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IHD Part 2 - BDS 3 > Clinical oncology 1/2 > Flashcards

Clinical oncology 1/2 Flashcards

1
Q

cancer

A

a group of diseases characterised by uncontrolled growth and spread of abnormal cells within a body

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2
Q

types of cancer

A

1) glandular
- adenocarcinoma
2) skin/mucosa
- squamous cell carcinoma
3) connective tissues
- sarcoma
4) small cell
- small cell carcinoma
5) lymph nodes
- lymphoma

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3
Q

TNM staging

A

tumour
node
metastases

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4
Q

risk factors for each type of cancer

A

1) colorectal
- diet and genetic
2) lung
- smoking
3) breast
- genetic
- obestity
4) skin
- UV light
5) cervix
- HPV
6) head and neck
- smoking
- alcohol
- diet/nutrition
- viruses eg HPV, EBV
- immunosuppression
- premalignant oral conditions (leucoplakia, lichen sclerosis)
- radiotherapy exposure

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5
Q

treatment options for cancer

A
  1. Surgery
  2. Radiotherapy
  3. Chemotherapy
  4. Hormonal therapy
  5. Targeted therapies
  6. Immunotherapy
  7. Laser therapy
  8. Cryotherapy
  9. Best supportive care
  10. Any combination of these
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6
Q

surgery

A 
aim to remove tumour with clear margins
side effects
- funcitonal
cosmetic
risk of anaesthesia
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7
Q

chemotherapy drugs

A

1) platinum
- cisplatin
2) taxanes
- docetaxel
3) anti metabolites
- 5 fluorouracil
4) alkylating agents
- dacarbazine
5) anthracyclines
- doxorubicin

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8
Q

why may pts be given chemo after

A
  • pts may not have disease and not require it
  • pts may get reoccurrence despite chemo
  • proportion will be cured, need to assess risk vs benefit
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9
Q

palliative treatmetn

A

tx to improve symptoms and extend life

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10
Q

side effects of chemo

A 
•General
–	Nausea and vomiting
–	Fatigue
•	Skin
–	Rash
–	Hair loss
–	Extravasation 
•	Nerves
–	Neuropathy
–	Hearing loss
•	Infertility/Premature menopause
Bone marrow
–	Anaemia
–	Neutropenia
–	Thrombocytopenia
Renal dysfunction
•	Liver dysfunction
•	Allergic reaction/Anaphylaxis
•	Lung toxicity
–	Fibrosis
–	Bleomycin
•	Cardiac Toxicity
–	Cardiomyopathy
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11
Q

how is chemotherapy given

A

in cycles

in 3 wks cycle 7-14 days is the highest risk of infection

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12
Q

general rule for dental treatments on chemo

A 
find out cycle
all urges work before chemo
FBC prior to check not neutropenic or thombocytopenic
-	neutropenia is neuts <1.0
-	thrombocytopenia is platelets <100
-	risk of bleeding if platelets <20/30
counts usually cover in the 3rd week
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13
Q

targeted treatment types of drugs

A

tyrosine kinases inhibitors

monoclonal antibiotics

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14
Q

types of immunotherapy drugs

A
  • PDL1 inhibitors – Pembrolizumab
  • immune checkpoint inhibitors – Nivolumab

other bad effects can be controlled by steriods

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15
Q

bone metastases

A

often a mixture of osteoblastic and clastic lesions

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16
Q

what can be used when there is bone involvement in cancer

A

bisphosphondates
RANK L inhibitors
radiopharmaceuticals

17
Q

what is the hallmark of metastatic bone disease

A

increased bone resorption

18
Q

bone destruction from tumorus

A
  • tumour cells produce factors (GF and cytokines) that stimulate OB that secret RANK L
  • OB increase expression of RANK L
  • overexpression of RANK L drives increased formation, function and survival of OC, leading to excessive bone resorption
  • Resorption releases growth factors/peptides from the growth matrix that may perpetuate tumour activity
19
Q

bisphosphnates cycle

A
  • decrease activity of OC
  • reduction in release of peptides
  • slowed tumour cell growth
  • reduced production of PTHrP and other factors
  • decrease in bone resorption
20
Q

denosumab

A

MC AB - tx for osteoporosis

Rank L

  • binds to RANK L preventing activation of RNAK receptor on OC
  • binding to Rank L inhibits OC formation, function and survival
  • prevents maturation of OC, decreasing bone resorption and breaking vicious cycle of bone destruction
21
Q

how does radiotherapy work

A
  • ionising radiation interacts with water molecules to make free radicals
  • free radicals cause DNA damage, no longer able to divide or multiply
  • malignant and normal cells damaged (side effect)
  • normal cells can repair if tolerance not exceeded
22
Q

radiotherapy

A

Use of ionising radiation to treat cancer

- energy of photos is higher in a therapeutic setting as opposed to diagnostic setting

23
Q

what can radiotherapy be used as

A

1) radical
- curative
2) palliative
- to improve symptoms
3) adjuvant
- alongside surgery
4) neoadjuvant
- before surgery

24
Q

radiotherapy dose and tx depends on

A
  • area being treated
  • intention of treatment – curative vs palliative
  • all of the cancer cells at different cell cyle stages are killed
25
Q

curative vs palliative planning

A
  • complex planning
  • acute localisation – CT
  • longer course of tx
  • more early side effects, less late side effects
  • can be long term effects eg scarring
    Palliative
  • simple planning
  • simple localisation via x ray
  • short course of tx
  • less early side effects, more late side effects
26
Q

treatment modalities of radiotherapy

A

X ray
election tx
brachytherapy (insertion of isotopes into tumour, where cancer is accessible)

27
Q

CT planned RT

A
  • less dose to underlying structures
  • less toxicity
  • marks where cancer is
  • helps estimate the dose
28
Q

standard conformal radiotherapy

A

beam from 3 different directions

concentrated in one area

29
Q

rapid Arc RT

A
  • machine constantly moves delivering beams
  • able to produce different controls and modulate final plan
  • stops dosage to structures not needed to have radiotherapy, more control

IHD Part 2 - BDS 3 (55 decks)

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