Last Modified: 09/16/2011
Management of Oral Complications During and After Chemotherapy and/or Radiation Therapy
Routine Oral Care
Oral Mucositis
Pain
Infection
Bleeding
Dry Mouth
Tooth Decay
Taste Changes
Fatigue
Malnutrition and Nutritional Support
Limited Jaw Movement
Swallowing Problems
Tissue and Bone Loss
Routine Oral Care
Continuing good dental hygiene during and after cancer treatment can reduce complications such as cavities, mouth sores, and infections. It is important to clean the mouth after eating. The following are guidelines for everyday oral care during chemotherapy and radiation therapy:
Tooth brushing
- Brush teeth with a soft bristle brush 2 to 3 times a day for 2 to 3 minutes. Be sure to brush the area where the teeth meet the gums and rinse often.
- Rinse the toothbrush in hot water every 15 to 30 seconds to soften the bristles, if needed.
- Use a foam brush only if a regular bristle brush cannot be used. Brush 2 to 3 times a day and use an antibacterial rinse. Rinse often.
- Allow the toothbrush to air dry between brushings.
- Choose toothpaste with care:
- Use a mild-tasting toothpaste; flavoring may irritate the mouth, especially mint flavors.
- If toothpaste irritates the mouth, brush with a solution of 1 teaspoon of salt added to 4 cups (1 quart) of water.
Rinsing
- Use a fluoride toothpaste.
- One of the following rinses made with salt and/or baking soda may be used:
- 1 teaspoon of salt in 4 cups of water.
- 1 teaspoon of baking soda in 1 cup (8 ounces) of water.
- ½ teaspoon salt and 2 tablespoons baking soda in 4 cups of water.
- An antibacterial rinse may be used 2 to 4 times a day for gum disease. Rinse for 1 to 2 minutes.
- If dry mouth occurs, rinsing may not be enough to clean the teeth after a meal. Brushing and flossing may be needed.
Flossing
- Floss gently once a day.
Lip care
- Use lip care products to prevent drying and cracking.
For special oral care during high-dose chemotherapy and stem cell transplant, see the Management of Oral Complications of High-Dose Chemotherapy and/or Stem Cell Transplant 1 section of this summary
Oral MucositisMucositis is an inflammation of mucous membranes in the mouth.
The terms "oral mucositis" and "stomatitis" are often used in place of each other, but their meanings are different.
- Mucositis is an inflammation of mucous membranes in the mouth. It usually appears as red, burn-like sores or as ulcer -like sores throughout the mouth.
- Stomatitis is an inflammation of tissues in the mouth, such as the gums, tongue, roof and floor of the mouth, and tissues inside the lips and cheeks. It includes infections of mucous membranes.
Mucositis may be caused by either radiation therapy or chemotherapy. The risk of having mucositis is increased when the cancer is treated with both chemotherapy and radiation therapy at the same time. In patients receiving chemotherapy, mucositis will heal by itself, usually in 2 to 4 weeks when there is no infection. Mucositis caused by radiation therapy usually lasts 6 to 8 weeks, depending on the duration of treatment.
The following problems may occur:
- Pain.
- Infection.
- Bleeding, in patients receiving chemotherapy. Patients undergoing radiation therapy usually do not have a bleeding risk.
- Inability to breathe and eat normally.
Swishing ice chips in the mouth for 30 minutes may help prevent mucositis from developing in patients who are given fluorouracil. Medication may be given to help prevent mucositis or keep it from lasting as long in patients who undergo high-dose chemotherapy and bone marrow transplant.
Care of mucositis during chemotherapy and radiation therapy focuses on cleaning the mouth and relieving the symptoms.
Treatment of mucositis caused by either radiation therapy or chemotherapy is generally the same. After mucositis has developed, proper treatment depends on its severity and the patient's white blood cell count. The following are guidelines for treating mucositis during chemotherapy, stem cell transplantation, and radiation therapy:
Cleaning the mouth
- Clean the teeth and mouth every 4 hours and at bedtime, more often if the mucositis becomes worse.
- Use a soft bristle toothbrush.
- Replace the toothbrush often.
- Use water-soluble lubricating jelly to moisturize the mouth.
- Use bland rinses or plain sterile water. Frequent rinsing removes particles and bacteria from the mouth, prevents crusting of sores, and moistens and soothes sore gums and the lining of the mouth.
- If crusting of sores occurs, the following rinse may be used:
- Equal parts hydrogen peroxide and water or saltwater (1 teaspoon of salt in 4 cups of water).
Relieving mucositis pain
- Try topical medications for pain. Rinse the mouth before applying the medication onto the gums or lining of the mouth. Wipe mouth and teeth gently with wet gauze dipped in saltwater to remove particles. Topical treatments may include coating agents and lozenges.
- Painkillers may provide relief when topical medications do not. Nonsteroidal anti-inflammatory drugs (NSAIDS, aspirin -type painkillers) should not be used by patients receiving chemotherapy because these patients have a bleeding risk.
- Zinc supplements taken during radiation therapy may help treat mucositis as well as dermatitis (inflammation of the skin).
- Povidone-iodine mouthwash that does not contain alcohol may help delay or decrease mucositis caused by radiation therapy.
See the Pain 2 section of this summary for more information on pain control.
PainA cancer patient's pain may come from more than one source.
Sources of pain in a cancer patient include:
- The cancer.
- Cancer treatments.
- Damage to the nervous system.
- Other medical conditions not related to the cancer.
