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5- Oral Cancer Flashcards

1
Q

What is the definition of cancer?

A

It is the condition characterized by uncontrolled growth of abnormal cells

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2
Q

What do malignant cells cause destruction by?

A

1.) Invasion of tissue through direct extension

2.) Spread to distant sites by metastasis through blood, lymph, or serous membrane surfaces

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3
Q

What is the leading cause of death in Canada?

A

Cancer (by 29.6%)

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4
Q

What are the 4 most common types of cancer in Canada?

A

1.) Lung
2.) Breast
3.) Colorectal
4.) Prostate Cancer

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5
Q

How are cancers named?

A

1.) By the location in the body where the cancer first developed (e.g: lung, breast, prostate cancer)

2.) By the type of tissue in which the cancer originated (the histological type) e.g: carcinoma, melanoma, sarcoma, leukemia etc)

3.) After the person who first discovered them

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6
Q

What is a carcinoma?

A

It is a cancer that begins in the skin or in tissues that lin or cover organs (epithelium)

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7
Q

What is melanoma?

A

It is a type of cancer that starts in cells called melanocytes

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8
Q

What do melanocytes produce?

A

They produce melanin (which is a pigment that gives skin its colour)

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9
Q

What are sarcomas?

A

They are a cancer that starts in connective or supportive tissues such as bone, tendon, cartilage, muscle, fat, or blood vessels

they are more rate than carcinomas

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10
Q

What are the 3 types of blood cancers?

A

1.) Leukemia
2.) Lymphoma
3.) Myeloma

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11
Q

What is leukemia?

A

It is a blood cancer starting in the bone marrow (where blood cells are made)

It is a person with leukemia that has many abnormal blood cells in the bone marrow and blood

aka the liquid cancers; does not form a solid tumour

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12
Q

What are lymphomas?

A

It is a blood cancer that starts in the lymphocytes (WBCs)

It is a person with lymphoma that has many abnormal lymphocytes that build up in the lymph nodes, lymph vessels, bone marrow, spleen and other parts of the body

aka a solid cancer; forms a tumour

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13
Q

What are myelomas?

A

They start in the plasma cells (WBCs) of bone marrow

A person with myeloma has many abnormal plasma cells (called myeloma cells) that build up in the bone marrow

aka a solid cancer; form tumours in bone or other tissues

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14
Q

What does cancer grading refer to?

A

It is the cellular appearance and growth (how advanced the cancer cells are)

What is the morphology, growth of the the individual cancerous cell

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15
Q

What does cancer stage refer to?

A

It is the disease classification (how advanced the disease as whole is)

It refers to the original size of tumor & how far the cancer has spread

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16
Q

What are the different grades for cancer?

A

1-4

1 being low grade: well differentiated & slow growing
4 being high grade: undifferentiated/poorly differentiated & fast growing

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17
Q

What are the different stages of cancer?

A

1-4

higher the number, the larger the tumor and or the more it has spread.

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18
Q

What is the TNM system?

A

It is a the tumor, node & metastasis classification system which is developed to stage different types of cancer based on certain, standardized criteria

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19
Q

What are the different levels of the “Tumour” classification system?

A

T1-4, size and or extension of the primary tumor

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20
Q

What are the different levels of the “Node” classification system?

A

N0= no palpable node
N1= single, homolateral, palpable node
N2= single, homolateral palpable (3-6cm) or multiple, homolateral nodes (none>6cm)
N3= single or multiple homolateral nodes (one >6cm) or bilateral nodes (both sides), or contralateral nodes (opposite sides)

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21
Q

What are the different levels of the “Metasatases” classification system?

A

MO= no known distant metastasis
M1= distant metastasis PUL (pulmonary), OSS (osseous), HEP (liver), BRA (brain)

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22
Q

what does stage 1 imply?

A

the cancer is localized and confined to organ of origin

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23
Q

what does stage 2 imply?

A

the cancer is regional, in nearby structures

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24
Q

what does stage 3 imply?

