October marks ‘Breast cancer awareness month’. Breast cancer has been marked as an important event considering every one in 8 women is suffering from breast cancer, debilitating the quality of life to an extent that it impacts the physical, social and psychological aspect. Sometimes these cancer cells transmit from their original site to elsewhere in the body usually through blood vessels and lymphatics aka metastases. Often times, breast cancer metastasized in jaw bones, causing persistent pain, swelling and other disturbances.
3.6% of all breast cancer develop bony metastases. And 0.2 % – 25% of oral metastases are from breast carcinoma. This spreading cancer can cause orofacial pain.
Facial pain is caused due to peri neuritis i.e. infiltration of cancer cells into nerves as found in 80 % of head face, neck cancer. The most affected nerves in head, face neck region are Trigeminal nerve and facial nerve. Affect on these nerves can cause difficulty in eating, drinking, swallowing, talking. Additionally, it can also cause symptoms of trigeminal neuropathy like pain
Cancer pain involving nerve i.e. neuralgic pain is characterized by sharp shooting, electric pain. The pain with blood vessels, aka neurovascular pain is felt as headaches. Headache of sudden onset with sharp pain is a warning sign and should not be ignored. Sharp shooting sudden headache is a warning sign for bigger disease and therefore should be taken seriously and investigated thoroughly.
These symptoms can be confused with other orofacial pain conditions. This is when the advice of trained orofacial pain consultants comes handy.
Careful examination of pain in teeth, gingiva, tongue, face, neck, ear and palate is necessary.
Breast cancer has also been known, to involve the pterygopalatine fossa, causing difficulty in opening of mouth. Pain in orofacial region is also caused post chemo and radiotherapy characterized by severe peripheral neurotoxicity. This causes reduced QoL- Moderate to severe pain in 1/3rd of patients.
Chemotherapy is known to cause severe peripheral neurotoxicity causing neuropathic pain
OFP of neuropathic origin can be caused due to surgery (tumour resection), chemo, radiotherapy, oral mucositis.
The ray of hope is that there are multiple treatment modalities available to manage orofacial pain conditions caused during and post malignancy. We at Neocare have been helping people with cancer pain, reach out to us for help and guidance on portals of your choice.