Because there can be many causes of oral pain, a careful diagnosis is important. This may include obtaining a medical history, performing physical and dental exams, and taking x-rays of the teeth. The patient may be asked to rate the level of pain at different times.
- Oral pain in cancer patients may be caused by the cancer.
Cancer can cause pain in different ways:
- The tumor presses on nearby areas as it grows, affecting nerves and causing inflammation.
- Leukemias and lymphomas, which spread through the body, may affect sensitive areas in the mouth.
- Multiple myeloma can affect the teeth.
- Brain tumors may cause headaches.
- Cancers may spread to the head and neck from other parts of the body, causing oral pain.
- With some cancers, pain may be felt in parts of the body not near the cancer. This is called referred pain. Tumors of the nose, throat, and lungs can cause referred pain in the mouth or jaw.
Pain caused by cancer may get worse as the cancer progresses.
- Oral pain may be a side effect of treatments for the cancer and its symptoms.
Oral mucositis is the most common side effect of radiation therapy and chemotherapy. Pain in the mucous membranes often continues for a while even after the mucositis is healed.
Damage to bone, nerves, and/or tissue by surgery may cause pain. Bisphosphonates, drugs taken to treat bone pain, sometimes cause bone to break down. This most commonly happens after a dental procedure such as having a tooth pulled. (See the Oral Complications Not Related to Chemotherapy or Radiation Therapy 3 section of this summary for more information.)
Patients who have transplants may develop graft-versus-host-disease, which can cause inflammation of the mucous membranes and joint pain. (See the Management of Oral Complications of High-Dose Chemotherapy and/or Stem Cell Transplant 4 section of this summary for more information).
- Certain anticancer drugs can cause damage to the nervous system that may result in oral pain.
If an anticancer drug is causing the pain, stopping the drug usually stops the pain. Because there may be many causes of oral pain during cancer treatment, a careful diagnosis is important. This may include obtaining a medical history, performing physical and dental exams, and taking x-rays of the teeth.
Tooth sensitivity may occur in some patients weeks or months after chemotherapy has ended. Fluoride treatments and/or toothpaste for sensitive teeth may relieve the discomfort.
- Pain in the teeth or jaw muscles may occur from tooth grinding or stress.
Pain in the teeth or jaw muscles may occur in patients who grind their teeth or clench their jaws, often because of stress or the inability to sleep. Treatment may include muscle relaxers, drugs to treat anxiety, physical therapy (moist heat, massage, and stretching), and mouth guards to wear while sleeping.
Pain control helps improve the patient's quality of life.
Oral and facial pain can affect eating, talking, and many other activities that involve the head, neck, mouth, and throat. Most patients with head and neck cancers have pain. The doctor may ask the patient to rate the pain using a rating system, for example on a scale from 0 to 10, with 10 being the worst. The level of pain felt may be affected by anxiety or depression, cultural factors, and whether there are problems sleeping. It's important for patients to talk with their doctors about pain. Controlling pain helps to improve the quality of life.
For oral mucositis pain, topical treatments will be tried first. See the Mucositis 5 section of this summary for information on relieving oral mucositis pain.
Pain control may include pain medicines. Sometimes, more than one pain medicine is needed. Opioids may be prescribed for use under careful supervision by the medical team. Muscle relaxers and medicines for anxiety or depression or to prevent seizures may be helpful in some cases.
Non-drug treatments may also help, including some of these:
- Physical therapy.
- TENS (transcutaneous electrical nerve stimulation).
- Applying cold or heat.
- Hypnosis.
- Acupuncture. (See the PDQ summary on Acupuncture 6.)
- Distraction.
- Relaxation therapy or imagery.
- Cognitive behavioral therapy.
- Music or drama therapy.
- Counseling.
Damage to the lining of the mouth and a weakened immune system make it easier for infection to occur.
Oral mucositis breaks down the lining of the mouth, allowing germs and viruses to get into the bloodstream. When the immune system is weakened by chemotherapy, even good bacteria in the mouth can cause infections, as can disease-causing organisms picked up from the hospital or other sources. As the white blood cell count gets lower, infections may occur more often and become more serious. Patients who have low white blood cell counts for a long time are more at risk of developing serious infections. Dry mouth, common during radiation therapy to the head and neck, may also raise the risk of infections in the mouth. These oral symptoms can make toothbrushing uncomfortable and may prevent the patient from eating well. Poor nutrition can further increase the risk of infection. Preventive dental care during chemotherapy and radiation therapy can reduce the risk of mouth, tooth, and gum infections.
The following types of infections may occur:
Bacterial infections
Treatment of bacterial infections in patients who have gum disease and receive high-dose chemotherapy may include the following:
- Medicated and peroxide mouth rinses.
- Brushing and flossing.
- Wearing dentures as little as possible.
Fungal infections
The mouth normally contains fungi that can exist on or in the body without causing any problems. An overgrowth of fungi, however, can be serious and requires treatment.
Antibiotics and steroid drugs are often used when a patient receiving chemotherapy has a low white blood cell count. These drugs change the balance of bacteria in the mouth, making it easier for a fungal overgrowth to occur. Fungal infections are common in patients treated with radiation therapy.
Candidiasis is a type of fungal infection that may occur in cancer patients, especially when treatment includes both chemotherapy and radiation therapy. Symptoms may include a burning pain and taste changes. Treatment of surface fungal infections in the mouth only may include mouthwashes and lozenges that contain antifungal drugs. These are used after removing dentures, brushing the teeth, and cleaning the mouth. An antibacterial rinse should be used to soak dentures and dental appliances and to rinse the mouth. When rinses and lozenges do not get rid of the fungal infection, treatment may be a drug taken by mouth or injection. Drugs may be given to prevent fungal infections from occurring.
