Risk of Secondary Oral Cancer Following Hematopoietic Cell Transplantation
Clinical relevance and practical considerations
- Clinicians should be aware of the higher risk for oral second malignancies in alloHCT survivors, and advocate for routine surveillance with an oral medicine specialist, an oral and maxillofacial surgeon or another health care professional with expertise in managing oral cancer patients. Special attention should be given to patients with cGVHD or history of cGVHD, particularly those with oral involvement.
- Survivors should be screened for oral cancer every 6–12 months lifelong, or more frequently if the health care provider or patient notices a change in the oral mucosa.
- Patients should be educated about the risk of oral cancer in order to increase compliance for lifelong cancer surveillance. The clinician should deliver this information in a non-stressful manner that will engage the patient in the follow-up plan. An empathic professional conversation is key for obtaining the patient’s collaboration.
- Patients should be informed about the importance of reducing/avoiding risk factors, including oral cancer–promoting lifestyle factors (e.g., smoking, betel nut use, alcohol abuse, sun exposure of the lips).
- In patients with suspected oral lesions in the presence of oral mucosal cGVHD, an intervention for oral cGVHD may be considered to differentiate the chronic disease from oral cancer [17].
- Biopsy and pathological examination should be performed in cases of suspicion for malignancy.
- The contribution of human papillomavirus (HPV) to risk of oral cancer post-HCT is not fully elucidated. Several studies reported of an association between HPV and oral cancer post-HCT, or evidence for higher risk for HPV-related cancer post-HCT [18, 19]. The implication of this will be revealed as more studies on the prognostic value of HPV in oral cancer post-HCT will be performed.
- Patients with FA and DKC have an increased risk of oral cancer. The need for oral cancer surveillance plan and discouragement of smoking and alcohol use in FA or DKC patients who underwent HCT is even more crucial. Therefore, increased frequency of follow-up should be considered in this group of patients.
Recommendation Grading
Abbreviations
- HCT: Hematopoietic Cell Transplantation
- alloHCT: Allogeneic HCT
- cGVHD: Chronic Graft Versus Host Disease
Disclaimer
Overview
Title
Risk of Secondary Oral Cancer Following Hematopoietic Cell Transplantation
Authoring Organizations
Multinational Association of Supportive Care in Cancer
International Society of Oral Oncology
Publication Month/Year
July 25, 2024
Last Updated Month/Year
August 29, 2024
Document Type
Consensus
Country of Publication
Global
Document Objectives
A MASCC/ISOO Clinical Practice Statement (CPS) is aimed at generating a concise tool for clinicians that concentrates practical information needed for the management of oral complications of cancer patients. This CPS is focused on the risk of secondary oral cancer following hematopoietic cell transplantation (HCT).
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Prevention
Diseases/Conditions (MeSH)
D018380 - Hematopoietic Stem Cell Transplantation
Keywords
oral cancer, Hematopoietic cell transplantation
Source Citation
Raber-Durlacher JE, Treister NS, Zadik Y, Dean DR, Miranda-Silva W, Fregnani ER, Epstein JB, Elad S. MASCC/ISOO Clinical Practice Statement: The risk of secondary oral cancer following hematopoietic cell transplantation. Support Care Cancer. 2024 Jul 25;32(8):545. doi: 10.1007/s00520-024-08685-y. PMID: 39048762; PMCID: PMC11269467.