Cancer Management Flashcards
Explain the connection between apoptosis and cancer development.
Normally, abnormal cell division is halted through apoptosis (programmed cell death). Cancer develops when these checkpoints are lost, allowing abnormal cells to continue dividing without control.
Compare and contrast the four major routes of cancer metastasis.
Cancer metastasizes through:
1) Direct spread to adjacent tissues
2) Lymphatic circulation,
3) Blood vessels (haematogenous spread)
4) Nerves (perineural spread)
5) Transcoelomic spread across body cavities. Each pathway allows cancer cells to establish secondary tumors at distant sites.
Classify the major types of cancer based on tissue of origin and provide an example of each.
Carcinoma: Epithelial origin (e.g., OSCC, breast, prostate, colorectal)
Sarcoma: Connective tissue origin (e.g., osteosarcoma)
CNS cancer: Brain or spinal cord origin (e.g., glioblastoma, astrocytoma)
Leukemia: Cancer of WBCs in circulation
Lymphoma: Cancer of WBCs in lymphatic syste
Identify the six “hallmarks of cancer” and explain what each means for cancer cell behavior.
- Evasion of apoptosis and immune system: Cancer cells avoid being killed by normal defenses
- Angiogenesis: Cancer cells recruit their own blood supply
- Tissue invasion and metastasis: Cancer cells spread to other tissues
- Insensitivity to anti-growth signals: Growth inhibitory signals don’t work (brakes don’t work)
- Self-sufficiency in growth signals: Cancer cells produce their own growth signals (accelerator stuck on)
- Limitless replicative potential: Cancer cells can produce infinite generations of descendants
List the most common sites of cancer metastasis from a primary tumor.
Brain, liver, bone, lung, and lymph nodes.
Explain why non-melanoma skin cancer, despite being the most common cancer in the UK, is not included in official cancer statistics.
Non-melanoma skin cancer is not counted in official UK cancer statistics because it is unusual to die from NMSC, despite it being the most common cancer with approximately 150,000 diagnoses per year.
Trace the complete patient journey from primary care to MDT discussion for a suspected cancer case.
Primary care appointment → USOC referral from GP/GDP to hospital specialist → Hospital clinic appointment with specialist → Tissue sample (biopsy) → Imaging (staging CT scan, PET scan) → MDT discussion
Differentiate between cancer stage and cancer grade, and explain their significance in treatment planning.
Cancer stage refers to how big the cancer is and whether it has spread, while cancer grade indicates how abnormal the cancer cells look under a microscope compared to normal tissue (indicating aggressiveness). Both factors, along with patient fitness, inform the management plan recommendations made by the MDT.
Explain the concept of “clear margins” in cancer surgery and its importance.
“Clear margins” refers to the absence of cancer cells at the edge of the tissue removed during surgery. This is important because it indicates that all of the cancer has been removed, which is critical for curative surgery.
Why might surgery involve removal of nearby lymph nodes, even if they appear normal?
Lymph nodes are removed and examined to determine if cancer has spread regionally, which is important for cancer staging and future treatment planning. This helps detect micrometastases that aren’t visible on imaging.
Explain three post-surgical rehabilitation considerations for cancer patients.
Post-surgical rehabilitation may include: Physiotherapy for mobility and strength, Occupational therapy for daily living adaptations, Speech and Language Therapy for communication/swallowing issues, and Dietary support from a dietician, depending on the cancer site and extent of surgery.
Contrast neoadjuvant, adjuvant, and palliative chemotherapy in terms of timing and purpose.
Neoadjuvant chemotherapy is given before surgery to shrink the tumor
Adjuvant chemotherapy is given after surgery to reduce the risk of cancer returning
Palliative chemotherapy is given to shrink cancer and relieve symptoms when cure is not possible.
Explain the mechanism of action of chemotherapy and why it affects both cancer cells and certain normal cells.
Chemotherapy uses cytotoxic medications that target rapidly dividing cells. It affects cancer cells because they divide quickly, but also affects normal rapidly dividing cells (bone marrow, hair follicles, GI tract, mouth, reproductive organs), causing side effects.
List five serious side effects of chemotherapy and explain their physiological basis.
