AUCTORES
Globalize your Research
Review Article | DOI: https://doi.org/10.31579/2690-8808/133
1 Research Scholar, Department of Pharmacy Practice, ISF College of Pharmacy, Moga, Punjab, India, 142001.
2 B.Pharm, Pharm.D, Assistant professor, Department of Pharmacy Practice, ISF College of Pharmacy, Moga, Punjab, India 142001.
*Corresponding Author: Mandeep Kaur, B.Pharm, Pharm.D, Assistant professor, Department of Pharmacy Practice, ISF College of Pharmacy, Moga, Punjab, India 142001
Citation: Mayank Virmani , Mandeep Kaur.(2022). Squamous Cell Carcinoma of Left Lateral Border of Tongue followed by Therapy Induced Mucositis Grade 4; Journal of Clinical Case Reports and Studies 3(9); DOI: 10.31579/2690-8808/133
Copyright: © 2022 Mandeep Kaur, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 24 May 2022 | Accepted: 02 June 2022 | Published: 10 October 2022
Keywords: OSSC; EBRT; RIOM; chemotheraputic agents; gray
Carcinomas are the major serious health issue in today’s healthcare system. while its prognosis is difficult at earlier stages. OSSC oral squamous cell carcinomas are reported more than 3 lakhs new cases world-wide and it is sixth most common cancer world-wide. Squamous cell carcinoma is defined as the cancer of soft, flat, thin squamous cells mainly affect the soft cell regions like tongue diagnosed by various investigational imaging and biochemistry parameters. In this case patient was diagnosed with High Grade Squamous Cell Carcinoma. Radiation therapy along with chemotherapy is the option for better therapeutic outcomes. Hence, EBRT therapy is given and in 2 gray every cycle and a total of 59.8 gray, 20 cycle therapy depending on condition of patient. In 90% cases radiation therapy leads to RIOM (Radiation Induced Oral Mucositis) which is totally unprotectable and there in no specific treatment option available in market approved by US-FDA yet. RIOM is diagnosed by WHO grading system based on the parameters and observations. In this condition patient suffers from inflammation, mouth ulcers and progressive condition and patient can not be able to swallow anything. It’s five stage process which treated by giving antibiotic in case of RIOM and oral hygenine, mouthpaints are advised. Levofloxaccin 750mg with clotrimazole mouthpaint was given to the patient. Radiation therapy continued with curative and Supportive therapy and was successful radiation therapy also shows good response and reduction in growth of tumor was observed and therapeutic goals were achieved.
Carcinoma is the term defines cancer occurring in cell, skinline or organ with soft tissues. Various types of cancer growth have been seen in the tongue, but the most common type is squamous cell carcinoma, Squamous cells are thin, flat cells that line the mouth and other organs. Oral cancer is found to be the sixth most common cancer worldwide. Approximately 300,373 new cases of oral squamous cell carcinoma (OSCC) are annually reported around the world[1-2],It typically occurs in elderly men during the fifth-eighth decade of life[3] . In 1976 two scientists Krolls and Hoffman analyzed 14,253 cases of squamous cell carcinoma of the oral soft tissues and found that 35.2% of the intra-oral lesions were observed only on the tongue [4]. In India, Oral carcinoma has become a major health problem mainly due to the high prevalence of smokeless tobacco use. There are two types of tongue cancer:
Through Grades we can identify the severity of cancer growing in the mouth and are as follows. There are 3 grades of mouth Cancer[5]:
Patient was suffering from squamous cell carcinoma and External Beam Radiation Therapy was given to treat but unexpextedly, Radiation therapy leads to RIOM as its adverse effect .