A

cancer extends beyond the regional site, crossing several tissue planes

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25
Q

what does stage 4 imply?

A

cancer spreads to distant sites; widely disseminated

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26
Q

What are therapeutic modalities to cancers?

A

1.) Surgery
2.) Radiation
3.) Cytotoxic, chemotherapeutic, & endocrine drugs
4.) Stem cell or bone marrow transplantation

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27
Q

What are some treatment factors we need to consider when treating cancer?

A

1.) Tumor
- type of tumour
- where it has spread, how fast it is growing?
- Is it curable? palliative?

2.) Treatment
- what tx is available?
- How likely is it to work without significant side effects?

3.) Patient
- How fit is the patient?

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28
Q

When is surgery used? what does it involve?

A
  • When the cancer is limited in size or anatomy permits for debulking of a tumour
  • Physically cut out the tumor or reduce it size
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29
Q

When is radiotherapy used? what does it involve?

A
  • When tissue cannot be excised & because cells are most susceptible to this therapy. They target a localized area.
  • it involves toxic radiation to kill cells by damaging cancer cell DNA & chromosomes needed for cell replication. It’s given through external beam.
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30
Q

When is chemotherapy used? what does it involve?

A
  • when it affects the entire body. when tissue cannot be excised & most effective against rapidly growing tumors.
  • It involves when medicine given (IV, pills) to kill fast-dividing cancerous cells by adversely affecting their DNA synthesis or protein synthesis
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31
Q

What kind of dosage do outpatient chemotherapy patients receive?

A

They receive a low-dose regimen on a 3-4week schedule to reduce side effects like nausea, hair loss, weakened, immune system.

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32
Q

How is a basal cell carcinoma described?

A

They have slightly raised lesions with rolled, waxy borders and central ulceration on a sun-exposed surface.

33
Q

How is squamous cell carcinoma described?

A

They are non-healing, white, red-white lesion, ulcer, or mass on the lateral tongue, the floor of the mouth, or the lower lip.

34
Q

How is a Kaposi’s sarcoma described ?

A

They appear as purple plaques or nodules of the palate, gingiva or face

35
Q

How is melanoma described?

A

They are brown/black enlarging plaques of skin or palate (+satellite lesions)

36
Q

How is mucoepidermoid described?

A

It is a salivary gland malignancy; dome-shaped swelling with carcinoma, central ulceration of the palate or retromolar region.

37
Q

How is the leukemia described?

A

Seen as a gingival enlargement, combined with bleeding, skin pallor, small hemorrhages of the skin and mucous membranes, and bruising.

38
Q

How is lymphoma described?

A

They are enlarged, non-painful lymph nodes, palatal or pharyngeal swelling.

39
Q

How is advanced breast, prostate, and renal cancer described?

A

a lytic osseous metastases in the mandible

40
Q

What is important to note about mucoepidermoid carcinomas?

A

They are the most common malignant salivary gland neoplasm arising at the parotid gland. they are usually seen in on the palate, lower lip, floor of the mouth, tongue, and retromolar pad.

low-grade tumours = good prognosis & rarely recur after local excision

41
Q

What are oral cancers?

A

They include a variety of malignant neoplasms that occur within the oral cavity

42
Q

90% of oral cancers are attributed to what kind of oral cancers?

A

To squamous cell carcinomas (SCCs)

43
Q

9% of carcinomas are attributed to what kind of oral cancers?

A

those involving the salivary gland tissue, sarcomas and lymphomas.

44
Q

1% of oral cancers are known as?

A

Metastatic oral cancers where they are found anywhere else in the body. (e.g: from the breast)

45
Q

T or F, early carcinomas are asymptomatic

A

True, they are asymptomatic; pain is often absent until late in the course of the disease.

46
Q

What do advanced lesions appear like?

A

They are more often ulcerated, with raised margins and induration.

47
Q

Which areas of the oral cavity are more susceptible to carcinogens?