Viral infections
Patients receiving chemotherapy, especially those with immune systems weakened by stem cell transplant, are at risk of mild to serious viral infections. Herpesvirus infections and other viruses that are latent (present in the body but not active or causing symptoms) may flare up. Finding and treating the infections early is important. Drugs may be used to prevent or treat viral infections.
BleedingBleeding may occur during chemotherapy when anticancer drugs affect the ability of blood to clot.
Areas of gum disease may bleed on their own or when irritated by eating, brushing, or flossing. Bleeding may be mild (small red spots on the lips, soft palate, or bottom of the mouth) or severe, especially at the gumline and from ulcers in the mouth. When blood counts drop below certain levels, blood may ooze from the gums.
With close monitoring, most patients can safely brush and floss throughout the entire time of decreased blood counts.
Continuing regular oral care will help prevent infections that may further complicate bleeding problems. The dentist or doctor can provide guidance on how to treat bleeding and safely keep the mouth clean when blood counts are low.
Treatment for bleeding during chemotherapy may include the following:
- Medications to reduce blood flow and help clots form.
- Topical products that cover and seal bleeding areas.
- Rinsing with a mixture of one part 3% hydrogen peroxide to 2 or 3 parts saltwater solution (1 teaspoon of salt in 4 cups of water) to help clean oral wounds. Rinsing must be done carefully so clots are not disturbed.
Dry mouth (xerostomia) occurs when the salivary glands produce too little saliva.
Saliva is needed for taste, swallowing, and speech. It helps prevent infection and tooth decay by neutralizing acid and cleaning the teeth and gums. Radiation therapy can damage salivary glands, causing them to make too little saliva. When dry mouth (xerostomia) develops, the patient's quality of life suffers. The mouth is less able to clean itself. Acid in the mouth is not neutralized, and minerals are lost from the teeth. Tooth decay and gum disease are more likely to develop. In addition, there is some evidence that salivary glands may be damaged by certain types of chemotherapy drugs given alone or in combination. Symptoms of dry mouth include the following:
- Thick, stringy saliva.
- Increased thirst.
- Changes in taste, chewing, swallowing, and speech.
- A sore or burning feeling (especially on the tongue).
- Cuts or cracks in the lips or at the corners of the mouth.
- Sensitive to spicy foods and strong flavorings.
- Difficulty wearing dentures.
Treatment of head and neck cancers may include ways to prevent or decrease radiation damage to salivary glands:
- Intensity-modulated radiation therapy (IMRT): The way this type of radiation therapy is given lessens the damage to healthy tissue near the tumor. This may be used in treating head and neck cancers.
- Salivary gland transfer: In some patients, a salivary gland from the area to be treated may be moved by surgery to an area that will not receive radiation, in order to save it.
- Amifostine: This is a drug used to protect normal tissues against the harmful effects of radiation or chemotherapy. It may help prevent salivary gland damage in patients treated with radiation therapy.
Salivary glands may not recover completely after radiation therapy ends.
Saliva production drops within 1 week after starting radiation therapy to the head and/or neck and continues to decrease as treatment continues. The severity of dry mouth depends on the dose of radiation and the number of glands irradiated. The salivary glands in the upper cheeks near the ears are more affected than other salivary glands.
Partial recovery of salivary glands may occur in the first year after radiation therapy, but recovery is usually not complete, especially if the salivary glands were directly irradiated. Salivary glands that were not irradiated may become more active to offset the loss of saliva from the destroyed glands.
Careful oral hygiene can help prevent mouth sores, gum disease, and tooth decay caused by dry mouth.
The following are ways to manage a dry mouth:
- Clean the mouth and teeth at least 4 times a day.
- Sip water or spray the mouth with water frequently.
- Floss once a day.
- Use a fluoride toothpaste when brushing.
- Apply fluoride gel once a day at bedtime, after cleaning the teeth.
- Rinse 4 to 6 times a day with a solution of salt and baking soda (mix ½ teaspoon salt and ½ teaspoon baking soda in 1 cup of warm water). Avoid foods and liquids that contain a lot of sugar. Sip water to relieve mouth dryness.
- Sugar-free lozenges, candy, or gum.
- Acupuncture.
A dentist can provide the following treatments:
- Solutions to replace minerals in the teeth.
- Rinses to fight infection in the mouth.
- Saliva substitutes or medications to stimulate the salivary glands.
- Fluoride treatments to prevent tooth decay.
Dry mouth and changes in the balance of oral bacteria increase the risk of tooth decay. Meticulous oral hygiene (as described in Routine Oral Care 7) and regular care by a dentist can help prevent cavities.
Taste ChangesChanges in taste are common during chemotherapy and radiation therapy.
Change in the sense of taste (dysgeusia) is a common side effect of both chemotherapy and head and/or neck radiation therapy. Graft-versus-host disease may also cause changes in taste. Foods may have no taste or may not taste as they did before therapy. These taste changes are caused by damage to the taste buds, dry mouth, infection, and/or dental problems. Chemotherapy patients may experience unpleasant taste related to the spread of the drug within the mouth. Radiation may cause a change in sweet, sour, bitter, and salty tastes.
