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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
What is systemic anti-cancer therapy?
Conventional chemotherapy Drugs which target the immune system (monoclonal antibodies)
26
How does conventional chemotherpy work?
Inhibits cell division
27
What is cetuximab?
Monoclonal antibody Targets epidermal growth factor receptor (EGFR)
28
What are nivolumab + pembrolizumab?
Monoclonal antibodies Checkpoint inhibitors (PD-1) which upregulate the immune system to target cancer cells
29
What are the potential advantages of SACT?
Improved survival Improved local control Relief of symptoms
30
What are the potential disadvantages of SACT?
Increased toxicity May increase rate of treatment related deaths
31
When do we use SACT?
Squamous cancers Locally advanced disease Palliation of symptoms
32
What are the absolute indications for adjuvant chemo radiation?
Positive resection margins Extracapsular lymph node spread
33
What are the relative indications for adjuvant chemo radiation?
Oral cavity primary site Poor differentiation Close margins <5mm Advanced T stage Perineural invasion Lymphovascular invasion Nodes - consider size, number and levels involved
34
What are the side effects of cetuximab?
Fatigue Diarrhoea Rash Nausea/vomiting Hair/nail changes
35
What ate the common side effects of nivolumab/pembrolizumab?
Fatigue Diarrhoea Rash Nausea/vomiting
36
What are the indications for orthognathic surgery?
Skeletal class 2 and 3 Open bite, deep bite, VME Cross bites, asymmetries
37
What clinical and psychological factors indicate orthognathic surgery?
Function issues (eating, speech, TMD, sleep apnoea) Aesthetics Pain/discomfort
38
What factors are taken into account when case selecting for orthognathic surgery?
Psychological status Family support Dental health Cooperation
39
What happens to the skeletal patterns in unfavourable growth?
Class 2 improve Class 3 get worse
40
What is the tx process for orthognathic surgery?
Referral Assessment and diagnosis Joint clinic Pre-surgical ortho Orthognathic surgery Post-surgical ortho Retainers/review
41
What imaging would be used to see condylar hyperplasias?
Technetium 99 radioisotope scan
42
What % of orthognathic patients have psychological disorders?
20%
43
How is BMI calculated?
Weight/height squared
44
What teeth would be extracted pre ortho surgery for class 2 and 3 cases?
Class 2 - lower premolars Class 3 - upper premolars
45
What are the types of orthognathic surgery for the mandible?
Bilateral Sagitta split osteotomy Vertical subsigmoid osteotomy Body osteotomy Genioplasty
46
What are the early complications of orthognathic surgery?
Bruising Swelling Pain Feeding Infection
47
What are the intermediate complications of orthognathic surgery?
Numbness of lips palate and tongue (100%)
48
What are the late complications of orthognathic surgery?
Prolonged numbness (5%) Relapse (partial/total) Infected screw/plate (12%) Speech/TMD problems

Module 7 (8 decks)

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