A

Areas that are less keratinized due to the absence of a protective layer.

(especially in regions where social habits result in placement of carcinogens)

48
Q

What are the high risk sites of oral cancers?

A

1.) Floor of the mouth
2.) Lateral (posterior) and ventral (anterior) surfaces of the tongue
3.) Soft palate
4.) Lower lip.

49
Q

What the common sites of oral cancers?

A

1.) Buccal mucosa
2.) Gingiva

50
Q

What are the rare sites of oral cancers?

A
  • Upper lip
  • Dorsum of tongue.
51
Q

What is the most common color characteristic of oral squamous cell carcinomas?

A

A white lesion with erythroplakia (this also has the greatest likelihood of being cancerous)

52
Q

What is the most common appearance of an SCC with erythyroleukoplakia?

A

It appears as a red patch in a diffuse white lesion. (p.7 in Oral Cancer Pt.2)

53
Q

What are the symptoms of squamous cell carcinoma (SCC)?

A

1.) Chronic hoarseness/sore throat (> 6 weeks)
2.) Dysphagia
3.) Ulcers (do not heal after 2 weeks)
4.) Bleeding
5.) numbness
6.) Loosening of teeth
7.) Difficulty opening
8.) Change in fit of a denture.

54
Q

In what ways can oral cancers lead to death?

A

1.) Local obstruction of the pathway for food and air
2.) General wasting
3.) Infiltration into major vessels of the head and neck
4.) Secondary infections
5.) Impaired function of other organs caused by distant metastases.
- Cancers from the maxillary region have a GREATER tendency to metastasize than do those in the mandibular region

55
Q

Why is a comprehensive exam needed before radiation therapy or chemotherapy for a patient?

A

To prevent any complications from arising with the patient. this includes:
- creating tx a plan to address any existing diseases
- obtain a baseline (assessments)
- Scan for metastatic lesions

56
Q

Eradication of inflammation and infection attribute to what concern for a patient undergoing radiation therapy or chemotherapy?

A

1.) address the periodontal health and ensure excellent oral hygiene & oral hygiene maintenance
2.) Eliminates caries
3.) Extracts all non-restorable or questionable teeth. (7-10 days before chemo & 14 days before radiation therapy)

57
Q

What are complications of head & neck radiotherapy & chemotherapy?

A

1.) Nausea & vomiting (acute onset)
2.) Ulceration
3.) Bleeding
4.) Mucositis: starts about 2nd week
5.) Taste alterations: about 2nd week
6.) Xerostomia: starts about 2nd week
7.) Secondary infection (fungal, bacterial, viral)
8.) Hypersensitive teeth (acute & delayed onset)
9.) Radiation caries (delayed onset)
10.) Pulpal pain and necrosis (delayed onset)
11.) Muscular dysfunction (delayed onset)
12.) Osteoradionecrosis (delayed onset - more common mandible, less common in maxilla).

58
Q

What is thrombocytopenia?

A

It is a condition due to low levels of thrombocytes (platelets) in the blood.

59
Q

Patients with what conditions are susceptible to thrombocytopenia?

A

1.) Patients with cancer
2.) Patients going through body radiation or high-dose chemotherapy
3.) patients who have bone marrow involvement due to disease

60
Q

How do patients with thrombocytopenia manage the bleeding?

A

1.) Avoid vigorous brushing of the teeth
2.) Use of softer devices such as toothettes or gauze (a lot softer and less aggressive)
3.) NO use of toothpicks, water-irrigation appliances, or dental flosses.

61
Q

What is mucositis?

A

It is an inflammation, ulceration, and sloughing off of mucosal tissue that can arise from radiation/chemotherapy.

initial appearances of mucositis may present as erythema and progress to ulcerations (white/yellow plaques)

62
Q

Where the common areas of mucositis?

A

1.) The tongue, insides of cheeks, and lip.