In most patients receiving chemotherapy and in some patients undergoing radiation therapy, taste returns to normal a few months after therapy ends. For many radiation therapy patients, however, the change is permanent. In others, the taste buds may recover 6 to 8 weeks, or later, after radiation therapy ends. Zinc sulfate supplements may help with the recovery for some patients.
FatigueCancer patients who are undergoing high-dose chemotherapy and/or radiation therapy often experience fatigue (lack of energy) that is related to either the cancer or its treatment. Some patients may have difficulty sleeping. The patient may feel too tired to perform routine oral care, which may further increase the risk for mouth ulcers, infection, and pain. (See the PDQ summary on Fatigue 8 for more information.)
Malnutrition and Nutritional SupportLoss of appetite can lead to malnutrition.
Patients undergoing treatment for head and neck cancers are at high risk for malnutrition. The cancer itself, poor diet before diagnosis, and complications from surgery, radiation therapy, and chemotherapy can lead to nutritional shortfalls. Patients can lose the desire to eat due to nausea, vomiting, trouble swallowing, sores in the mouth, or dry mouth. When eating causes discomfort or pain, the patient's quality of life and nutritional well-being suffer. The following suggestions may help patients with cancer meet their nutritional needs:
- Change the texture of food. Serving food chopped, ground, or blended can reduce the amount of time it needs to stay in the mouth before being swallowed.
- Eat between-meal snacks to add calories and nutrients.
- Choose foods high in calories and protein.
- Take supplements that provide vitamins, minerals, and calories.
Nutritional counseling may be helpful during and after treatment.
Nutritional support may include liquid diets and enteral feedings.
Many patients treated for head and neck cancers who receive radiation therapy alone are able to eat soft foods. As treatment progresses, most patients will include or switch to liquid diets using high-calorie, high-protein nutritional drinks. Some patients may need enteral tubefeeding to meet their nutritional needs. Almost all patients who receive chemotherapy and head and/or neck radiation therapy at the same time will require enteral nutritional support within 3 to 4 weeks. Studies show that patients benefit when they begin enteral feedings at the start of treatment, before weight loss occurs.
Normal eating by mouth begins again when treatment is finished and the site that received radiation is healed. The return to normal eating often needs a team approach, including a speech and swallowing therapist to ease the adjustment back to solid foods. Tubefeedings are decreased as a patient's intake by mouth increases, and are stopped when the patient is able to get enough nutrients by mouth. Although most patients will regain their ability to eat solid foods, many will have lasting complications such as taste changes, dry mouth, and trouble swallowing. These complications can interfere with meeting their nutritional needs and with their quality of life.
Limited Jaw MovementA long-term complication of radiation therapy is the growth of benign tumors in the skin and muscles. These tumors may make it difficult for the patient to move the mouth and jaw normally. Oral surgery may damage nerves or muscles and also affect jaw movement. This muscle stiffness in the jaw is called trismus or lockjaw.
Limitations in opening the jaw (a locked jaw) may lead to serious health problems:
- Malnutrition and weight loss from being unable to eat normally.
- Slower healing and recovery from poor nutrition.
- Dental problems from being unable to clean the teeth and gums well and have dental treatments.
- Weakened jaw joint and muscles from not using them.
- Emotional problems from avoiding social contact with others because of the trouble speaking and eating.
The risk of developing jaw stiffness from radiation therapy increases with higher doses of radiation and with repeated radiation treatments. The stiffness usually begins near the end of radiation treatments and may get worse over time, remain the same, or get somewhat better on its own. Treatment should begin as soon as possible to keep the condition from getting worse or becoming permanent. Treatment may include the following
- Oral medical devices.
- Pain treatments.
- Medicine to relax muscles.
- Jaw exercises.
- Medicine to treat depression.
Pain during swallowing and being unable to swallow (dysphagia) are common in cancer patients before, during, and after treatment.
Swallowing problems occur most often in patients who have head and neck cancers, but they can develop with other cancers also. Cancer treatment side effects such as oral mucositis, dry mouth, skin damage from radiation, infections, and graft-versus-host-disease may all contribute to problems with swallowing.
Trouble swallowing increases the risk of other complications.
Other complications can develop from being unable to swallow and these can further decrease the patient's quality of life:
- Pneumonia and respiratory failure: Patients who have trouble swallowing may aspirate (inhale food or liquids into the lung) when trying to eat or drink. Aspiration can lead to serious conditions, including pneumonia and respiratory failure.
- Poor nutrition: Being unable to swallow normally makes it hard to eat well. Malnutrition occurs when the body doesn't get all the nutrients needed for health. Wounds heal more slowly and the body is less able to fight off infections.
- Use of tubefeeding: A patient who is not able to take in enough food by mouth may be fed through a tube. The healthcare team and a registered dietitian can explain the benefits and risks of tubefeeding for patients who have swallowing problems.
- Side effects of pain medicine: Opioids for painful swallowing may cause dry mouth and constipation.
- Emotional problems: Being unable to eat, drink, and speak, normally may cause depression and the desire to avoid other people.
Whether radiation therapy will affect swallowing depends on several factors.
The following factors may affect the risk of developing swallowing problems after radiation therapy:
- Total dose and schedule of radiation therapy. Higher doses over a shorter time often have more side effects.
- The way the radiation is given. Some types of radiation spare more healthy tissue.
- Whether chemotherapy is given at the same time. The risk of side effects is increased if both are given.
- The patient's genetic makeup.
- Whether the patient is taking any food by mouth or only by tube-feeding.
- Whether the patient smokes.
- How well the patient copes with problems.
