Malignant haematology Flashcards
have a basic understanding of leukaemia, lymphoma, myeloma and be able to identify features of blood cancer and oral implications of cancer management
what is leukaemia?
a group of blood cancers from myeloid and lymphoid lineage
what does leukaemia cause in the body?
4
loss of bone marrow function due to the production of abnormal white blood cells
* RBC deficiency (anaemia)
* WBC deficiency (impaired immunity)
* platelet deficiency (easy bleeding)
what are the subtypes of leukaemia and describe them
acute lymphoblastic - often in kids
acute myeloid - in adults
chronic lymphocytic - older adults, slow proliferation
chronic myeloid leukaemia - philadelphia chromosome
acute is more dangerous as faster onset and affects younger people
what are the clinical features of leukaemia?
7
fatigue
fever
weight loss
easy bruising
easy bleeding
abnormal infections
lymphadectomy
how is leukaemia diagnosed?
3
blood tests - FBC, RBC, WBC, platelets
bone marrow biopsy
scans
how do you manage leukaemia?
3
chemotherapy
targerted therapies (monoclonal antibodies)
bone marrow transplant
what is chemotherapy?
medication (usually IV) used to kill cancer cells or slow/halt their growth
what kinds of cells does chemoherapy target?
3
oral mucosa cells
gut mucosa cells
hair cells
what are the general side effects of chemotherapy?
8
hair loss
nausea, vomiting, diarrhoea
infertility
bone marrow suppression
cardiac toxicity
oral mucositis
immunosuppression
depression/anxiety
what is lymphoma?
1
cancer affecting the white blood cells in the lymphatic system
what is the classical presenting symptom of lymphoma?
swollen lymphnodes
what are the two types of lymphoma?
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
what are the B symptoms of lymphoma?
3
fever
night sweats
weight loss
what are general symptoms of lymphoma?
6
fatigue
itching
cough
shortness of breath
abdominal pain
recurrent infections
how is lymphoma diagnosed?
2
lymph node biopsy
PET scan - shows cells with fast turn over
what are the key histological cell type in Hodgkin’s lymphoma?
Reed-Sternberg (owl eyes)
how do you manage lymphoma?
4
chemotherapy
radiotherapy
targeted therapy - monoclonal antibodies
stem cell transplant
what is staging and how is lymphoma staged?
1,4
staging determines the size and spread of cancer
stage 1 - one lymph node affected
stage 2 - more than one affected on one side of diaphragm
stage 3 - more than one affected on both sides of diaphragm
stage 4 - organ/s have been affected
what is a myeloma?
2
cancer that affects the plasma cells (make antibodies)
results in overproduction of paraprotein which deposits in organs/tissues and causes impairment
how do you diagnose myeloma?
Bence-Jones protein is present in urine
what are the key features of myeloma?
4
Calcium increased - bone becomes soft and Ca enters blood
Renal impairment
Anaemia
Bone lesions - pathological fractures
what does myeloma present as?
8
unexplained fever
weightloss
fatigue
anaemia
renal impairment
bone pain
pathological fractures
rarely presents in mout
how do you manage myeloma?
4
no cure
disease control
* chemotherapy
* stem cell transplant
* bisphosphonates (bone related diseases)
what are the dental manifestations of haematological malignancy?
easy bleeding
* petechiae (bruising)
* haemorrhage
* spopntaneous bleeding
low immunity
* candidosis
* herpes simplex virus
anaemia
* pallor
gingival swelling
what are the oral side effects of chemotherapy?
4
oral mucositis
dry mouth (xerostomia) - caries, dysphagia
infection - fungal, viral
easy bleeding - thrombocytopenia
what are the oral side effects of radiotherapy?
3
dry mouth (xerostomia)
osteoradionecrosis of jaw
fibrosis = trismus (restricted jaw movement)
what are the side effects of the adjuncts used to treat cancer?
2
bisphosphonates - MRONJ (medication related ostenecrosis of the jaw)
bone marrow transplant - significant immunosuppression
how can you optimise dental health prior to chemo/radiotherapy?
7
remove teeth/caries 10 days before
oral hygiene instruction
dietary advice
fluoride toothpaste/varnish
mouthguard so teeth dont irritate inflammed mucosa
remove traumatic edges
prepare pt for unexpected side effects
how can you optimise dental health during chemo/radiotherapy?
hygienist support
maintenance of oral hygiene
ongoing caries prevention
assess and manage mucositis
provision of saliva substitutes
avoid elective dental treatment e.g. veneers, whitening
