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BDS4 SPECIAL CARE DENTISTRY > Head and Neck Oncology > Flashcards

Head and Neck Oncology Flashcards

1
Q

How much more likely are you to develop SCC if you drink alcohol & smoke cigarettes?

A

16x more likely to get SCC

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2
Q

What are some causes of SCC cancers?

A
  • smoking
  • alcohol
  • HPV
  • EBV
  • HIV
  • Betel/paan chewing
  • previous SCC
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3
Q

How can SCC present in the oral cavity?

A
  • ulcerated
  • uneven surface
  • indurated
  • rolled edges
  • well defined margins
  • exophytic
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4
Q

How is performance status graded when evaluating head and neck cancer patients?

A

ECOG performance status

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5
Q

Why might you take a CT scan on a potential head & neck cancer pt?

A
  • assess primary tumour
  • assess for any synchronous head and neck tumours
  • assess for regional spread
  • assess for distant metastasis or unrelated second cancers
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6
Q

Why might you take an MRI instead of a CT scan when checking for H&N cancer?

A
  • no radiation
  • improved soft tissue definition
  • not affected by dental amalgam
  • extent of bone involvement
  • extent of nerve involvement
  • surgical planning
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7
Q

When might you perform an ultrasound on a head and neck cancer pt?

A

Pt presents with a salivary or neck mass

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8
Q

What is a positron emission scan?

A

Radioactive tracer injected into pt and tracked

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9
Q

What radioactive tracer is used in a positron emission scan?

A

Fluorodeoxyglucose

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10
Q

Who might be involved in a head and neck cancer MDT?

A
  • OMFS surgeon
  • ENT surgeon
  • pathologists
  • clinical oncologists
  • radiologists
  • speech and language therapist
  • dietician
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11
Q

What does the T, N & M stand for in the TNM classification?

A

T = primary tumour size/depth
N = nodal status
M = disease distant to primary tumour

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12
Q

Why do we stage cancer patients?

A
  • treatment planning
  • prognostic
  • research purposes
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13
Q

What treatment options are available for head and neck cancer patients?

A

Curative vs Palliative
- surgery alone
- radiotherapy alone
- chemoradiotherapy
- dual or triple modality
- immunotherapy

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14
Q

What surgical options are available for the primary cancer site?

A
  • resection & packing
  • resection and primary closure
  • resection & reconstruction
  • local flap, pedicled flap, free flap
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15
Q

When performing resection surgery of oral cancer, how big should the margin be?

A

at least 1cm of healthy tissue surrounding cancer site

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16
Q

What is involved in reconstruction of pts that have had oral cancer resection?

A
  • seal oral cavity from neck
  • fill dead space
  • maintain oral competence
  • maintain function
  • facilitate restorative options
  • avoid trismus
  • aesthetics
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17
Q

What is a free flap?

A

tissue is completely detached from its blood supply at the original location & then transferred to another location

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18
Q

When is radiology input required for cancer care?

A
  • diagnosis
  • staging
  • pre-radiotherapy
  • treatment response
  • recurrence
  • post op complications
  • dental rehabilitation
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19
Q

When would you take a radiograph for cancer diagnosis vs soft tissue imaging?

A

If suspicious lesion in:
- retromolar trigone
- non-healing socket
- coming out of hard palate

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20
Q

What might you see on a radiograph that indicates bony cancers of head & neck?

A
  • moth eaten bone
  • pathological fractures
  • non-healing sockets
  • floating teeth
  • spiking root resorption [suggests agressive]
  • unusual periodontal bone loss
  • spiculated periosteal reaction
  • generalised widening of PDL space and loss of lamina dura
  • loss of bony outlines for anatomical features
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21
Q

What are some signs on an ultrasound that may suggest cancer

A
  • rounded lymph nodes
  • enlarged lymph nodes
  • conglomerate nodes [lymph nodes matted together - warning sign for aggressive malignancy]
  • necrosis of nodes
  • increased vascularity or avascular
  • loss of hilum
  • internal calcification
  • extrascapular spread [prognosis drops by another 50%]
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22
Q

How does your survival prognosis drop after lymph node involvement of cancer?

A

30-50% drop

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23
Q

What methods exist for ultrasound guided biopsies?

A
  • fine needle aspirate
  • core biopsy [more invasive & requires small incision in skin]
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24
Q

What type of cancer must you do a core biopsy (vs a fine needle aspirate)?