Swallowing problems sometimes go away after treatment, but they sometimes continue or appear years later.
Some side effects go away by 3 months after the end of treatment, and patients are able to swallow normally again. Head and neck cancer treatments, however, may cause permanent damage or late effects, side effects that appear long after treatment has ended. Some conditions that may cause permanent swallowing problems or late effects include:
- Damaged blood vessels.
- Wasting away of tissue in the treated areas.
- Lymphedema (build up of lymph fluid in the body).
- Overgrowth of fibrous tissue in head or neck areas that may lead to lockjaw.
- Chronic dry mouth.
- Infections.
Managing swallowing problems involves a team and may begin when planning cancer treatment.
The oncologist works with other health care experts who specialize in head and neck cancers and the care of oral complications of cancer treatment. These specialists may include the following:
- Speech therapist: A speech therapist can assess how well the patient is swallowing, give the patient information to better understand the problem, and provide swallowing therapy.
- Dietician: A dietician can help plan a safe way for the patient to receive the nutrition needed for health while swallowing is a problem.
- Dental specialists: Replacing missing teeth and other oral structures with artificial devices may help swallowing.
- Psychologist: For patients who are having a hard time adjusting to the being unable to swallow and eat normally, psychological counseling may help.
Radiation therapy can destroy very small blood vessels within the bone. These blood vessels carry both nutrients and oxygen to the bone. When the blood vessels are destroyed, bone death occurs. When tissue death occurs, ulcers may form in the soft tissues of the mouth, grow in size, and cause pain or loss of feeling. Infection becomes a risk. As bone tissue is lost, fractures can occur. Preventive care can lessen the severity of tissue and bone loss.
Treatment of tissue and bone loss may include the following:
- Maintaining a well-balanced diet.
- Wearing removable dentures or appliances as little as possible.
- Not smoking.
- Not drinking alcohol.
- Using topical antibiotics.
- Using painkillers.
- Undergoing surgery to remove dead bone or to reconstruct bones of the mouth and jaw.
- Receiving hyperbaric oxygen therapy, a method of delivering oxygen under pressure to the surface of a wound to help it heal.
(See the PDQ summary Nutrition in Cancer Care 9 for more information about managing mouth sores, dry mouth, and taste changes.)
Glossary Termsacid (A-sid)A chemical that gives off hydrogen ions in water and forms salts by combining with certain metals. Acids have a sour taste and turn certain dyes red. Some acids made by the body, such as gastric acid, can help organs work the way they should. An example of an acid is hydrochloric acid. Acidity is measured on a scale called the pH scale. On this scale, a value of 7 is neutral, and a pH value of less than 7 to 0 shows increasing acidity.acupuncture (AK-yoo-PUNK-cher) The technique of inserting thin needles through the skin at specific points on the body to control pain and other symptoms. It is a type of complementary and alternative medicine.alcohol (AL-kuh-hol) A chemical substance found in beer, wine, and liquor, and some medicines, mouthwashes, household products, and essential oils (scented liquid taken from plants). Alcohol contains a carbon atom attached to a hydroxyl group (a molecule made of an oxygen atom and a hydrogen atom).amifostine (A-mih-FOS-teen) A drug used as a chemoprotective drug to control some of the side effects of chemotherapy and radiation therapy.antibacterial (AN-tee-bak-TEER-ee-ul) A substance that kills bacteria or stops them from growing and causing disease.antifungal (AN-tee-FUN-gul) A drug that treats infections caused by fungi.anxiety (ang-ZY-eh-tee) Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.aspirin (AS-pih-rin) A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention.bacteria (bak-TEER-ee-uh) A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium.benign tumor (beh-NINE TOO-mer) A growth that is not cancer. It does not invade nearby tissue or spread to other parts of the body.bisphosphonate (bis-FOS-foh-nayt) A drug or substance used to treat hypercalcemia (abnormally high blood calcium) and bone pain caused by some types of cancer. Forms of bisphosphonates are also used to treat osteoporosis and for bone imaging. Bisphosphonates inhibit a type of bone cell that breaks down bone. Also called diphosphonate.blood cell count (blud sel kownt) A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood. Also called CBC and complete blood count.blood clot (blud klot) A mass of blood that forms when blood platelets, proteins, and cells stick together. When a blood clot is attached to the wall of a blood vessel, it is called a thrombus. When it moves through the bloodstream and blocks the flow of blood in another part of the body, it is called an embolus.blood vessel (blud VEH-sel) A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.bone marrow transplantation (bone MAYR-oh tranz-plan-TAY-shun) A procedure to replace bone marrow that has been destroyed by treatment with high doses of anticancer drugs or radiation. Transplantation may be autologous (an individual's own marrow saved before treatment), allogeneic (marrow donated by someone else), or syngeneic (marrow donated by an identical twin).brain tumor (brayn TOO-mer) The growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (not cancer) or malignant (cancer).calorie (KA-luh-ree) A measurement of the energy content of food. The body needs calories as to perform its functions, such as breathing, circulating the blood, and physical activity. When a person is sick, their body may need extra calories to fight fever or other problems.cancer (KAN-ser) A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.candidiasis (KAN-dih-DY-uh-sis) A condition in which Candida albicans, a type of yeast, grows out of control in moist skin areas of the body. It is usually a result of a weakened immune system, but can be a side effect of chemotherapy or treatment with antibiotics. Candidiasis usually affects the mouth (oral candidiasis); however, rarely, it spreads throughout the entire body. Also called