Oral Ulcers Secondary to Cancer Chemotherapy
Chemotherapeutic drugs are frequently used to effect remission of both solid tumors, hematologic malignancies, and bone marrow transplantation. Similar drugs are used for patients with bone marrow transplants. One of the common side effects of the anticancer drugs is multiple oral ulcers. Dentists who practice in hospitals where these drugs are used extensively may see oral ulcers secondary to such drug therapy more frequently than any other lesion described in this chapter.
Chemotherapeutic drugs are frequently used to effect remission of both solid tumors, hematologic malignancies, and bone marrow transplantation. Similar drugs are used for patients with bone marrow transplants. One of the common side effects of the anticancer drugs is multiple oral ulcers. Dentists who practice in hospitals where these drugs are used extensively may see oral ulcers secondary to such drug therapy more frequently than any other lesion described in this chapter.
Anticancer drugs may cause oral ulcers directly or indirectly. Drugs that cause stomatitis indirectly depress the bone marrow and immune response, leading to bacterial, viral, or fungal infections of the oral mucosa. Others, such as methotrexate, cause oral ulcers via direct effect on the replication and growth of oral epithelial cells by interfering with nucleic acid and protein synthesis, leading to thinning and ulceration of the oral mucosa.
A recent publication by Sonis describes a new hypothesis that explains the severe stomatitis observed in patients receiving cytotoxic drugs for stem cell transplantation.It is noted that an inflammatory reaction precedes ulceration and that anti-inflammatory drugs may be useful in minimizing bone marrow–related ulceration.
Details of the diagnosis and management of these lesions are discussed in Chapters 19, Transplantation Medicine, and 16, Hematologic Disease.