- Bone marrow suppression: Damage to rapidly dividing blood stem cells
- Oral mucositis: Damage to rapidly dividing oral mucosal cells
- Hair loss: Damage to rapidly dividing hair follicle cells
- Cardiac toxicity: Direct toxic effect on heart tissue
- Peripheral neuropathy: Nerve damage from certain chemotherapy agents
Compare and contrast the three clinical applications of radiotherapy in cancer management.
Radiotherapy can be neoadjuvant (given before surgery to shrink tumors), adjuvant (given after surgery to kill remaining cancer cells), or palliative (given to relieve symptoms in advanced disease). Each uses high-energy rays to destroy cancer cells but with different timing and goals.
Explain why the side effects of radiotherapy are related to the beam direction and provide a comprehensive list of side effects for head and neck radiotherapy.
Radiotherapy side effects relate to beam direction because the radiation affects normal tissues in its path. Head and neck radiotherapy side effects include: mucositis, skin reactions, dry mouth (salivary gland damage), osteoradionecrosis, dysphagia, vocal changes, trismus, and fibrosis of the neck.
Compare and contrast the three main types of immunotherapy used in cancer management.
Monoclonal antibodies (e.g., rituximab, cetuximab): Target specific cancer cell proteins
Checkpoint inhibitors: Block cancer cells’ ability to deactivate immune cells
CAR T-cell therapy: Patient’s T-cells are genetically engineered to recognize and target cancer cells
Explain the mechanism by which checkpoint inhibitors improve the immune system’s ability to fight cancer.
Cancer cells can evade the immune system by activating “checkpoint” proteins that switch off immune cells. Checkpoint inhibitors block these checkpoint proteins, preventing cancer cells from deactivating the immune system, thus allowing T-cells to recognize and attack cancer cells.
Describe the complete process of CAR T-cell therapy, from collection to patient treatment.
CAR T-cell therapy involves:
1) Collecting T-cells from the patient’s blood
2) Genetically engineering these cells in the lab to express chimeric antigen receptors (CARs) that recognize cancer cells
3) Expanding these modified cells
4) Re-infusing them into the patient where they can target and destroy cancer cells.
List six symptoms that palliative care might address in advanced cancer patients.
Palliative care addresses: pain, nausea/vomiting, delirium/agitation, respiratory secretions, weakness/fatigue, hiccups, cachexia (extreme weight loss), depression, and mouth care issues.
Explain how haematological malignancies can manifest in the oral cavity, connecting specific blood cell deficiencies to their oral signs.
Thrombocytopenia (platelet deficiency): Petechiae, spontaneous gingival bleeding, hemorrhage after extraction
Leukopenia/neutropenia (WBC deficiency): Candidosis, herpes simplex virus infections
Anemia (RBC deficiency): Oral pallor
Specific to AML: Gingival swelling
Rare: Myeloma presenting in the mandible
Define oral mucositis and describe its progression in patients undergoing cancer therapy.
Oral mucositis is inflammation and ulceration of oral mucous membranes caused by free-radical damage during chemo/radiotherapy. It progresses from erythema → atrophy → ulceration → necrosis. It typically begins within one week for chemotherapy patients and within two weeks for radiotherapy patients.
Differentiate between osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) in terms of cause, presentation, and management.
ORN results from radiation damage to jaw bone vasculature, causing bone death, while MRONJ is caused by certain medications (like bisphosphonates) that affect bone metabolism. Both present as exposed necrotic bone but have different risk factors and slightly different management approaches
Explain why dental assessment before cancer therapy is essential and list at least five specific interventions that should be completed.
Dental assessment before cancer therapy is essential to prevent complications during treatment when healing is compromised. Interventions should include: removal of hopeless teeth, stabilization of caries, removal of traumatic edges, thorough oral hygiene instruction, prescription of high-fluoride toothpaste, fluoride varnish application, dietary advice, and completion of all invasive treatments at least 10 days before chemotherapy.
Describe the long-term dental management considerations for a patient who has completed head and neck radiotherapy.
Long-term dental management after head and neck radiotherapy includes: lifelong risk assessment for osteoradionecrosis (ORN), management of xerostomia (dry mouth), intensive caries prevention protocols, management of trismus (limited mouth opening), and careful planning of any invasive dental procedures with consideration of hyperbaric oxygen therapy when indicated.