candidosis and thrush.cavity (KA-vih-tee) A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.chemotherapy (KEE-moh-THAYR-uh-pee) Treatment with drugs that kill cancer cells.chronic (KRAH-nik) A disease or condition that persists or progresses over a long period of time.combination chemotherapy (KOM-bih-NAY-shun KEE-moh-THAYR-uh-pee) Treatment using more than one anticancer drug.complication (kom-plih-KAY-shun) In medicine, a medical problem that occurs during a disease, or after a procedure or treatment. The complication may be caused by the disease, procedure, or treatment or may be unrelated to them.constipation (KON-stih-PAY-shun) A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.counseling (KOWN-suh-ling) The process by which a professional counselor helps a person cope with mental or emotional distress, and understand and solve personal problems.culture (KUL-cher) The beliefs, values, and behaviors that are shared within a group, such as a religious group or a nation. Culture includes language, customs, and beliefs about roles and relationships.dentist (DEN-tist) A health professional who specializes in caring for the teeth, gums, and other tissues in the mouth.depression (dee-PREH-shun) A mental condition marked by ongoing feelings of sadness, despair, loss of energy, and difficulty dealing with normal daily life. Other symptoms of depression include feelings of worthlessness and hopelessness, loss of pleasure in activities, changes in eating or sleeping habits, and thoughts of death or suicide. Depression can affect anyone, and can be successfully treated. Depression affects 15-25% of cancer patients.dermatitis (DER-muh-TY-tis) Inflammation of the skin.device (dee-VISE) An object that has a specific use. In medicine, wheelchairs, pumps, and artificial limbs are examples of devices.diagnosis (DY-ug-NOH-sis) The process of identifying a disease, such as cancer, from its signs and symptoms.diet (DY-et) The things a person eats and drinks.distraction (dis-TRAK-shun) In medicine, a pain relief method that takes the patient's attention away from the pain.dose (dose) The amount of medicine taken, or radiation given, at one time.drug (drug) Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.dysgeusia (dis-GOO-zee-uh) A bad taste in the mouth. Also called parageusia.enteral nutrition (EN-teh-rul noo-TRIH-shun) A form of nutrition that is delivered into the digestive system as a liquid. Drinking nutrition beverages or formulas and tubefeeding are forms of enteral nutrition. People who are unable to meet their needs with food and beverages alone, and who do not have vomiting or uncontrollable diarrhea may be given tubefeedings. Tubefeeding can be used to add to what a person is able to eat or can be the only source of nutrition. A small feeding tube may be placed through the nose into the stomach or the small intestine, or it may be surgically placed into the stomach or the intestinal tract through an opening made on the outside of the abdomen, depending on how long it will be used.fatigue (fuh-TEEG) A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.fibrous (FY-brus) Containing or resembling fibers.fluid (FLOO-id) A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.fluoride (FLOOR-ide) A form of the element fluorine that helps prevent tooth decay. Fluoride may be naturally present in drinking water or may be added to it. Fluoride may also be put directly on the teeth, as a gel, toothpaste, or a rinse.fluorouracil (floor-oh-YOOR-uh-sil) A drug used to treat cancers of the breast, stomach, and pancreas, and certain types of colorectal and head and neck cancers. It is also used in a cream to treat basal cell skin cancer and actinic keratosis (a skin condition that may become cancer). It is being studied in the treatment of other conditions and types of cancer. Fluorouracil stops cells from making DNA and it may kill cancer cells. It is a type of antimetabolite. Also called 5-fluorouracil, 5-FU, Adrucil, Efudex, and Fluoroplex.fungus (FUN-gus) A plant-like organism that does not make chlorophyll. Mushrooms, yeasts, and molds are examples. The plural is fungi.genetic (jeh-NEH-tik) Inherited; having to do with information that is passed from parents to offspring through genes in sperm and egg cells.graft-versus-host disease (... dih-ZEEZ) A disease caused when cells from a donated stem cell graft attack the normal tissue of the transplant patient. Symptoms include jaundice, skin rash or blisters, a dry mouth, or dry eyes. Also called GVHD.gums (gumz) The tissue of the upper and lower jaws that surrounds the base of the teeth. Also called gingiva.head and neck cancer (... KAN-ser) Cancer that arises in the head or neck region (in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx [voice box]).herpesvirus (HER-peez-VY-rus) A member of the herpes family of viruses.high-dose chemotherapy (hy-dose kee-moh-THAYR-uh-pee) An intensive drug treatment to kill cancer cells, but that also destroys the bone marrow and can cause other severe side effects. High-dose chemotherapy is usually followed by bone marrow or stem cell transplantation to rebuild the bone marrow.hydrogen peroxide (HY-droh-jen peh-ROK-side) A chemical used in bleaches, dyes, cleansers, antiseptics, and disinfectants. In a concentrated form, it is toxic and irritating to tissues.hygiene (HY-jeen) The science of health, and the practice of cleanliness that promotes good health and well-being.hyperbaric oxygen (HY-per-BAYR-ik OK-sih-jen) Oxygen that is at an atmospheric pressure higher than the pressure at sea level. Breathing hyperbaric oxygen to enhance the effectiveness of radiation therapy is being studied.imagery (IH-muh-jree) A technique in which a person focuses on positive images in his or her mind. It can help people reach a relaxed, focused state and help reduce stress and give a sense of well-being. Also called guided imagery.immune system (ih-MYOON SIS-tem) The complex group of organs and cells that defends the body against infections and other diseases.infection (in-FEK-shun) Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.inflammation (IN-fluh-MAY-shun) Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.injection (in-JEK-shun) Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."intensity-modulated radiation therapy (in-TEN-sih-tee-MAH-juh-LAY-tid RAY-dee-AY-shun THAYR-uh-pee) A