A

If you suspect lymphoma

25
Prior to radiotherapy, why is a dental assessment required?
Teeth with active disease OR teeth with poor prognosis should be treated/extracted PRIOR TO TREATMENT
26
When might you do a radiological assessment of treatment response of head and neck cancer?
- lymphomas - some oro-pharyngeal carcinomas - sarcomas
27
When will a recurrence scan be taken?
about 6 months after the original surgery
28
Why can't we take MRI scans soon after a biopsy?
May get a false positive as areas of inflammation from biopsy will be highlighted
29
What post radiotherapy treatment complications exist?
- infection - osteoradionecrosis [must be within the radiotherapy field, if NOT then it cannot be ORN]
30
What is the role of the pathologist in the head and neck cancer MDT ?
- helps establish the diagnosis of cancer (subtype & grade) - outline the anatomic extent of the tumour - identify other prognostic factors [eg molecular markers] - final staging of disease
31
What happens when a cancer specimen/biopsy arrives at the pathology lab?
- request form is checked - fixed in formaldehyde for at least 24 hours - specimen photograph as appropriate
32
Why are the lymph nodes checked after primary tumour diagnosis?
to check lymph node for micro-metastases
33
Why should microscopy cancer tissue slides that have been examined histopathologically be reported & uploaded into a database?
- epidemiology - future healthcare planning
34
Potential oral cancer features:
- induration - ulceration - swelling - erythema - speckled ret and white patch
35
What are some potentially malignant lesions?
- leukoplakia - erythroplakia - lichen planus (1-4% chance of turning malignant) - submucous fibrosis - palatal keratosis in reverse smokers
36
What can GDPs do in the monitoring of H&N cancers?
- record your findings every time - watch & monitor with suspicious - take clinical pictures
37
Give examples of cancer referral systems?
- letters - electronic exchange systems [eg. SCI]
38
What are some benefits of E-system referral systems?
- rapid & safe delivery of the referral request - some systems ensure that all relevant info is provided before acceptance - review status of referral
39
What is the role of dentist & dental team in H&N cancer pts?
- early detection of soft tissue lesions - pre-treatment assessment and dental care - minimal role during treatment - maintenance of oral and dental health post treatment - palliative care
40
WHat general advice can you give to mucositis patients?
- stop smoking - avoid spirits - avoid spicy foods - avoid tea & coffee - give non prescription MWWHa
41
What topical management options exist for mucositis patients?
- lidocaine - saline mouthwashe - benzydamine spray - gelcair
42
What preventative post-cancer-treatment care can be provided by dentist?
- diet advice - OHI - fluoride advice/prescriptions - trismus management - smoking
43
How does saliva consistency change after cancer treatment?
- decreased pH - increased viscosity
44
What 2 aspects of radiotherapay increase your likelihood of ORN development?
- dose (>50Gy [lymphoma get treated with less than this so they are lower risk]) - field site
45
When should you refer a patient on suspicion of head and neck cancer?
- persistent unexplained H&N lumps >3 weeks - ulceration or unexplained swelling of oral mucosa persisting for >3 weeks - all red or mixed red and white patches of oral mucosa >3weeks - persistent hoarseness >3 weeks - dysphagia or odynophagia >3 weeks - persisten throat pain >3 weeks
46
Who is involved in the MDT of a cancer patient?
- oncologist - radiologist - surgeons - clinical nurse specialist - dentist - physio & occupation therapist - psychologist
47
At a cancer pre-assessment what do you provide as a GDP?
- detailed OHI - fluoride application & prescription - dietary advice - PMPR - chlorhexidine - definitively restore caries - removal of any trauma - denture hygiene & instruction - XLA of teeth with poor prognosis (must be 10 days before starting treatment) - smoking & alcohol advice
48
What are the side effects of surgical cancer treatment?
- severe alterations to normal anatomy (affects function & appearance)
49
How does radiotherapy cancer treatment affect patients?
- radiation damage to normal tissues (altered function)
50
What is oral mucositis?
- begins 1-2 weeks after chemotherapy/radiotherapy treatment starts - lasts until approx 6 weeks after tx complete - causes inflammation and ulceration of mucous membranes - chemotherapy attacks cells with high turnover rate [aka oral mucosal cells]
51
How is oral mucositis prevented and managed?
- Caphosol [calcium phosphate mouth rinse] - Gelclair - soluble aspirin - Benzdamine hydrochloride [difflam] - zinc supplements - aloe vera - mauka honey - good OH
52
How can xerostomia as a result of cancer tx be managed?
- Oral gel/lubricants - Pilocarpine HCL (5mg TID) - Oral stimulants (chewing gum - Saliva replacement
53
What can cause trismus after cancer treatment?
- post-surgical inflammation - fibrosis of tissues of MoM - potential tumour recurrence
54
What devices can help trismus via stretching the muscles of mastication?
- Therabite - stacked tongue depressors (wooden sticks)
55
When are patients at particular risk of developing ORN following cancer treatment?
- radiation dose >60Gy - dose fraction large with high number of fractions - local trauma eg tooth XLA, periodontal disease, ill fitting denture - person is immunodeficient - person is malnourished
56
When there is a high risk of ORN occurring due to tooth extraction what should be given?
- Pentoxyfylline (improves blood flow) - Vitamin E (antioxidant therapy)
57
What are the different stages of ORN?
Stage 0 = mucosal defects only; bone exposed Stage I = radiological evidence of necrotic bone, dento-alveolar only Stage II = positive radiographic findings above ID canal with denuded bone intraorally Stage III = clinically exposed radionecrotic bone, along with skin fistulas and infection with addition of potential or actual pathological fracture
58

BDS4 SPECIAL CARE DENTISTRY (4 decks)

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