Tobacco smoking causes more than just bad breath and stained teeth. Tobacco smoking is one of the main causes for lung cancer. Lung cancer is one of the leading causes of death around the world. Non-small cell lung cancer is one of two types of lung cancer. Non-small cell lung cancer can be broken down into three different types of carcinoma. I am going to focus on adenocarcinoma which is the most common type to be found in previous smokers.
My patient smoked tobacco for a number of years. As a result, in 2016 he was diagnosed with non-small cell adenocarcinoma of the lungs. Quickly after the diagnoses, he started chemotherapy and went for treatment every three weeks. His symptoms from the lung cancer caused him to have shortness of breath, coughing, chest pains, and infections of the lungs. Ever since his diagnosis, he has been taking medication to help treat his lung cancer and manage side effects from the chemotherapy. I chose non-small cell adenocarcinoma because the cancer itself and the side effects of treatment has a major impact on my patients’ overall oral health.
1The main etiology of non-small cell adenocarcinoma is tobacco smoking. Carcinogens from tobacco smoking gets into the body when inhaled and slowly damages the cells in the lungs. The cells become mutated and eventually over time start to grow uncontrolled then metastasize to other parts of the body.
Physical manifestations of non-small cell adenocarcinoma can result in wheezing, weight loss, and infections that will not go away. 2One of the most prevalent symptoms is pain. Pain is one of the most prevalent symptoms because it is the result of the cancer spreading to different parts of the body and the cancer cells slowly damaging the tissues around it.
Medications along with chemotherapy are used to treat the cancer and the symptoms associated with non-small cell adenocarcinoma. As a result of chemotherapy, xerostomia, diminished salivary flow, and difficulty swallowing can present in the oral cavity. 4This can eventually lead to coronal caries, potentially root caries, and periodontitis due to being susceptible to bacteria. Without the presence of saliva, the oral cavity is at a higher risk for dental caries due to the fact of the low clearance rate, and periodontal disease due to being immunocompromised.
3Determining what treatment needed for this cancer depends on the patients’ health and the stage of the cancer. Treatment of non-small cell adenocarcinoma includes medication, radiation therapy, and chemotherapy. For stages one and two, surgery is the first option to remove the tumor. For the later stages, radiation therapy coupled with chemotherapy can be used to shrink the tumor before having it surgically removed.
For a patient who has lung cancer, and is undergoing chemotherapy, it is beneficial for the patent to not lay all the way back. If a patient is laying in supine position, it could cause the patient to choke because they have difficulty swallowing. It is also important to rinse the mouth out in small bursts of water and to always suction so there will not be a pool of water in their mouth causing them to choke.
Due to the medications and chemotherapy, patients with lung cancer have a variety of side effects. Since treatment of lung cancer causes effects such as dry mouth and diminished salivary flow, it is important to wet the patients’ cheeks down throughout the appointment so the mouth mirror will not stick to the cheeks causing damage to the buccal mucosa.
Chemotherapy is a draining treatment that decreases the immune system, so in order for the patient to be as comfortable as possible it is important to schedule appointments at least a week before chemotherapy. A week prior to chemotherapy, patients are at their strongest and after chemotherapy, patients are very sick and weak and it is not best to do any dental treatments due the their increased risk of infection.
Non-small cell adenocarcinoma is one of the most common types of lung cancer. People who get diagnosed with lung cancer have numerous side effects that they deal with on a daily basis that effects everyday living. The treatment and the medications can have a serious impact on the patients’ oral health. Good oral hygiene instructions can help decrease some of the side effects that occur in the oral cavity.
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