Clinical Oncology

Question 1

Role of dentist within oncology?

Answer 1

Screen for oral cavity tumours, health promotion, dental assessment pre-tx

Question 2

Considerations of oncology pt in dental setting

Answer 2

Dental XLA, how tx abscess, pt immunocompromised, secondary problems e.g ORNJ

Question 3

How are tumours graded and staged?

Answer 3

Grade - G1-3

TNM staging: T size of tumour, N- spread to lymph nodes, M - spread distal organs

Question 4

Name some examples of prognostic marks used in oncology?

Answer 4

HER2 - breast cancer
BRAF - melanoma
HPV - head and neck

Question 5

What are some tx options for cancer pt?

Answer 5

Surgery, radio or chemotherapy
Hormonal therapy, targeted therapy, immunotherapy
Supportive care

Question 6

What is chemotherapy and what drugs are used?

Answer 6

Drugs which affect cell function

Platinum, taxanes, anti-metabolites, alkylating agents

Question 7

What is palliative tx?

Answer 7

Lower intensity tx to improve symptoms and extend life - often single drug with less side effect

Question 8

Side effects of chemotherapy?

Answer 8

Nausea, vomiting, fatigue, change in taste, bowel disturbance
Skin rash hair loss
Neuropathy
Infertility
Cardiac/ lung toxicity

Question 9

Dental tx of pt on chemotherapy?

Answer 9

Ideally all tx commenced before chemo
If 3 weekly cycle - max risk immune-suppression between 7-14 days
FBC check white cell count

Question 10

Problem with dental abscess?

Answer 10

Neutropenic sepsis

Question 11

What are modern targeted agents?

Answer 11

Tyrosine kinase inhibitors - oral

Mononclonal ab - iv

Question 12

Tx of pt on modern targeted agents?

Answer 12

Usually not immunosuppressed but risk of infection significant

Question 13

What is metastatic bone disease?

Answer 13

Increased bone resorption - bone cells increase expression RANK - drives increase formation function and survival of osteoclast - excessive resorption

Question 14

Effect of bisphosphonate on cycle of bone destruction?

Answer 14

Decreased activity of osteoclast - slow tumour growth

Question 15

Pharmokinetic of bisphosphonate?

Answer 15

Half life is short

50% of circulation is taken up by skeletal - liberated during osteoclast resorption

Question 16

Side effect bisphosphonate

Answer 16

Upper GI inflammation, diarrhoea and abdo pain
IV: fever, hypocalcemia incident, renal toxicity (Rare)
ONJ

Question 17

What is denosumab?

Answer 17

Targeted agent for bone cancer - target RANK ligand - prevent activation of RANK receptor of osteoclast

Question 18

Adv denosumab?

Answer 18

Given SC - no concern about renal safety

Question 19

What is HPV and relevance to cancer?

Answer 19

DNA virus - cervical and oro-pharyngeal cancer

SCC type 16 most common

Question 20

HPV cancer?

Answer 20

Younger pt, often not smokers or heavy alcohol drinks

Associated orogential and oroanal sex and increased no. partners

Question 21

Problems with radiotherapy in H&N

Answer 21

Critical structure - spinal cord, optic chasm, brain

Pt need to be same reproducible position - immobilised

Question 22

Early and late side effects radiotherapy?

Answer 22

Early - common and resolve - xerostomia, altered taste, loss hair, fatigue, soreness of skin

Late - very and irreversible -xerostomia, altered taste, ORN, alopecia, hypothyroidism, secondary malignancy

Question 23

Effect radiotherapy on dental care?

Answer 23

Xerostomia accelerates dental decay
ORNJ - can happen any time after RT, worse if poor dental hygiene, death bone due to damage blood vessel
Pt may need dental clearance