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BDS3 Human Disease > ELFH Common cancers in the dental Pt > Flashcards

ELFH Common cancers in the dental Pt Flashcards

1
Q

What are the most common cancers in childhood?

A

leukaemia

lymphoma

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2
Q

The most common adult cancers are?

A

Breast
Prostate
Lung
Colorectal
Bladder

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3
Q

Risk factors for breast cancer are?

A

Reproductive history
Hormone therapy
Breast density
Family history (BRAC1 BRAC2)

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4
Q

breast cancer gene?

A

BRAC1 BRAC2

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5
Q

The types of breast cancer are?

A
  • Ductal carcinoma in situ
  • Lobular carcinoma in situ
  • Invasive ductal breast cancer
  • Invasive lobular breast cancer
  • Inflammatory breast cancer
  • Paget disease
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6
Q

Treatment of breast cancer?

A

Surgery
Radiotherapy
Chemotherapy
Combination of above

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7
Q

Where does the malignant cell in bone derive from?

A

Haematopoietic stem cell

  • grows uncontrollably and invades an takeover the bone marrow
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8
Q

How does a haematopoietic stem cell cause cancer?

A

grows uncontrollably and invades and takes over the bone marrow, at which point it will then spill into the blood to be found everywhere and even infiltrate and enlarge other organs, such as the liver, lymph nodes and the spleen.

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9
Q

Depending on the origin and maturity, and thus speed of growth, leukaemias are divided into the following?

A

AML: acute myeloid (myeloid cell line)
ALL: acute lymphoblastic (immature lymphocytic cell line)
CML: chronic myeloid
CLL: chronic lymphocytic (more mature lymphcytic cell derivative)

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10
Q

AML?

A

Acute myeloid (myeloid cell line)

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11
Q

ALL?

A

acute lymphoblastic (immature lymphocytic cell line)

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12
Q

CML?

A

chronic myeloid

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13
Q

CLL?

A

chronic lymphocytic (more mature lymphocytic cell derivative)

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14
Q

aetiology of leukemia?

A

most part unknown

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15
Q

environmental associations with leukaemia?

A

Chemicals such as benzene
Drugs such as chlorambucil
Radiation treatment

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16
Q

genetic events associated with CML and ALL leukaemia?

A

There is an increase incidence in Down’s syndrome patients

Philadelphia chromosome (long arm chromosome 22 translocated to long arm of chromosome 9 (t9:22).

This creates a gene which makes a protein capable of altered cell differentiation, proliferation and reduced cell death called Bcr-abl

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17
Q

leakaemia is associated with what disorder?

A

Down’s syndrome

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18
Q

genetic events associated with AML leukaemia?

A

(pro-myelocytic) is associated with (t15:17) preventing the normal maturation of the myeloid cell line

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19
Q

What is acute leukaemia?

A

bone marrow is overrun with immature myeloid and lymphoid precursors are unable to mature further. As a consequence the bone marrow loses it functioning ability

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20
Q

Consequences of acute leukaemia’s?

A
  • Anaemia, due to reduced red cells
  • Bleeding, due to reduced platelets
  • Infections due to functional white cells
  • Organ enlargement e.g .liver, spleen and lymph nodes due to cells leaving the bone marrow and spreading via the blood
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21
Q

AML more common in adults or children?

A

children

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22
Q

ALL more common childhood or adults?

A

childhood

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23
Q

Main tx options for acute leukaemia’s?

A
  • Correction of RBC and platelet problems
  • Treat any infections
  • Keep hydrated and guard against the release of cell constituents when leukemic cells are destroyed e.g. uric acid, potassium, phosphate (which binds and reduces the calcium) called acute tumour lysis syndrome (ATLS)
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24
Q

AML tx option?

A

requires cytosine arabinoside and daunorubicin to induce remission and possible bone marrow transplant to consolidate. There is a 40% cure rate.

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25
Q

ALL tx option?

A

similar to AML

requires vincristine, prednisolone and daunorubicin for remission and repeated for consolidation.

ALL frequently involves the brain thus may require intra-thecal methotrexate and/or radiation. There is a 90% response rate and 60% cure in children (less in adults - 30% cure).

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26
Q

Wat age does CML occur?

A

middle age

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27
Q

Symptoms of CML?

