Risk of Secondary Oral Cancer Following Hematopoietic Cell Transplantation

Publication Date: July 25, 2024
Last Updated: August 16, 2024

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.

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