Core principles Flashcards
what is the main pathology
SCC (tough mucosal layer = protection)
what is the only site to have a different staging system
nasopharynx
what is the histological types
SCC
benign
lymphomas
aetiological factors
excessive alcohol
smoking
when is prophylactic irradiation common
when the tumour is midline, bilateral spread is common due to the lymphatic channel cross over
- larger fields are needed
what is the prophylactic dose
54Gy in 30
what happens if the patient has a poor nutritional status
low QOL
malnutrition = deteriation
what is the pre-treatment for dental
identify mandible invasion/obstruction
orthopantomogram
look at healthy teeth
unhealthy teeth need to be removed, dentures may be needed
what is the nutrition pre-treatment
PEG
what is the SLT role before treatment
understanding prior surgery
regain speech or re-train breathing for trachestomy
swallowing exercises, PEGs weaken these muscles
what are the considerations for multi-modality
functional outcomes
cosmetic outcomes
survival rates
patient choice
late stages might need all options
what is the early stage treatment
surgery and RT
what is the late stage treatment
multimodality
what are the SE from surgery
face disfiguration
speech changes
trismus
aspiration
nasal regurgitation
oral regurgitation
poor wound healing
loss of taste, smell
difficulty chewing
drooling, pocketing of food and fluid
why is IV contrast given
to visualise LN, and tumour delineation
describe patient position
neck needs to be in a straight neutral position, which is straight at the C-vertebrae
bear claws + hand supports
indexed = reproducibility
shoulders dropped, greater length from the neck
knee support relieves back pressure
what is mucositis and how can it be managed
inflammation of the OC, cells become damaged at a greater rate than can be replenished
ulcerated, deep and persistent pain
mouthwash with opoid for T3/T4
baby toothbrush
high fluoride toothpaste and mouthwash
saline: keep oral cavity clean
gargle paracetamol 30 min before treatment and food
how to manage loss of taste
swap metal cutlery for other forms
bitter and saltier foods tend to go first
metallic taste
eat small meals regularly
keep trying foods
how to manage dysphagia
avoid sharp and spicy foods
blander foods
high calorific foods
what is xerostomia and how is it managed
dry mouth
sticky thick saliva
parotid = dose constraint
regular sips of water to keep mouth moist
artificial saliva
nebuliser
how to manage skin reaction
moisturise regularly
stay out of the sun
electric razor, more favourable
avoid makeup in that area
MDS = non absorbent, hydrocolloid gels
cisplatin infusion
weekly or 3 weekly infusion
if platinum intolerant then cetuximab is used
can be neoadjuvant
chemo heightens reactions