RIOM (Radiation-Induced Oral Mucositis) is one of the major ionizing radiation toxicities defined as an injury of tissues caused by radiation/radiotherapy (RT), Eventually marked adverse effects on patient quality of life and continuity of cancer therapy [6]. In the United States, its economic cost was approximately to achieve 17,000.00 USD per patient with head and neck cancers. Varies between 7 to 98 days. . RIOM of grades 3 and 4 have been observed in 56% of head and neck cancer patients treated with radiotherapy[6-7]. While risk factors are [8]:-
WHO has designed grading system for stating severity stage of oral mucositis which is as follows:-
The WHO Grading system for Oral mucositis[9]
Mucositis uplift stage by stage and various worsten changes observed as it converted to higher stage followed by healing at last stage which are as follows:-
Developmental Stages Of Mucositis [10]
In 2004, Sonis, a Scientist suggested five stages of Oral Mucositis:-
A 54 years old male patient was admitted in cancer department having complaints of tongue bite while taking meal in afternoon. After 2 days unbearable inflammation and pain at the site of the bite. After some time a sore formation takes place at the left lateral border of the tongue and the patient started following home remedies to cure it. But there's no satisfactory improvement and it was continuously causing discomfort to the patient and condition to become more worsen than earlier. After that patient starts facing difficulty in swallowing and eating food and was not feeling well while talking and sleeping and eating. Afterward, the patient feels much pain and inflammation in the affected region of the tongue. Patient-reported to the hospital and was admitted to Hematology/Oncology department. All the physical examinations, and possible investigations were done. The sore formation that had taken place earlier was converted into a tumor on the left lateral side of the tongue downward basal and identifications were done and were found to be Squamous Cell Carcinoma of Tongue. Socioeconomically patient is non-smoker and follows a vegetarian diet. There is no history of allergy or no previous medication history. After all the investigations ( Table 1), a drug regimen was designed and a follow-up was started (Table 2). The patient was later on drugs and Radiation therapy was started. But on the 6th radiation Cycle patient complained about oral sores and difficulty in swallowing liquid and eating a semi-solid diet. Physical examination was done and on the behalf of investigations itwas confirmed that the patient was suffering from Radiation-induced oral mucositis (RIOM), Grade 4 stage. Radiation therapy cycles were continued, and along with it Supportive therapy for the same was designed and started at that time. Later, After 3 days patient observe a reduction in oral sores and was able to take some liquid diet.
Figure 1 -Image Showing The affected area diagrammatically, Source:- Internet
Biopsy
Laboratory Investigations:-
Table1: Laboratory findings of the Patient
Microcystosis and Hypochromia observed
Microcytosis is a blood disorder in which the mean blood cellular volume becomes less than 82 μm3 (82 fL) in adults.
Hypochromia means that the red blood cells have less color than normal when examined under a microscope.
Decreased level of lymphocytes stated that it is due to the known adverse effect of radiation therapy. Many researchers have also stated that(13).
Treatment and Management
Radiotherapy 20 Cycles Advised :- EBRT (External Beam Radiation
Therapy) was given To treat Tongue Cancer (Squamous Cell Carcinoma).
After 6 Cycles Adverse effect of Mucositis grade 3 following grade 4 was observed. The patient was apparently on a semisolid diet
Due to mouth ripe patient was not able to swallow .
Pt was advised to take oral care as :-
Table2: Indicating Patients Drug Regimen
Same treatment follow-up for the next 3 days was given to the patient. While the Patient was on treatment on its 6Th radiation cycle he observed some difficulties like mouth ripe Which were later confirmed as Mucositis a major adverse effect of Radiation Therapy.
According to studies Approximately 90% of confirmed malignant tumors diagnosed in the oral cavity are Oral Squamous Cell Carcinomas, especially in the tongue, and affect mostly men rather than women[1] . Same in this case a 54 years old male patient was affected and the study also shows a high risk of recurrence of Tumor[1]. Biopsy reports confirmed high-grade squamous cell carcinoma of the lateral region of the tongue. But the patient is quite responsive and in the positive recovery phase. Studies revealed that RIOM occurs in 100% of altered fractionation radiotherapy head and neck cancer patients and cant be protectable lasts between 7-98 days and causes inflammation in the tongue, mucosa, and pharynx[7]. Exactly the same was seen inpatient as the patient was complaining of sores, and was not able to swallow/intake food. Antibiotics are necessary for treatment so antibiotics were prescribed for cure Levofloxacin 750 mg was administered and clotrimazole mouth paint was advised for application to the affected region. No single therapeutic agent has been approved by the US FDA for the treatment of RIOM so random supportive therapy is prescribed for treatment. The patient shows improvement in the condition and for the next three days, the same therapy was continued with radiation therapy for cancer.
The patient is responsive and has a good recovery record with both the conditions Squamous cell carcinoma and RIOM with the treatment plan designed for both the problems. Oral hygiene was highly focused on administering Drug a designed drug regimen at accurate doses, Nutrition is also maintained as the patient was not able to swallow solid and semi-solid diet. Radiation therapy continued even after adverse effects because there is no other successful treatment option for the squamous cell carcinoma later when the patient complained of discomfort supportive treatment was designed and successful therapeutic goals were achieved. Radiation therapy shows a good response in reducing carcinoma growth.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
