The Etiology of Oral Cancer and Evaluation of Mucositis and Xerostomia as Complications

Cannon, Scott E., Tazumi, Spencer H. J., Lindberg, John P.
Faculty / Advisor: Chang, Myung M.
University of Pennsylvania School of Dental Medicine, Department of Oral & Maxillofacial Surgery/Pharmacology


The aim of this handbook is to provide practitioners evidence-based information regarding various aspects of oral cancer. The information presented in this study focuses primarily on the etiology of oral cancer and two major complications associated with treatment of oral cancer: mucositis and xerostomia.


A literature review was conducted using PubMed, and articles were identified using terms mucositis, oral cancer, radiotherapy, chemotherapy between January 2019 until May 2020, with no language restrictions.


Oral cancer represents 2.9% of all new cancer cases and is a disease that disproportionately affects the elderly with a median age of diagnosis of 63. Survival rates have increased over time: between 1960-2009 the average five-year survival rate was approximately 50% whereas a recent study in 2017 has shown the survival rate to be 66.2%. There are various risk factors that contribute to the development of oral cancer, some of which cannot be controlled like one’s gender, race, or gene mutations and others that can such as betel quid, tobacco, and alcohol use. Mucositis often presents as a painful or burning sensation accompanied by red, shiny, swollen, ulcerated lesions. Patients typically experience difficulty speaking, swallowing, xerostomia and bleeding. The most critical consequence of mucositis is that it can sometimes cause unscheduled pauses in radiotherapy or chemotherapy due to extreme pain. Xerostomia presents as erythematous, cobblestoned or a fissured tongue, and lips that can appear pealed or cracked. The consequences of xerostomia include dysgeusia, dysphagia, dysarthria, increased risk for developing ulcers, caries, periodontal disease, halitosis, as well as candidiasis. Often xerostomia is caused by damage to salivary glands during radiation therapy or when major salivary glands are removed entirely during surgical resection of tumors.


Oral cancer has various risk factors leading to its development, but continues to see improvement in survival rates, likely due to better surveillance and advancing treatment options. For oral cancer patients that experience mucositis and xerostomia, it is essential that these symptoms are identified and appropriately treated to improve the quality of life of oral cancer patients.