Head and Neck Cancer Flashcards
what is the characteristic presentation of oral cavity cancer
ulcerated
uneven surface
indurated
rolled edges
well defined margins
exophytic
what imaging is used for head and neck cancer
CT scan
MRI
ultrasound
PET CT
what is the purpose of a CT scan in head and neck cancer
assess primary tumour
assess synchronous head and neck tumours
assess regional spread
assess for distant metastasis or unrelated second cancers
what are the advantages of MRI scanning
no radiation
improved soft tissue definition
not affected by amalgam
extent of bone involvement
extent of nerve involvement
surgical planning
what are ultrasounds used for
neck mass
salivary gland mass
what system is used for staging
TNM
what does T stand for in TNM
primary tumour size/depth
what does N stand for in TNM
nodal status
what does M stand for in TNM
disease distant to primary tumour
what is the purpose of staging
treatment planning
prognostic
research purposes
what are the different treatment options for head and neck cancer
curative vs palliative
surgery alone
radiotherapy alone
chemoradiotherapy
dual or triple modality
immunotherapy
when is radiology needed
diagnosis
staging
pre-radiotherapy
treatment response
recurrence
post operative complications
dental rehabilitation
what are the features on an OPT that are significant of cancer
moth eaten bone
pathological fractures
non-healing sockets
floating teeth
spiking root resorption
unusual periodontal bone loss
spiculated periosteal reaction
generalised widening of PDL spaces and loss of lamina dura
loss of bony outlines for anatomical features
thinning of cortico-endosteal margin
what are the ultrasound features of cancer
rounded lymph nodes
enlarged lymph nodes
conglomerate lymph nodes
necrosis of nodes
increased vascularity or avascular
loss of hilum
internal calcification
extrascapular spread
what is the role of the pathologist in head and neck cancer
establish diagnosis, subtype and grading of cancer
examine surgical margins of specimen in laboratory
establish final staging of disease
why is it important to report malignancies
epidemiology
healthcare planning
what are the risk factors for oral and oropharyngeal cancer
HPV
cigarettes and alcohol
betel nut
nutrition
poor OH and dental health
what are the potentially malignant lesions
erythroplakia
leukoplakia
submucous fibrosis
lichen planus
SCC arising in pre-existing actinic keratosis
palatal keratosis in reverse smokers
what guidelines do we refer to when referring someone for head and neck cancer
scottish referral guidelines for suspected cancer
what is the role of the dentist in head and neck cancer
early detection of soft tissue lesions
pre-treatment and assessment
minimal role during treatment
maintenance of oral and dental health post-treatment
palliative care
what treatment do we provide for patients before cancer treatment
make sure dentally fit
immediate treatment
scaling
impressions for fluoride trays
start fluoride therapy
why is prevention a key aspect of pre-treatment
avoid unscheduled interruption of chemotherapy
avoid exacerbation of mucositis
remove potential source of infection
what are the effects of radiotherapy
mucositis
trismus
dry mouth
caries
ORN
what issues do dentists need to deal with during cancer treatment
oral ulceration
oral infection
emergency dental treatment
what is the presentation of mucositis
inflammation and ulceration
severe pain
impacts on eating
what advice do we give for mucositis
stop smoking
no spirits
avoid spicy foods
what treatment do we give for mucositis
topical lidocaine
saline mouthwash
benzydamine HCL
gelclair
cryotherapy
morphine
what is the role of the dentist in post-treatment for cancer
prevention
monitoring
what does the risk of ORN depend on
dose and field
what dose of radiation gives a higher chance of ORN
over 50Gy
if you must extract a tooth before radiotherapy treatment when must it be done
10 days prior at least
