Routine Oral Care
Oral Mucositis
Infection
Bleeding
Dry Mouth
Tooth Decay
Taste Changes
Fatigue
Malnutrition and Nutritional Support
Pain
Jaw Stiffness
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 and gums with a soft bristle brush 2 to 3 times a day for 2 to 3 minutes.



• Rinse the toothbrush in hot water every 15 to 30 seconds to soften the bristles, if needed.



• If it is necessary to use a foam toothbrush, use it with an antibacterial rinse, when possible.



• Allow the toothbrush to air dry between brushings.



• Choose toothpaste with care:
  • Use a mild-tasting toothpaste; flavoring may irritate the mouth.
  • If toothpaste irritates the mouth, brush with a solution of 1 teaspoon of salt added to 4 cups (1 quart) of water.
  • Use a fluoride toothpaste.

Rinsing

• Rinse the mouth 3 or 4 times while brushing.
• Avoid rinses containing alcohol.
• 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.

Mucositis 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. 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. The following rinse may be used to neutralize acid and dissolve thick saliva:
  • ½ teaspoon salt and 2 tablespoons baking soda in 4 cups of water.



• 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).
  This should not be used for more than 2 days because it will keep mucositis from healing.

Relieving 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.



• 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.



• Capsaicin, the active ingredient in hot peppers, may be used to increase a person's ability to tolerate pain. When capsaicin is put on inflamed tissues in the mouth, mucositis pain may decrease as the burning feeling from the capsaicin decreases. The side effects of capsaicin are not known.



• 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.

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. 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.

Bacterial infections in patients undergoing radiation therapy are usually treated with antibiotics.

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.

Drugs may be given to prevent fungal infections from occurring. 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 on dentures and dental appliances and to rinse the mouth.

Deeper fungal infections, such as those in the esophagus or intestines, are treated with drugs taken by mouth or injection.

Viral infections

Patients receiving chemotherapy, especially those with weakened immune systems, are at risk of mild to serious viral infections. Finding and treating the infections early is important. Drugs may be used to prevent or treat viral infections.

Herpesvirus infections may recur in radiation therapy patients who have these infections.

Bleeding 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, 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.
• Changes in the surface of the tongue.
• Difficulty wearing dentures.

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 guidelines for managing dry mouth:

• Clean the mouth and teeth at least 4 times a day.
• 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.

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 ¹) and regular care by a dentist can help prevent cavities.

Changes 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. 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.

Cancer 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. (Refer to the PDQ summary on Fatigue ² for more information.)

Loss 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.

Certain anticancer drugs can cause nerve damage 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 the following:

• Muscle relaxers.
• Drugs to treat anxiety.
• Physical therapy (moist heat, massage, and stretching).
• Mouthguards to wear while sleeping.

A 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 also affect jaw mobility. Management of jaw stiffness may include the following:

• Physical therapy.
• Oral appliances.
• Pain treatments.
• Medication.

Radiation therapy can cause tissue and bone in the treated area to waste away. 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:

• Eating 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.

(Refer to Nutrition in Cancer Care ³ for more information about managing mouth sores, dry mouth, and taste changes.)

Glossary Terms

A chemical substance found in beer, wine, and liquor. Alcohol is also found in some medicines, mouthwashes, essential oils (scented liquid taken from plants), and household products.

A substance that kills bacteria or stops them from growing and causing disease.

A drug used to treat infections caused by bacteria and other microorganisms.

A drug that treats infections caused by fungi.

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.

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.

A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium.

A noncancerous growth that does not invade nearby tissue or spread to other parts of the body.

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.

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.

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).

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.

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 cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is 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.

A component of certain plants, including cayenne and red pepper, used topically for peripheral nerve pain. It is also being studied for controlling mucositis pain after chemotherapy and radiation therapy.

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.

Treatment with drugs that kill cancer cells.

Treatment using more than one anticancer drug.

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.

A health professional who specializes in caring for the teeth, gums, and other tissues in the mouth.

Inflammation of the skin.

The process of identifying a disease, such as cancer, from its signs and symptoms.

The things a person eats and drinks.

The amount of medicine taken, or radiation given, at one time.

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.

A bad taste in the mouth. Also called parageusia.

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.

The muscular tube through which food passes from the throat to the stomach.

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

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.

A drug used to treat symptoms of cancer of the colon, breast, stomach, and pancreas. It is also used in a cream to treat certain skin conditions. Fluorouracil stops cells from making DNA and it may kill cancer cells. It is a type of antimetabolite. Also called 5-fluorouracil and 5-FU.

A plant-like organism that does not make chlorophyll. Mushrooms, yeasts, and molds are examples. The plural is fungi.

The tissue of the upper and lower jaws that surrounds the base of the teeth. Also called gingiva.

Cancer that arises in the head or neck region (in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx [voice box]).

A member of the herpes family of viruses.

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.

A chemical used in bleaches, dyes, cleansers, antiseptics, and disinfectants. In a concentrated form, it is toxic and irritating to tissues.

The science of health, and the practice of cleanliness that promotes good health and well-being.

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.

The complex group of organs and cells that defends the body against infections and other diseases.

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.

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.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

The long, tube-shaped organ in the abdomen that completes the process of digestion. The intestine has two parts, the small intestine and the large intestine. Also called bowel.

An element that is necessary for the body to make thyroid hormone. It is found in shellfish and iodized salt.

Treated with radiation.

A disorder caused by a lack of proper nutrition or an inability to absorb nutrients from food.

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.

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

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.

A complication of some cancer therapies in which the lining of the digestive system becomes inflamed. Often seen as sores in the mouth.

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.

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.

A drug that decreases fever, swelling, pain, and redness. Also called NSAID.

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.

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.

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.

By or having to do with the mouth.

A measure of weight (one-sixteenth pound) and volume (one-eighth cup).

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 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.

An exam of the body to check for general signs of disease.

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.

Medical doctor.

Used to prevent disease.

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.

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.

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.

To come back or to return.

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.

A gland in the mouth that produces saliva.

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.

The back, muscular (not bony) part of the roof of the mouth.

Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body.

A specialist who evaluates and treats people with communication and swallowing problems. Also called speech pathologist.

A method of replacing immature blood-forming cells that were destroyed by cancer treatment. The stem cells are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells.

Unable to produce children. Also means free from germs.

A type of drug used to relieve swelling and inflammation. Some steroid drugs may also have antitumor effects.

Inflammation or irritation of the mucous membranes in the mouth.

Adding nutrients to the diet.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

A group or layer of cells that work together to perform a specific function.

On the surface of the body.

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.

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.

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.

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.

Having to do with a virus.

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.

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.

To eject some or all of the contents of the stomach through the mouth.

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.

A break in the skin or other body tissues caused by injury or surgical incision (cut).

A type of high-energy radiation. 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.

Dry mouth. It occurs when the body is not able to make enough saliva.

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.