Final Flashcards
What is the 1 way to definitively diagnosis cancer
Biospy
What are the conditions that can be treated with oral bisphosphonates
Pagets ds and osteoporosis
What are the conditions that can be treated with IV bisphosphonates
Osteoporosis and bone metastases
What is the length of time where lower instances of BRONJ would occur?
18 months
What is the transplant that will be most likely to result in Graft vs host ds
Allogenic (different donor to host but are a match)
What is autologous
The pts own bone marrow or stem cells are removed and preserved for transplantation
What is allogenic
Bone marrow or stem cells from a HLA (human leukocyte antigen) matched individual are used for transplantation. Still risk for rejection
What is syngeneic
Bone marrow or stem cells from an identical twin are used for transplantation
What are the medications used to treat different opportunistic infections? Viral?
Acyclovir and famciclovir
What are the medications used to treat different opportunistic infections? Bacterial?
What are the medications used to treat different opportunistic infections? Fungal?
Nystatin and fluconazol
What is the platelet threshold when invasive procedures should be avoided?
> 75,000 mm3 for chemo pts
What is the absolute neutrophil count threshold when invasive procedures should be avoided?
ANC > 1000 mm3 for chemo pts
What is nadir and when does it occur
When a pt is at their lowest blood counts
Low blood counts 7-14 days after chemo
Bc of this the best time to tx them is right before their next round of chemo. Do procedures day 28 for tx every month.
What is the recommended hyperbaric oxygen regiment for pts that are to have ext or other osseous surgeries
If the pt receives radiation over 50 gy they are at risk of osteroradionecrosis so 20 dives before ext and extraction following with 10 dives after.
Only used once in a lifetime, not for every procedure
what are ways that pts with xerostomia can reduce their caries risk
Drink lots of water salivary substitutes sugar free or xylitol gum sialogogues minimize carbs and alcohol use alcohol free mouth rinse
What are the indications for extracting teeth prior to radiation
Non-restorable caries or high caries rate
per pocketing >5mm
Furcation involvement
impacted teeth
What is the the threshold of radiation when taste is lost?
60 gy
what is the threshold of radiation when osteoradionecosis is likely to occur
50 gy
what is the threshold of radiation when hypofunction of the salivary glands is likely to occur
25 gy
what are the 5 R’s of fractionation
Repair Redistribution Repopulation Reoxygenation Radiosensitivity
What are the differences btw fixed beam radiation and intensity modulated radiation therapy
Fixed beam is all the tissues btw the portals receives the same dose
Intensity modulated radiation therapy is constantly moving beams that administers different amounts of radiation to the tissues, so tumor receives highest amount, minimal amounts of radiation to vital structures
What are the types of HPV associated with oropharyngeal cancer
16 and 18
What are the structures considered in the oral cavity
Gingiva floor of mouth anterior portion of tongue buccal mucosa hard palate teeth
What are the structures considered in the oropharynx
Soft palate
Tonsils (lingual and palatine)
Base of tongue
Pharynx (later and posterior
What are the risk factors for oral cancer
HPV Smoking Alcohol Smokeless tobacco Marijuna Betel quid Chronic irritation
What is the percent of head and neck cancers make up compared to all cancers?
3%
What radiographic method uses a radio tracer (18 F-fluorodeoxyglucose) to detect tumors?
PET scan
What is the criteria for stage 1 cancer?
Localized stage cancer 2 cm or less in greatest dimension Has not grown deeply into nearby tissues Has not spread into lymph or other parts 5-yr SR = 85%
What is the criteria for stage 2 cancer?
Early locally advanced
2-4 cm or less in the greatest dimension
Has not grown deeply into nearby tissues
Has not spread into lymph or other parts
5-yr SR = 66%
What is the criteria for stage 3 cancer?
Late locally advanced Larger than 4cm across Has not grown deeply Cancer cells ARE PRESENT in 1 lymph, which is located on the same side of the head or neck as the primary tumor and is smaller than 3cm across 5-yr SR = 35-45%
What is the criteria for stage 4 cancer?
Metastasized
Cancer has reached an advanced stage and has distant metastasis
5-yr SR = 9%
Define Occult metastasis
Non-detectable metastasis
What is the percent reduction in SR of pts with lymph node metastasis with squamous cell carcinoma
50%. it cuts it in half
Define tumor grading
Look at the tumor cell differentiation and rate of growth under microscopic examination. The pathologist carries out the description of a tumor based on how abnormal the tumor cells are. Grading helps the pathologist determine if there is a degree of dysplastic changes in the tumor and how quickly it is likely to grow
What are the TNM classifications
T = size and depth of primary tumor N = whether the cancer has spread to the lymph nodes M = whether the cancer has spread to another part of the body
What are the T’s
TX, T0, Tis, T1, 2, 3, 4
TX = tumor cannot be assessed T0 = no evidence of tumor Tis = carcinoma in situ T1 = tumor 2cm or less 2 = tumor > 2 cm but < 4 cm 3 = Tumor > 4cm 4 = Tumor invades deep adjacent structures
What are the N’s
N0, N1, N2a, N2b, N2c, N3
N0 = No palpable nodes N1 = Single ipsilateral node 6cm
What is the percent of oral cancers that are squamous cell carcinomas?
90%
Identify the clinical signs that would indicate a biopsy is needed
Intense whiteness Redness/ulceration bleeding Granular or verruciform surface Exophytic growth Mass formation, induration
What is the dye commonly used to ID dysplastic tissue
Toludine blue
What are the M’s
MX, M0, M1
MX = distant metastasis cannot be assessed M0 = no distant metastasis M1 = Distant metastasis