A

weight loss

sweating

anaemia

bleeding

infections

enlarged spleen

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28
Q

After 3-4 years what can CML transform into?

A

acute leukaemia and rapid death

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29
Q

What age does CLL occur?

A

old pts

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30
Q

Is CLL incurable?

A

no - incurable

31
Q

What is CLL?

A

incurable malignant proliferation of predominantly mature B cells (rarely T cells)

progresses slowly

leading to anaemia, bleeding and infection

32
Q

The progress of CLL is so slow, how can it be detected?

A

discovered by chance blood testing

pt may also have enlarged lymph nodes and spleen

33
Q

How to confirm a CLL?

A
  • Increase in WBC and predominantly lymphocytes, anaemia and thrombocytopenia on blood testing
  • Lymphocytes on blood film (smear cells as they rupture)
  • Bone marrow biopsy
34
Q

What can be prescribed for symptomatic control of CLL?

A

Oral chlorambucil, with or without oral prednisolone, can be prescribed for symptomatic control.

There is a survival rate of an average 8 years, unless bone marrow failure ensues.

35
Q

Can you list any side effects of chemotherapy used in the treatment of leukaemia?

A
  • Anaemia (reduced bone marrow)
  • Thrombocytosis (thrombocytopenia)
  • Mandibular tori
  • Mucositis (and ulceration)
  • Dysphagia
  • Hair loss (hair follicle turnover - reversible)
  • Sterility (affects high turnover sperm cell. Pre-treatment samples can be saved)
  • Cataracts
  • Vomiting (there is a direct stimulation of the vomiting centre in brain stem)
36
Q

Lymphomas are caused by malignant transformation of normal B and T cells found in lymphoid tissue.

What types of lymphoma are you aware of?

A

The two types of lymphoma are:

Hodgkin’s disease
Non-Hodgkin’s lymphoma

37
Q

What pts does Hodgkins disease affect?

A

young adults

38
Q

How does Hodgkins show?

A

painless rubbery lymphadenopathy

Additional symptoms include sweating (especially at night), fever, weight loss, pruritis, fatigue, anorexia and pain in the lymph nodes on drinking alcohol.

39
Q

A pt with Hodgkin’s disease will develop what?

A

Patients will develop anaemia with raised ESR and will have abnormal liver function tests.

40
Q

How to diagnose Hodgkin’s disease?

A

Diagnosis and staging information is achieved with a lymph node biopsy, chest X-ray, CT scans and bone marrow.

  • Typical lymph-node result shows Reed-Sternberg cells (malignant B cell)
41
Q

Stages of Hodgkin’s disease?

A
42
Q

Treatment for stage I Hodgkin’s disease?

A

radiotherapy

43
Q

Treatment for stage II Hodgkin’s disease?

A

Radiotherapy (if there are B symptoms then chemotherapy aswell)

44
Q

Treatment for stage III and IV Hodgkin’s disease?

A

chemo

45
Q

What is non-hodgkin’s lymphoma?

A

Non-Hodgkin’s lymphoma is a highly heterogenous disease of malignant lymphatic cells which can infiltrate a variety of structures.

46
Q

2 categories of non-hodgkin’s lymphoma?

A

high grade (high cell division)

low grade (low division)

47
Q

Where is the body is affected by non-hodgkin’s lymphoma?

A

anywhere although common for lymph nodes to be affected

48
Q

When do more major issues occur with non-hodgkin’s lymphoma?

A

with bone marrow involvement which lead to bruising, anaemia and infections

49
Q

What tests can confirm a non-hodgkin’s lymphoma diagnosis?

A
  • Reduced RBC and platelet numbers, with raised white cell count on blood tests
  • Abnormal liver function tests if liver involved
  • A chest x-ray and CT scan will show masses which will require a biopsy to provide sub-type diagnosis.
  • Bone marrow aspirate is needed to determine spread
50
Q

Clinical features on lung cancer?

A
  • Cough, haemoptysis, chest pain
  • Bone spread leading to fractures, invasion of the brachial plexus causing pain (Pancoast’s tumour), invasion of the sympathetic ganglions (Horner’s syndrome); involves recurrent laryngeal nerves leading to hoarseness and invasion of the oesophagus, heart and veins
  • Metastases to bone and the brain
  • Finger clubbing, weight loss, lymphadenopathy
51
Q

biopsy for lung cancer?

