Understanding Oral Candidiasis After Radiotherapy: Causes, Symptoms, and Management

Fungal Infection in the Mouth After Breast Cancer Treatment

Mouth Thrush, Oral Candidiasis, Fungal Infection in the Mouth During The Breast Cancer Treatment

Patient's story: A 48-year-old female patient had swelling in her abdomen. As a result of the examination, cancerous tissue and widespread intra-abdominal tumor metastasis (peritonitis carcinomatosis) were detected in the right breast. As a result of the detailed evaluation, the patient was initially started on radiotherapy. A few weeks after the patient's radiotherapy treatment started, he applied for an ear, nose and throat examination because he experienced burning, dryness and a feeling of pins and needles in his throat. During the examination, "typical thrush lesions" were seen on the soft palate, which were white, slightly painful with sharp edges, and slightly raised from the surface. Endoscopic examination revealed that these lesions continued into the esophagus. The patient was advised to use local antimycotic solutions, dietary changes, antacid treatment, increasing the amount of water drunk orally, increasing the consumption of fibrous green vegetables, and using acidic and flora regulators such as natural vinegar. The patient is a valuable person who has been smoking for many years and who unfortunately I love very much. Unfortunately, at a time when cancer was so common, smoking was a serious mistake, although many studies did not reach a conclusion that smoking directly caused breast cancer. I hope my patient recovers as soon as possible and has a long and happy life with his family.

Oral candidiasis, commonly known as thrush, is a fungal infection caused by the overgrowth of Candida species, primarily Candida albicans, in the oral cavity. While this condition can affect anyone, individuals undergoing radiotherapy, particularly for head and neck cancers, are at an increased risk of developing oral candidiasis. This article explores the causes, symptoms, and management of oral candidiasis in the context of radiotherapy.

Causes of Oral Candidiasis Infection After Radiotherapy

Radiotherapy is a common treatment modality for various cancers, including those affecting the head and neck region. While it is effective in targeting cancer cells, it can also have unintended consequences on healthy tissues, including the mucous membranes of the oral cavity. The damage to these tissues, coupled with the suppression of the immune system due to radiation, creates an environment conducive to the proliferation of Candida species.

Mouth Thrush, Oral Candidiasis, Fungal Infection in the Mouth During The Breast Cancer Treatment

Furthermore, the use of broad-spectrum antibiotics during cancer treatment can alter the normal oral flora, promoting the overgrowth of Candida. Poor oral hygiene, compromised salivary gland function, and the use of removable dental prosthetics can also contribute to the development of oral candidiasis in individuals undergoing radiotherapy.

How Radiotherapy Paves the Way for Oral Candidiasis

Radiotherapy, a powerful treatment against cancer, can inadvertently create a breeding ground for oral candidiasis, a fungal infection caused by Candida species. Understanding the intricate relationship between radiotherapy and oral candidiasis is essential for both patients and healthcare providers.

The Impact of Radiotherapy:

Radiotherapy is designed to target and destroy cancer cells, but its effects extend beyond the tumor. Particularly in the context of head and neck cancer treatment, radiation can cause significant damage to healthy tissues, including the delicate mucous membranes lining the oral cavity. The irradiation disrupts the normal cellular architecture and compromises the integrity of the mucosal barrier, creating an environment conducive to the overgrowth of Candida.

Suppression of the Immune System:

Another factor contributing to oral candidiasis after radiotherapy is the suppression of the immune system. Radiation not only affects cancer cells but also compromises the immune response in the treated area. This immune suppression weakens the body's ability to control the natural balance of microorganisms in the oral environment, allowing Candida to flourish.

Antibiotics and Altered Oral Flora:

During cancer treatment, patients often receive broad-spectrum antibiotics to prevent or treat infections. While these antibiotics target harmful bacteria, they also disrupt the balance of the oral microbiome. The eradication of beneficial bacteria opens a niche for opportunistic pathogens like Candida to thrive, leading to an overgrowth and subsequent infection.

Dry Mouth and Salivary Gland Dysfunction:

Radiation therapy can damage the salivary glands, leading to a condition known as xerostomia or dry mouth. Saliva plays a crucial role in maintaining oral health by washing away debris and helping to control the growth of microorganisms. In the absence of sufficient saliva, the oral environment becomes more favorable for the proliferation of Candida, increasing the risk of infection.

Symptoms of Mouth Thrush

Patients who develop oral candidiasis after radiotherapy may experience a range of symptoms, including:

White Lesions: The most characteristic sign of oral candidiasis is the presence of creamy white or yellowish lesions on the tongue, inner cheeks, and other oral mucosal surfaces.

Pain and Discomfort: The overgrowth of Candida can lead to irritation and soreness in the mouth, making it uncomfortable for patients to eat, drink, or speak.

Difficulty Swallowing: In severe cases, oral candidiasis can cause difficulty in swallowing, leading to weight loss and nutritional deficiencies.

Burning Sensation: Some individuals may report a burning sensation in the mouth, especially when consuming hot or spicy foods.

Treatment of Oral Fungal Infection

Managing oral candidiasis in patients undergoing radiotherapy involves a multifaceted approach:

Antifungal Medications: Topical or systemic antifungal medications, such as nystatin, fluconazole, or clotrimazole, are commonly prescribed to eliminate the fungal infection.

Good Oral Hygiene: Maintaining proper oral hygiene practices, including regular and gentle brushing of teeth and tongue, can help control the growth of Candida.

Salivary Substitutes: Since radiation therapy can compromise salivary gland function, the use of salivary substitutes or artificial saliva may alleviate dry mouth symptoms and create an environment less favorable for Candida growth.

Dietary Modifications: Patients may benefit from dietary modifications, including the avoidance of sugary and acidic foods, which can exacerbate oral candidiasis symptoms.

Regular Dental Check-ups: Regular dental check-ups are crucial for individuals undergoing radiotherapy. Dentists can monitor oral health, provide preventive care, and address any emerging issues promptly.

Recognizing the link between radiotherapy and oral candidiasis is crucial for effective management and prevention. Close collaboration between oncologists and oral health professionals is essential. Antifungal medications, good oral hygiene practices, and salivary substitutes can help mitigate the risk and manage oral candidiasis in patients undergoing radiotherapy.

Mouth Thrush, Oral Candidiasis, Fungal Infection in the Mouth During The Breast Cancer Treatment

Oral candidiasis is a common complication in individuals undergoing radiotherapy, impacting their quality of life during an already challenging time. Recognizing the risk factors, understanding the symptoms, and implementing appropriate management strategies are essential for healthcare professionals and patients alike. A collaborative approach, involving oncologists, dentists, and other healthcare providers, can contribute to the effective prevention and management of oral candidiasis in the context of radiotherapy.

While radiotherapy is a life-saving treatment for cancer, its impact on the oral cavity can lead to unintended consequences such as oral candidiasis. Awareness of the factors contributing to this fungal infection is vital for healthcare providers to tailor preventive measures and interventions. By understanding the intricate relationship between radiotherapy and oral candidiasis, we can enhance the overall care and well-being of individuals undergoing cancer treatment.

The link group you can click to read my previously published articles about Oral Candidiasis >> https://www.ent-istanbul.com/search?q=Oral+Candidiasis

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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