Pathology · patient case question
What is the MOST common oral manifestation in patients receiving chemotherapy?
Patient case: Oral pain during head and neck radiotherapy
Patient: Female, 61 years old
Chief Complaint: “My whole mouth is raw and I can barely eat.”
Background: Currently in week four of radiotherapy for a squamous cell carcinoma of the tonsil, with concurrent chemotherapy.
Current Findings: Diffuse erythema and confluent ulceration of the buccal and labial mucosa and the soft palate. The pain is generalised and clearly NOT of dental origin. No white plaques that can be wiped off. No individual tooth is tender to percussion. Salivary flow markedly reduced.
Show answer and explanation
Correct answer: A. Mucositis
- A. CORRECT. Mucositis is the most common and most debilitating oral complication of chemotherapy. Rapidly dividing basal epithelial cells of the oral mucosa are among the first non-tumour tissues affected, and the resulting ulceration typically appears within one to two weeks, peaks around the end of the second week, and impairs eating, speaking and drug tolerance.
- B. Trismus follows radiation fibrosis of the muscles of mastication and the TMJ capsule, and it develops over months.
- C. Xerostomia is characteristic of RADIOTHERAPY involving the salivary glands. Chemotherapy can reduce salivary flow, but mucositis is the dominant chemotherapy-related oral problem.
- D. Osteoradionecrosis is a complication of RADIOTHERAPY to the jaws, not of chemotherapy, and it appears months to years later — not during treatment.