A

bronchospcopy

52
Q

lab investigation for lung malignant cells?

A

sputum cytology for malignant cells

53
Q

investigations for lung cancer?

A

chest x-ray for masses, sputum cytology for malignant cells, bronchospcopy for biopsy and a CT scan for peripheral lesions.

54
Q

How to asses spread of lug cancer?

A

The spread is assessed with a CT to see if it is operable and an MRI for accurate staging

55
Q

types of lung cancers?

A

Non-small cell
- Squamous cell carcinoma (Fig 1)
- Large cell
- Adenocarcinoma (asbestos)
- Alveolar

Small cell
- Endocrine cells which often secrete polypeptide hormones

56
Q

extrapulmonary features related to lung cancer?

A
  • Endocrine: Cushings syndrome (ACTH secretion), ADH (diutional hyponatraemia) and hypercalcaemia (PTH like peptide release)
  • Skeletal: clubbing and painful wrists and ankles
  • Skin: pigmented skin in axillae (acanthosis nigricans), herpes zoster and dermatomyositis
  • Nerves: myasthenic like symptoms multiple
    individual nerve involvement and muscle weakness
  • Blood: anaemia, disseminated intravascular coagulation and multiple phlebitic limb veins
57
Q

tx for lung cancer?

A

non-small cell cases are suitable for surgery

Radiotherapy produces equivalent results but also has a role in controlling local problems.

Chemotherapy is used for small cell cases, although survival is only measured in months.

Local emergencies need treating to maintain quality of life, e.g. laser, endobronchial radiation and stenting obstructions; effusions need draining.

Palliation needs coordination and a focus on symptomatic monitoring and relief, e.g. pain (opiates) and appetite (steroids).

haemodialysis

haemofiltration

peritoneal dialysis

58
Q

stages of colorectal cancer?

A
59
Q

Where is colorectal cancer located?

A

mostly on the descending colon

60
Q

symptoms of colorectal cancer?

A

bleeding, narrowing and obstruction, leading to alternating diarrhoea and constipation, which may be accompanied by bleeding per rectum.

61
Q

How to diagnose colorectal cancer?

A

A barium enema (Fig 1)

endoscopy

USS of liver (jaundice) and bloods to check for anaemia and LFTs.

62
Q

tx for colorectal cancer?

A

primary tx = surgery

chemo = stage B and C

preventative radiotherapy ay also help

A liver lobectomy can be successful if there are localised metastases, otherwise it requires chemotherapy.

63
Q

prostate specific antigen?

A

PSA - shows up in screenings

64
Q

How can prostate cancer present itself?

A

screening PSA gene

obstructive urinary flow

also can show as bone bone die to metastasis

65
Q

How to diagnose prostate cancer?

A

rectal examination

  • enlarged hard prostate, elevated PSA , biopsy, trans rectal USS
66
Q

tx for prostate cancer?

A

Prostatectomy and radiotherapy

Metastases need androgen ablation therapy, e.g. anti-androgens such as cyproterone acetate, orchidectomy or even luteinizing hormone analogues such as goserelin.

67
Q

common tumour of the bladder?

A

transitional cell malignancy

68
Q

risk factors for bladder cancer?

A
  • Cigarette smoking
  • Exposure to chemicals such as bezidine
  • Drugs such as cyclophosphamide
  • Chronic infections such as schistosomiasis
69
Q

symptoms for bladder cancer?

A

haematuria, which is usually painless.

70
Q

How to diagnose bladder cancer?

A

cytological examination of the urine, dye-based investigations such as urography and endoscopic procedure (cystoscopy).

71
Q

tx for bladder cancer?

A

treatment will depend upon the stage of the tumour ranging from local resection or diathermy to bladder resection and radiotherapy, occasionally with added chemotherapy.

72
Q

issues associated with chemo?

A

affecting growth in younger children, cardiac side effects, lung fibrosis and impaired bone marrow function.

In addition, children face the risk of developing secondary cancers in later life.

73
Q

effect of radiotherapy in dentistry?

A

jaws does pose a problem with osteoradionecrosis

74
Q

Which of the following blood tests is helpful in Prostate cancer diagnosis and monitoring?

A

PSA

prostate specific antigen

BDS3 Human Disease (33 decks)

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