 84 based on sodiumcarboxymethylcellulosephosphate and Salinum, which is based on linseed oil. The patients are recommended to try out which preparation alleviates the symptoms the most.

From an odontologic point of view a patient with pronounced xerostomia is in the risk zone, and therefore individual prophylactic treatment is of the essence. This treatment can be carried out by recommending the patient douching with a fluorine solution, alternatively flourine tablets or flourine chewing gum [12]. Regular check-ups at the dentist’s or dental hygienist with counseling regarding eating habits and mouth hygiene, as well as professional cleaning and flourine treatment, are perceived as very valuable by many patients. Proper mouth hygiene and adequate parodontal status considerably lessens the risk of osteoradionecrosis, which invariably can be found in irradiated patients [13].

In those cases where the jawbone has been exposed to irradiation fibrosis will set in, resulting in a disturbed circulation of the blood in the jawbone. The effect is lifelong and means that this patient will always have a diminished resistance to infections of the jaw. At surgical interventions where the jawbone is exposed, i e including common extractions, these patients should be treated with antibiotics until a primary healing of the wound is attained, which, as a rule, is at least a week. First choice is a phenoxymethylpenicillin (pcV), e g Calciopen®, Kåvepenin®. If the patient is hypersensitive to this, clindamycin, Dalacin®, is used.

Surgical intervention of a tumour disease in the oral cavity often implies resectioning of parts of the jaw, and covering the defect with various flap techniques. The anatomical prerequisites for a reconstruction of the bite have then been made considerably more difficult. Before rehabilitation of the bite a concerted evaluation from all specialists (maxillofacial surgeon, oncologist, plastic surgeon, prosthetist, ENT doctor) involved in the tumour treatment is made. Previously bite rehabilitation was done by using removable prosthetics; today most patients can experience considerably improved function with implants. *CASE* Thereby, for this patient category a greatly improved quality of life has materialized.

After the conclusion of the tumour management, those patients that have been treated for a malignant tumour disease in the head and neck region are followed-up for at least five years by the tumour team that treated the patient initially. Early diagnostics is equally important for any recurrence as for the primary illness. Therefore, it is important to carry out a careful inspection of the oral cavity in accordance with the aforementioned recommendations. At the slightest suspicion of any recurrence or new cancer, a so-called “second primary”, contact should be made with someone in the tumour team at the hospital where the patient was treated.

Local recurrences are most common within the first two years after treatment, while the risk for second primaries (usually 2-3 % each year) remains for the rest of the life span. The risk is considerably higher if the patient continues to smoke. All patients are informed of the connection between tobacco and alcohol and the tumour disease afflicting them, and are encouraged to stop their harmful habits, but even then, many are unable to do so.