6. Cancer Therapy Flashcards
(27 cards)
What are the risk factors for squamous cell carcinoma?
- Age
- Race
- Tobacco/alcohol
- Immune suppression
- Viral (HPV 16/18)
What are the clinical descriptors of cancerous lesions in the mouth?
- Anatomical site
- Size
- Multiple lesions? Proliferative verrucous leukoplakia
What are the staging steps for epithelial dysplasia to malignant transformation?
- Mild
- Moderate
- Severe
- Carcinoma In-situ
What is the role of oral health care providers in cancer in patients?
- Prevention!
- Risk for infection
- Dental Caries
- Periodontal disease
- Risk for osteonecrosis of the jaw
- Screenings
What is the purpose of a pre-radiation dental screening?
To locate and eliminate oral foci of infection
What are the characteristics of the per-cancer treatment health exam?
- Ideally 1 month prior cancer Tx
- Establish a schedule for dental Tx
- Identify and treat sites of low-grade and acute oral infections:
- Caries, perio & endo disease, mucosal lesions
- Identify and eliminate areas of trauma/problems
- Instruct patients about oral hygiene
- Educate patients on preventing demineralization and dental caries
What would you want to know on a med consult for a patient about to recieve cancer treatment?
- Diagnosis with TNM staging
- Timing of treatment
- Field of radiation
- Dosage of radiation, specific to the areas you will be working in
- Prior history of surgery to area
- Chemotherapy?
- Type of radiation treatment
What’s the dental treatment for head and neck radiation patients?
- Pre-treatment comp maxillofacial exam and prophy
- Treat all sources of infection
- Focus on prevention
- Prophy, fluoride treatment, trismus (remove orthobands)
What’s considered oral foci of infection and should be eliminated prior to radiation?
- Deep caries that could lead to pulp exposure
- Active perio disease
- >6mm pockets
- Furcation grade I
- Recession >6mm
- Non-restorable teeth
- Large restorations, root caries
- Periapical abnormalities or necrotic pulp
- Partially impacted or erupted teeth
What’s the dental treatment DURING radiation therapy?
- Monitor patient’s oral hygiene
- Watch for mucositis and infection
- Advise against wearing removable devices during treatment
What’s the dental treatment after radiation therapy?
- Establish appropriate recall interval
- Reinforce good oral hygiene
- Monitor patient for trismus
- Consult with oncology team regarding use of appliances after healing of oral mucositis
- Monitor for demineralization and caries
- Avoid elective surgical procedures
- Dentures: do not begin fabrication until 3-4 months after therapy
What does chemotherapy target?
- The vasculature and affects the healing response of the oral cavity
- Targets hematopoietic cells of the bone marrow
- Leads to anemia, thrombocytopenia and leukoplakia
What complications can arise with chemotherapy?
- Mucositis, oral ulceration
- Anemia, thrombocytopenia, leukoplakia
- Infection: viral, bacterial, fungal
- Neurotoxicity, secondary to medication
- Osteonecrosis of the jaw
When do you want to perform pre-chemotherapy treatment?
At least 1 week before it starts
Should patients wear removable appliances during chemotherapy?
No - should advise them not to
How long before chemo should you perform extractions, gingivoplasties or any flap surgery?
3 weeks or a minimum of 10-14 days prior
Is a medical consult needed for treating patients while they’re going through chemotherapy?
Yes - even for prophy’s
Get blood work
When do you post-pone treatment during chemo?
- Platelet count is less than 50,000 or abnormal clotting factors are present
- Absolute neutrophil count is less than 1,000/mm3
Before perfoming dental treatment after chemotherapy what do you want to make sure of with the patient?
- Granulocyte count >2000 cells/mm3
- Platelet count >50,000 cells/mm3
- Ask about IV bisphosphonate therapy or been treated with a RANKL inhibitor
When do patients feel best after chemotherapy?
Around 17-20 days after, good time for elective dental care.
What is Hematopoietic Stem Cell Transplanation?
- Intentional destruction of the bone marrow
- Leaves patient with no functioning immune system.
- Diseases include:
- Leukemias, aplastic anemia, myelodysplasia, myeloma, lymphoma
- Types:
- Autologous
- Allogeneic
- Syngeneis
What is important in regarding pre-HSCT dental treatment?
- Risk for infection is paramount
- Risk for bleeding is paramount
- Confirm platelet count, neutrophil count
- Follow similar principles for pts going through chemo
What do you watch for in treating patient after their HSCT ?
- Watch for infections - herpes simplex & candida albicans
- Graft-vs-host disease
- Secondar malignancies in oral area
How long do you delay dental treatment after HSCT?
Delay elective Tx for 1 year.
- First 100 (and up to 365 days)days after is crucial to maintain oral health - provide only routine oral hygiene, emergency care
- >180 days (autologous) or >365 (allogeneic) routine oral hygiene and standard care
- Chronic GVHD - emergency care only
