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CMS2 > Cancer Symposium > Flashcards

Cancer Symposium Flashcards

1
Q

What is the Epidemiology of head and neck cancer?

A

5-10 per 100,000 population in the UK (less than breast and prostate cancer)

M:F 2:1

Peak age : 55-65

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2
Q

Which cancer has the highest prevalance?

A

Breast, prostate, colorectal, lung and oral

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3
Q

Which cancer is most preventable?

A

Lung and oral cancer

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4
Q

Which cancer has highest survival rate?

A

Prostate and breast

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5
Q

Cancer risk factors?

A

smoking and alcohol (in the UK)

paan (in asia)

Drugs

Human Pappilloma Virus

Fanconi anemia (macrocytic aneamia)

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6
Q

how is HPV transmitted

A

sexual transmission

more likely in immuno-compromised patients/ patients with transplants

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7
Q

what are the risk factors for fanconi aneamia

A

inherited

increases risk of developing cancer and genetic mutauions

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8
Q

How did cancer develop?

A

Normal mucosa –> dysplasia(R+W patches picked up at the dentist-refer) –> canrcinoma in situ –> invasive carcinoma (metastisize)

Takes around 2 – 4 years

It will develop from primary site (tongue) –> regional lymphnodes –> distant metastises

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9
Q

How do you stage for oral cancer?

A

TNM system

Tumour

Regional lymph nodes

Distant metastises

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10
Q

in which stage is the highest chances of survival?

A

local tumour stage

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11
Q

in which stage are the lowest chances of survival?

A

metastases

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12
Q

What are the symptoms of oral cancer?

A

Pain/ disconfort

May be painless

May be present for a long time- doesnt mean its okay (red and white patches)

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13
Q

What are the signs of oral cancer?

A

white/red/speckled patches

Ulcers (present for more than 3 weeks + rasied rolled margins)

Lumps (not normal tissue growth)

Unexplained loose teeth

Poorly defined radiolucency on the radiograph

Unexplained bleeding

Rapid bone loss in the absence of chronic periodontitis

Unexplained radiolucency

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14
Q

what are the high risk areas for red and white patches

A

floor of the mouth

lateral tongue

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15
Q

what are the signs of an ulcer suggesting high risk for cancer?

A

present for more than 3 weeks

raised, rolled margins

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16
Q

How to determine survival rate for cancer?

A

Using TNM system

Local = 90% survival

Regional = 60% survival

Distant = 10% survival

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17
Q

How to determine outcomes of treatment?

A

Using quality of life e.g.

The deeper the invasion the lower the quality of life therefore poor outcome

The higher the stage of cancer the lower the quality of life therefore poor outcome

If conservative surgery is required the higher the quality of life therefore better outcome

Radiotherapy reduces quality of life therefore poor outcome

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18
Q

what is the best case scenario for cancer?

A

small tumour

easy surgery

no lymph node involvement

no radiotherapy required

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19
Q

Summary

A

Oral cancer is uncommon

Known risk factors are environmental, not inherited

Disproportionately affects people of deprived background

Disease progression and development follows a reliable pattern

Early cancer can be aymptomatic

Early lesions may be present for years before becoming asymptomatic

Early disease = better survival and better QOL

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20
Q

What questions to ask if patient is diagnosed with oral cancer (father previosly diagnosed with oral cancer too)?

A

do the have a greater risk of developing it due to the father?

why was the fathers cancer so advanced when diagnosed?

would the father have survived if he had surgery?

why was palliative radiotherapy offered instead of radical radiotherapy?

what can pt do to reduce risk of dying from oral cancer?

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21
Q

what are the organisation of services available for cancer?

A

white patches, dyplasia, potential malignant lesions –> head and neck cancer MDT –> referral for suspected cancer –> diagnosis and staging of oral cancer

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22
Q

what does a white patch look like?

A

thickened epithilium and moisture = white patch

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23
Q

what is the differential diagnosis of white patches?

A

frictional keratosis

lichen planus

chronic hyperplastic candidiasis

idiopathic (geographical longue)

smokers keratosis

acute psudomembronous candidiasis

oral luekoplakia

  • difficult to diagnose without biopsy
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24
Q

what is frictional keratosis?

A

common cause of thickened skin in oral mucosa e.g. occlusal line

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25
Q

what does lichen planus look like?

A

has a reticular pattern

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26
Q

what is chronic hyperplastic candiasis?

A

chronic thrush commonly found on buccal mucosa

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27
Q

what is smokers keratosis?

A

due to heat from smoking - leads to chronic thermal injury on the palate

increases risk of cancer

28
Q

what is acute pseodomembraneous candiasis?

A

acute thrush which can be wiped off

29
Q

what is an oral luekoplakia?

A

white patch (due to dysplasia)

30
Q

what steps to take if spot red and white patches?

A

make a differential diagnosis

refer for specialist opinion

biopsy (difficult to make diagnosis without biopsy)

31
Q

what does dyplasia suggest?

