Cancer Symposium Flashcards
What are some of the risk factors for oral cancer?
- Smoking
- Alcohol
- HPV (affects oropharyngeal/tonsil)
- Immune suppression
How is dysplasia developed?
damage to the normal mucosa repeatedly
What is low grade /mild dysplasia limited to?
basal 1/3 of the mucosa
What is high grade / severe dysplasia limited to?
top 2/3 of the mucosa
What stages of cancer is no longer reversible?
Carcinoma In-situ and Invasive carcinoma
What does TNM stand for in the classification?
Tumour
Nodes
Metastases
What does symptom mean?
What the patient experiences
What does sign mean?
What we can see clinically
What are common signs of oral cancer?
White patches (leukoplaplakia)
Red patches (erythroplakia)
Speckled patches (spelled leukoplakia)
Ulcer
Lumps
Unexplained bleeding
Unexplained pain
Osteolytic lesion
Trismus (if cannot open more than 15mm)
What is known to be a high risk area for oral cancer and why?
Floor of the mouth
(toxins from tobacco/alcohol - gravity hold them in the floor of the mouth)
What is a common site for oral cancer?
Lateral border of the tongue
What appearance would a cancerous ulcer have?
big ulcer with raised rolled edge
After how long should persistent ulcers be treated with suspicion?
3 weeks
What does MDT stand for? What do they do?
Multi-disciplinary team - This is a team of health professionals who work together to decide on the best treatment and care for you. It can include: specialist head and neck surgeons. doctors who specialise in cancer drug treatments (medical oncologist)
What appearance does frictional keratosis have in the mouth?
Long occlusal line from cheek biting on buccal mucosa
What increased risk does a patinet with high grade/severe dysplasia have of developing oral cancer if untreated?
50%
If an individual has been referred to oral surgery, how long should they expect a diagnosis/tx plan and 1st tx?
within 31 days and first tx within 62 days
What assessment would you undertake for the primary site of cancer?
- clinical assessment
- radiographic
- scans (MRI/CT)
What scan would you take if you suspect bone involvement?
CT
What assessment would you undertake for the regional lymph nodes of cancer?
- clinical assessment
- scans (MRI)
- CT scan
What assessment is routine to undertake for the distant metastases of cancer?
CT scan of the chest
What is the measurement of limited mouth opening (trismus) that would be concerning and a red flag for oral cancer?
cannot open >15mm
which lymph nodes tend to metastasis first in cancer?
submandibular lymph nodes
How is lymph involvement treated?
Neck dissection
How might a white patch with some ulceration on the side of the tongue be treated?
Wide local excision
Why is it important to cut out the cancer and get 1cm around it (if possible?)
Due to microscopic disease spreading from the primary tumour into tissues that you cant see - it is done to reduce the risk of recurrent disease
What is the treatment for regional metastases?
Surgery/neck dissection/reconstruction/radiotherapy/chemotherapy
As radiotherapy affects the salivary glands, what effects can this have on the oral cavity?
Dry mouth
What is osteoradionecrosis?
Occurs when radiotherapy affects the fibroblasts and endothelial cells in blood vessels (they tend to get thicker) and you get a condition called endarteritis obliterans (very small arteries in the tissue get blocked and so the bone cannot heal)
What is the role of GDP in oral cancer?
promote oral health and oral cancer awareness
screening
What are the effects of radio treatment?
Loss of teeth
Changes in soft tissues/hard tissues
Dry mouth
Caries risk increased
ORN
What is the roll of a dentist in the long term follow up of Oral cancer pts?
Recurrent disease
Managing tooth loss (dentrure)
Managing changes in soft and hard tissues
Managing pt caries risk
Managing risk of developing osteoradionecrosis
What is the period of follow up?
5 years
Every month for 1st year
Every 2months for 2nd year
Every 3 months for 3rd year
Every 4-6months for the 5th year
How do we reduce patient delay?
Patient awareness
Public awareness
Populated screening
Targeted screening (high risk groups)
Opportunistic screening (dental appt)
How do we reduce referral delay?
Clinician awareness
Guidelines
What is populartion screening?
Whole of the at risk popilation
What is opportunistic screening?
Dental check up
What is targeted screening?
Those at the highest risk
