Cancer symposium P2 Flashcards
How do we treat regional metastases
- Selective Neck dissection for pts who are at risk of acult neck nodes or if they have clinical and radiographic evidence of neck node
- Neck nodes would be treated with radiotherapy if the nodes were large or a lot of them or on other side of neck from primary site
what are treatment options for cancer
surgery
chemotherapy
radiotherapy
when treating cancer what would a surgical procedure involve
What does surgery involve
- Resection of the primary site with adequate margins
- Some sort of neck dissection
- And radiotherapy – for pts with extensive disease or have got close margins
- If the tumor is invading out of the capsule of the lymph node then you would recommend radiotherapy as cancer has poor prognosis
What are the side effects of radiotherapy
- Skin reaction
- Mucositis
- Oropharyngeal thrush
- Xerostomia – cant swallow
- Due to painful mucositis pt is unable to eat so they have high sugar food to increase calorie intake – poor dental health
- Osteoradionecrosis – radiotherapy affects fibroblasts and endothelial cells in blood vessles – they get very thick and block end arteries – affects healing of bone
If a pt has osteoradionecrosis how was that affect extractions and RCT
these pts can have impaired healing following these procedures
they can get necrosis of the bone that can lead to chronic infection of the
In addition to radiotherapy what tx can be offered to a pt
Chemotherapy
How does chemotherapy work
- Amplifies the effect of radiotherapy
- Makes the tumour more susceptible to the radiotherapy but also makes normal tissue more susceptible to radiotherapy
- Works by affecting cell division or blood supply to tumour
What are the side effects of chemotherapy
- Bleeding
- Bruising
- Infection
- Deafness
- Exaggerate the side effects of radiotherapy
What are the effects chemotherapy has on dental treatment
- Pts will need posterior teeth removing as risk of osteonecrosis is greater in the posterior teeth and mandible
- Changes in soft tissue and hard tissue
- Dry mouth
- Caries risk
- Osteoradionecrosis risk
What is the role of a dentist in the long term follow up of oral cancer pts
- Managing any recurrent disease
- Managing the loss of teeth as a result of OC
- Managing the changes in hard and soft tissues
- Managing the pts caries risk
- Managing the risk of developing osteoradionecrosis
Is caries risk for cancer pts lifelong?
- Yes
Is osteoradionecrosis risk for cancer pts lifelong?
- No, it reduces with time
What is the benchmark for the discharge of cancer pts from oncology team
- 5 years postop
Which stage of cancer has the highest chance of long term survival
stage 1
How can we reduce patient delay to seeking help for oral cancer
- Patient awareness – if you have an ulcer in your mouth to seek help
- Public awareness
- Population screening
- Targeted screening for high risk group
- Opportunistic screening –e.g. dental examination