63
Q

How is mucositis managed? (hint: the goal and the recommendation)

A

Goal:
eliminate the infection and irritation; establish good oral hygiene

Recommendations:
1.) Mouth rinses:
- Salt & sodium bicarbonate mouthwash (1tsp of each in 1 pint of water)
- Viscous lidocaine 0.5% or elixir of diphenhydramine (benadryl) in milk of magnesia
- Chlorhexidine 0.12%

2.) Prescription of anti-inflammatory agents
3.) Use of protectants (orabase)
4.) No alcohol, tobacco, carbonated drinks
5.) Follow a soft diet; maintain hydration
6.) Use a humidifier or vaporizer
7.) Consider topic and systemic antimicrobials

64
Q

What can patients experience if they are given chemotherapeutic agents?

A

1.) Bitter tastes
2.) Unpleasant odors
3.) Aversions to foods

65
Q

Why do patients who receive radiation therapy have a diminished sense of smell?

A

Due to the damage to the microvilli.

The ability to taste is restored within 3 to 4 months after completion of radiotherapy.

66
Q

What are recommendations used to manage neural & chemosensory?

A

1.) Avoiding cologne, and perfume when in contact with patients undergoing radiation and/or chemotherapy
2.) Zinc supplementation may help with a loss of taste.

67
Q

What is the difference between xerostomia and hyposalivation?

A

Xerostomia: is the FEELING of dry mouth (observational)
Hyposalivation: the DECREASED saliva flow rate (measured)

68
Q

What are the recommendations to manage xerostomia?

A

1.) Drink water or liquids (non-cariogenic + non-acidic)
2.) Avoid alcohol
3.) Sugarless candies
4.) Xylitol or sorbitol-based chewing gum
5.) Buffered solution of glycerine and water
6.) other salivary substitutes

69
Q

What are radiation caries?

A

Caries from the the direct/indirect effects of head and neck radiation

*often develops after a few months of radiation.

70
Q

What are some management strategies to manage radiation caries?

A

1.) education on maintaining oral hygiene
2.) daily application of fluoride
* alternatives: single brush-on application of 5000ppm fluoride toothpaste (prevident or clinpro)
3.) Frequent dental recall. Confirm patient compliance through montly recalls
4.) Restore early carious lesions

71
Q

How do we manage tooth sensitivity during and after radiotherapy?

A

1.) topical application of fluoride gel or MI Paste Plus

72
Q

What are candida albicans?

A

They are infections affecting individuals undergoing cancer therapy.

*can produce pain, burning, taste alterations & intolerance to certain foods

73
Q

What is pseudomembranous candidiasis?

A

Is similar to candidiasis, but does not have any of the apparent risk factors for development of candidiasis

  • has a classic curdled milk appearance that reveals mild erythematous mucosal surface.
74
Q

how is candida albicans managed?

A

1.) Topical oral antifungal agents: nystatin or clotrimazole

  • if the infections are recurrent
75
Q

How does HSV present itself orally?

A

As a large ulcer on the palate of a patient undergoing chemotherapy.

*may take longer to heal and are larger if they recurrent in patients

76
Q

How is HSV managed?

A

With antiviral agents (prophylactic use)

77
Q

How is trismus managed?

A

1.) with a mouth block when using receiving an external beam radiation.
2.) Jaw exercises
3.) Warm, moist heat

78
Q

What is osteoradionecrosis?

A

It is the high-dose radiation that can damage the jaw and hamper the bone’s ability to withstand trauma or avoid infection

*It is characterized by the exposed bone that fails to heal after high-dose radiation to jaws.

79
Q

How is osteoradionecrosis prevented?

A

1.) Extraction of teeth with questionable and hopeless prognosis at least 2 weeks before radiotherapy

2.) Avoid extractions during radiotherapy: - - mandible > risk than maxilla & posterior > risk than anterior

3.) Minimize infections by using prophyactic antibiotics, use of plain anesthetic

4.) Minimize trauma: endodontic therapy > extraction

5.) Consider hyperbaric oxygen therapy

6.) Maintaining good oral hygiene

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