A

increased risk to progression to cancer

50% chance to progressing to high grade dysplasia over 4 yrs

need a close follow up for patients with dysplasia diagnosis

32
Q

what are the problems with the organisation of cancer services?

A

problem 1: difficult to tell benign from malignant
early diagnosis = good outcome
benign white patches are more common

  • make referral easier and quicker

problem 2: need to standardise care
coordinate referral, dignosis, staging and surgery

  • improving outcomes by having a 2 week wait referral if urgent
33
Q

what is a 2 week wait referral?

A

pt seen within 2 weeks

most pts DONT have cancer

biopsy if needed

if pt has cancer- diagnosis and treatment plan within 31 days

first treatment within 62 days

34
Q

what does the MDT consist of

A
  • surgeons
  • oncologists
  • pathologists
  • radiologists
  • dentist
  • hygeinist
  • technician
  • nurses
35
Q

what happens in the 2 week wait referral?

A

biopsy

diagnosis and staging (to check advancement)

36
Q

how to check advancement of cancer?

A

clinical assessment and radiographic imaging of primary site and regional lymphnodes

37
Q

how is distant metastises detected?

A

using radiographic imaging

CT scan of the lung, liver and adrenal area

38
Q

why is oral cancer staging important?

A

-for patient prognosis:
- dictates tx
-estimate survival: regional lymph nodes has 60% chance of survival

39
Q

how is oral cancer treated?

A

surgery at the primary site +/ regional lynphnodes +/ recontruction

radiotherapy

chemotherapy

rehabilitation

follow p

40
Q

In surgery how do we ensure parts of the tumour havent been left?

A

remove 1.5 mm all the way around the tumour

41
Q

which incision for cancer surgery will have better healing

A

primary site incision - good outcome with resections

42
Q

whats the treatment if the cancer has spread to regional lympnodes?

A

lymph nodes removed by surgery

43
Q

how do we reconstruct after surgery?

A

use a flap of muscle fat or skin and stich it in the mouth

e.g anterior-thigh flap used to fill a gap and aid function

44
Q

when is radiotherapy used?

A

-if disease is very extensive

-if excised as much as possible but still cant remove infected areas

-lypmh node involvement: extracapsular spread: tumour is invading out of the capusle of lymph nodes

45
Q

how long does radiotheraphy last?

A

for 6-7 weeks 5 days a week

46
Q

what are the side effects of radiotherapy?

A

skin reactions

mucositis (cant eat or drink)

oropharangeal thursh

xerostomia (increases caries risk)

osteoradionecrosis

47
Q

what happens in osteoradionecrosis?

A

end arteries are obliterated and get blocked

leads to chronic necrosis

Bone unable to heal

smelly and infected mouth :(

48
Q

what does chemotherapy involve?

A

3 types of medications:
- cicplatin
- 5-flouracil
- cetuximab

affects cell division and blood supply to tumour

amplifies the effects of radiotherapy but affect normal cells too

49
Q

side effects of chemotherapy?

A

bleeding

bruising

infection

deafness

exacerbate effects of radiotherapy

50
Q

effects of cancer treatment?

A

loss of teeth (especially post mandible)

changes in soft tissues

changes in hard tissues

dry mouth

caries risk

osteoradionecrosis risk

51
Q

what is the role of a dentist in MDT?

A

removal of teeth
denture making
managing hard and soft tissues
managing caries risk and ORN

52
Q

when is follow up appropriate after cancer tx?

A

risk of relapse highest in 1-3 years after cancer tx. 5 yrs is baseline

dentl rehab is longer - caries management/tooth loss/ reoccurances

53
Q

according to statistics oral cancer survival is lower in ______ areas

A

most deprived areas

54
Q

which area has the highest risk of cancer development?

A

poorer areas have a higher risk of developing cancer

55
Q

areas of higher deprivation are more likely to have ______

A

late presentations of cancer

56
Q

if submandibular gland is blocked by tumour, what symptoms will you have?

A

pain at meal times

57
Q

what are the patient factors delaying tx for cancer?

A

change occurs –> pt experiences change –> recognize its abnormal –> realize significance –> decide to seek help

58
Q

what are dentist/doctor factors delaying tx of cancer?

A

examination by dentist –> decide whther or not to refer –> refer –> hospital appt –> biopsy

59
Q

what is the treatment delay in tx cancer?

A

diagnosis
staging
tx plan
tx

60
Q

how to reduce patient delay in cancer tx?

A

patint awareness

public awareness

pop screening (everyone)

oppurtunistic screening (dentist/GP)

targetted screening (high risk groups)

61
Q

what is the biggest source of delay in cancer tx?

A

patient delay

62
Q

how to minimize referral delay ?

A

clinician awareness
2www

63
Q

what is targetted screening for breast cancer?

A

radio graphic assessment for females above the age of 50

64
Q

what is the screening for lung cancer?

A

chest Xray/CT scan

65
Q

what is the screening for oral cancer?

A

visual inspection

66
Q

who is most at risk for developing oral cancer?

A

age 55-65 years

smokers

CMS2 (29 decks)

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