type of 3-dimensional radiation therapy that uses computer-generated images to show the size and shape of the tumor. Thin beams of radiation of different intensities are aimed at the tumor from many angles. This type of radiation therapy reduces the damage to healthy tissue near the tumor. Also called IMRT.iodine (I-oh-dine) An element that is necessary for the body to make thyroid hormone. It is found in shellfish and iodized salt.irradiated (ih-RAY-dee-AY-ted) Treated with radiation.joint (joynt) In medicine, the place where two or more bones are connected. Examples include the shoulder, elbow, knee, and jaw.late effects (layt eh-FEKTS) Side effects of cancer treatment that appear months or years after treatment has ended. Late effects include physical and mental problems and second cancers.latent (LAY-tint) Describes a condition that is present but not active or causing symptoms.leukemia (loo-KEE-mee-uh) Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.lung (lung) One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.lymph (limf) The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.lymphedema (LIM-fuh-DEE-muh) A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged, or removed by surgery.lymphoma (lim-FOH-muh) Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One kind is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer.malnutrition (mal-noo-TRIH-shun) A condition caused by not getting enough calories or the right amount of key nutrients, such as vitamins and minerals, that are needed for health. Malnutrition may occur when there is a lack of nutrients in the diet or when the body cannot absorb nutrients from food. Cancer and cancer treatment may cause malnutrition.massage therapy (muh-SAZH THAYR-uh-pee) A treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Massage therapy may help people relax, relieve stress and pain, lower blood pressure, and improve circulation. It is being studied in the treatment of cancer symptoms such as lack of energy, pain, swelling, and depression.medical history (MEH-dih-kul HIH-stuh-ree) A record of information about a person’s health. A personal medical history may include information about allergies, illnesses, surgeries, immunizations, and results of physical exams and tests. It may also include information about medicines taken and health habits, such as diet and exercise. A family medical history includes health information about a person’s close family members (parents, grandparents, children, brothers, and sisters). This includes their current and past illnesses. A family medical history may show a pattern of certain diseases in a family.medication (MEH-dih-KAY-shun) A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.mineral (MIH-neh-rul) In medicine, a mineral is a nutrient that is needed in small amounts to keep the body healthy. Mineral nutrients include the elements calcium, magnesium, and iron.mucositis (myoo-koh-SY-tis) A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth.mucous membrane (MYOO-kus MEM-brayn) The moist, inner lining of some organs and body cavities (such as the nose, mouth, lungs, and stomach). Glands in the mucous membrane make mucus (a thick, slippery fluid). Also called mucosa.multiple myeloma (MUL-tih-pul MY-eh-LOH-muh) A type of cancer that begins in plasma cells (white blood cells that produce antibodies). Also called Kahler disease, myelomatosis, and plasma cell myeloma.nausea (NAW-zee-uh) A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.nerve (nerv) A bundle of fibers that receives and sends messages between the body and the brain. The messages are sent by chemical and electrical changes in the cells that make up the nerves.nonsteroidal anti-inflammatory drug (NON-steh-ROY-dul AN-tee-in-FLA-muh-TOR-ee ...) A drug that decreases fever, swelling, pain, and redness. Also called NSAID.nutrient (NOO-tree-ent) A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.nutrition (noo-TRIH-shun) The taking in and use of food and other nourishing material by the body. Nutrition is a 3-part process. First, food or drink is consumed. Second, the body breaks down the food or drink into nutrients. Third, the nutrients travel through the bloodstream to different parts of the body where they are used as "fuel" and for many other purposes. To give the body proper nutrition, a person has to eat and drink enough of the foods that contain key nutrients.nutritional counseling (noo-TRIH-shuh-nul KOWN-suh-ling) A process by which a health professional with special training in nutrition helps people make healthy food choices and form healthy eating habits. In cancer treatment, the goal of nutritional counseling is to help patients stay healthy during and after treatment and to stay strong enough to fight infections and the recurrence of disease. Also called dietary counseling.oncologist (on-KAH-loh-jist) A doctor who specializes in treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation.opioid (OH-pee-OYD) A substance used to treat moderate to severe pain. Opioids are like opiates, such as morphine and codeine, but are not made from opium. Opioids bind to opioid receptors in the central nervous system. Opioids used to be called narcotics. An opioid is a type of alkaloid.oral (OR-ul) By or having to do with the mouth.ounce (ownts) A measure of weight (one-sixteenth pound) and volume (one-eighth cup).oxygen (OK-sih-jen) A colorless, odorless gas. It is needed for animal and plant life. Oxygen that is breathed in enters the blood from the lungs and travels to the tissues.PDQ PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun) An exam of the body to check for general signs of disease.physical therapy (FIH-zih-kul THAYR-uh-pee) The use of exercises and physical activities to help condition muscles and restore strength and movement. For example, physical therapy can be used to restore arm and shoulder movement and build back strength after breast cancer surgery.physician (fih-ZIH-shun) Medical doctor.prescription (prih-SKRIP-shun) A doctor's order for medicine or another intervention.preventive (pree-VEN-tiv) Used to prevent disease.progression (pruh-GREH-shun) In medicine, the course of a disease, such as cancer, as it becomes worse or spreads in the body.protein (PROH-teen) A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.psychological (SY-koh-LAH-jih-kul) Having to do with