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Module 7 > Mafax/cancer > Flashcards

Mafax/cancer Flashcards

1
Q

What is the aetiology of oral cancer?

A

Tobacco
Alcohol
Genetic predisposition
HPV (mainly oropharyngeal cancer)
EBV (nasopharyngeal cancer)
HHV 8 (Kasposi’s, not OSCC)

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2
Q

What are the oral pre-malignant disorders?

A

Leukoplakia
Erythroleukoplakia
PVL
Submucous fibrosis

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3
Q

What is the prevalence of leukoplakia?

A

1-4%

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4
Q

What are the types of leukoplakia?

A

Homogenous
Non-haemogenous
Focal
Multi focal

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5
Q

What biopsy’s could be taken for leukoplakia?

A

Incisional
Mapping
Excisional

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6
Q

What is the malignant transformation of leukoplakia?

A

8-22%

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7
Q

What are the tx options for leukoplakia?

A

Surgical excision
Serial biopsies
Serial reviews w/ photography

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8
Q

What is erythroleukoplakia?

A

Non-homogenous leukoplakia
Red, pebbly granular plaque

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9
Q

What % of erythroleukoplakia will have dysplasia/CIS/invasive disease?

A

90%

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10
Q

What are the risk factors for submucous fibrosis?

A

Areca nut
Betel quid
Genetics?

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11
Q

How is submucous fibrosis characterised?

A

Juxtaepithelial inflammation and fibrosis of oral mucosa with progressive trismus

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12
Q

What causes submucous fibrosis?

A

Areca nut induced activity of TGF-beta and collagen production, inhibits collagen degradation which causes fibrosis

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13
Q

What are the signs of submucous fibrosis?

A

Mucosal burning
Ulceration
Dryness
Fibrosis
Rigidity
Trismus

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14
Q

What is the transformation rate of submucous fibrosis?

A

7-30%

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15
Q

Who is most prone to proliferative verrucous leukoplakia?

A

Elderly women

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16
Q

Name 7 red flags for malignancy

A
  1. Ulcer persists >2 weeks despite removal of causation
  2. Rolled margins, central necrosis
  3. Speckled appearance
  4. Cervical lymphadenopathy, firm, fixed, tethered, non-tender
  5. Worsening pain
  6. Referred pain
  7. Weight loss
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17
Q

What are the tx options for oral cancer?

A

Curative
Palliative
Best supportive care
Surgery
Radiotherapy
Chemoradio therapy
Dual or triple modality
Immunotherapy

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18
Q

What is radiotherapy?

A

High energy x-rays targeted to tumour +/- nodes

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19
Q

What are the 3 types of radiotherapy?

A

Radical (curative)
Adjuvant (after surgery)
Palliative

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20
Q

What are the 5 stages of radiotherapy process?

A
  1. Immobilisation
  2. Scanning
  3. Image fusion
  4. Planning
  5. Verification and daily set-up
21
Q

What are the advantages of radiotherapy?

A

Preserves tissue function
Treats microscopic disease

22
Q

What are the disadvantages of radiotherapy?

A

4-6 weeks treatment
Acute side effects
Late sequelae.

23
Q

What are the acute side effects of radiotherapy?

A

Skin reaction
Muscosal reaction
Fatigue
Glut

24
Q

What are the late side effects of radiotherapy??

A

Dry mouth
Altered taste
Fibrosis
Telangiectasia
2nd malignancy

25
Q

What is systemic anti-cancer therapy?

A

Conventional chemotherapy
Drugs which target the immune system (monoclonal antibodies)

26
Q

How does conventional chemotherpy work?

A

Inhibits cell division

27
Q

What is cetuximab?

A

Monoclonal antibody
Targets epidermal growth factor receptor (EGFR)

28
Q

What are nivolumab + pembrolizumab?

A

Monoclonal antibodies
Checkpoint inhibitors (PD-1) which upregulate the immune system to target cancer cells

29
Q

What are the potential advantages of SACT?

A

Improved survival
Improved local control
Relief of symptoms

30
Q

What are the potential disadvantages of SACT?

A

Increased toxicity
May increase rate of treatment related deaths

31
Q

When do we use SACT?

A

Squamous cancers
Locally advanced disease
Palliation of symptoms

32
Q

What are the absolute indications for adjuvant chemo radiation?

A

Positive resection margins
Extracapsular lymph node spread

33
Q

What are the relative indications for adjuvant chemo radiation?

A

Oral cavity primary site
Poor differentiation
Close margins <5mm
Advanced T stage
Perineural invasion
Lymphovascular invasion
Nodes - consider size, number and levels involved

34
Q

What are the side effects of cetuximab?

A

Fatigue
Diarrhoea
Rash
Nausea/vomiting
Hair/nail changes

35
Q

What ate the common side effects of nivolumab/pembrolizumab?

A

Fatigue
Diarrhoea
Rash
Nausea/vomiting

36
Q

What are the indications for orthognathic surgery?

A

Skeletal class 2 and 3
Open bite, deep bite, VME
Cross bites, asymmetries

37
Q

What clinical and psychological factors indicate orthognathic surgery?

A

Function issues (eating, speech, TMD, sleep apnoea)
Aesthetics
Pain/discomfort

38
Q

What factors are taken into account when case selecting for orthognathic surgery?

A

Psychological status
Family support
Dental health
Cooperation

39
Q

What happens to the skeletal patterns in unfavourable growth?

A

Class 2 improve
Class 3 get worse

40
Q

What is the tx process for orthognathic surgery?

A

Referral
Assessment and diagnosis
Joint clinic
Pre-surgical ortho
Orthognathic surgery
Post-surgical ortho
Retainers/review

41
Q

What imaging would be used to see condylar hyperplasias?

A

Technetium 99 radioisotope scan

42
Q

What % of orthognathic patients have psychological disorders?

A

20%

43
Q

How is BMI calculated?

A

Weight/height squared

44
Q

What teeth would be extracted pre ortho surgery for class 2 and 3 cases?

A

Class 2 - lower premolars
Class 3 - upper premolars

45
Q

What are the types of orthognathic surgery for the mandible?

A

Bilateral Sagitta split osteotomy
Vertical subsigmoid osteotomy
Body osteotomy
Genioplasty

46
Q

What are the early complications of orthognathic surgery?

A

Bruising
Swelling
Pain
Feeding
Infection

47
Q

What are the intermediate complications of orthognathic surgery?

A

Numbness of lips palate and tongue (100%)

48
Q

What are the late complications of orthognathic surgery?

A

Prolonged numbness (5%)
Relapse (partial/total)
Infected screw/plate (12%)
Speech/TMD problems

Module 7 (8 decks)

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