how the mind works and how thoughts and feelings affect behavior.psychologist (sy-KAH-loh-jist) A specialist who can talk with patients and their families about emotional and personal matters, and can help them make decisions.quality of life (KWAH-lih-tee ... life) The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.radiation therapy (RAY-dee-AY-shun THAYR-uh-pee) The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.recover (ree-KUH-ver) To become well and healthy again.registered dietitian (...dy-eh-TIH-shun) A health professional with special training in the use of diet and nutrition to keep the body healthy. A registered dietitian may help the medical team improve the nutritional health of a patient.relaxation therapy (ree-lak-SAY-shun THAYR-uh-pee) A type of therapy that helps reduce muscle tension and stress, lowers blood pressure, and controls pain. It may involve tensing and relaxing muscles throughout the body. It may be used with guided imagery (focusing the mind on positive images) and meditation (focusing thoughts).saliva (suh-LY-vuh) The watery fluid in the mouth made by the salivary glands. Saliva moistens food to help digestion and it helps protect the mouth against infections.salivary gland (SA-lih-VAYR-ee gland) A gland in the mouth that produces saliva.seizure (SEE-zher) Sudden, uncontrolled body movements and changes in behavior that occur because of abnormal electrical activity in the brain. Symptoms include loss of awareness, changes in emotion, loss of muscle control, and shaking. Seizures may be caused by drugs, high fevers, head injuries, and certain diseases, such as epilepsy.side effect (side eh-FEKT) A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.soft palate (... PAL-et) The back, muscular (not bony) part of the roof of the mouth.soluble (SOL-yoo-bul) Able to be dissolved in a liquid.speech therapist (speech THAYR-uh-pist) A specialist who evaluates and treats people with communication and swallowing problems. Also called speech pathologist.stem cell transplant (stem sel tranz-plant) A method of replacing immature blood-forming cells in the bone marrow that have been destroyed by drugs, radiation, or disease. Stem cells are injected into the patient and make healthy blood cells. A stem cell transplant may be autologous (using a patient’s own stem cells that were saved before treatment), allogeneic (using stem cells donated by someone who is not an identical twin), or syngeneic (using stem cells donated by an identical twin).sterile (STAYR-il) Unable to produce children. Also means free from germs.steroid drug (STAYR-oyd ...) A type of drug used to relieve swelling and inflammation. Some steroid drugs may also have antitumor effects.stomatitis (STOH-muh-TY-tis) Inflammation or irritation of the mucous membranes in the mouth.stress (stres) The response of the body to physical, mental, or emotional pressure. This may make a person feel frustrated, angry, or anxious, and may cause unhealthy chemical changes in the body. Untreated, long-term stress may lead to many types of mental and physical health problems.supplementation (SUH-pleh-MEN-TAY-shun) Adding nutrients to the diet.surgery (SER-juh-ree) A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.symptom (SIMP-tum) An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.TENS A procedure in which mild electric currents are applied to some areas of the skin. Also called transcutaneous electrical nerve stimulation.throat (throte) The hollow tube inside the neck that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). The throat is about 5 inches long, depending on body size. Also called pharynx.tissue (TIH-shoo) A group or layer of cells that work together to perform a specific function.topical (TAH-pih-kul) On the surface of the body.transplantation (tranz-plan-TAY-shun) A surgical procedure in which tissue or an organ is transferred from one area of a person’s body to another area, or from one person (the donor) to another person (the recipient).tubefeeding (toob-FEE-ding) A type of enteral nutrition (nutrition that is delivered into the digestive system in a liquid form). For tubefeeding, a small tube may be placed through the nose into the stomach or the small intestine. Sometimes it is surgically placed into the stomach or the intestinal tract through an opening made on the outside of the abdomen, depending on how long it will be used. People who are unable to meet their needs with food and beverages alone, and who do not have vomiting or uncontrollable diarrhea may be given tubefeedings. Tubefeeding can be used to add to what a person is able to eat or can be the only source of nutrition.tumor (TOO-mer) An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.ulcer (UL-ser) A break on the skin, in the lining of an organ, or on the surface of a tissue. An ulcer forms when the surface cells become inflamed, die, and are shed. Ulcers may be linked to cancer and other diseases.ulceration (UL-seh-RAY-shun) The formation of a break on the skin or on the surface of an organ. An ulcer forms when the surface cells die and are cast off. Ulcers may be associated with cancer and other diseases.viral (VY-rul) Having to do with a virus.virus (VY-rus) In medicine, a very simple microorganism that infects cells and may cause disease. Because viruses can multiply only inside infected cells, they are not considered to be alive.vitamin (VY-tuh-min) A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.vomit (VAH-mit) To eject some or all of the contents of the stomach through the mouth.white blood cell (hwite blud sel) A type of immune cell. Most white blood cells are made in the bone marrow and are found in the blood and lymph tissue. White blood cells help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are white blood cells. Also called leukocyte and WBC.wound (woond) A break in the skin or other body tissues caused by injury or surgical incision (cut).x-ray (EX-ray) A type of radiation used in the diagnosis and treatment of cancer and other diseases. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.xerostomia (ZEER-oh-STOH-mee-uh) Dry mouth. It occurs when the body is not able to make enough saliva.zinc sulfate (zink SUL-fayt) A substance required for cell growth and tissue repair. It is being studied as a way to prevent or decrease mucositis caused by radiation therapy. |