Med Management Flashcards
Medical Management: Physical exam includes what types of evaluations?
- Medical, anesthetic, surgical assessment
- Lab Evaluation
- Electrocardiogram
- Pulmonary Function Test
Medical Management: When are electrocardiograms necessary?
For patients over 55 years old, with diabetes, HTN or other cardiac risk factors
Medical Management: When are pulmonary function tests indicated?
In those with preexisting pulmonary disease
Imaging Modalities: Describe when Panoramic Radiography is used
Usually for dental treatment planning prior to cancer therapy
Imaging Modalities: Describe what ultrasonography is used for
To assess nodal metastasis in the neck to guide the fine-needle aspiration biopsy.
Imaging Modalities: Describe when computed tomography is used
Asses extent of tumor, lymph node involvement
Imaging Modalities: Describe what magnetic resonance imaging (MRI) is used for
Soft tissue assessment, perineural spread, bone marrow invasion, non calcified-cartilage involvement
Imaging Modalities: Describe when positron emission tomography (PET) is used
To further assess the tumor extent and metastasis
Imaging Modalities: Describe what the combined PET/CT detects
Detection of head and neck cancer
Imaging Modalities: Describe what plain film chest x-rays screens for
Lung metastasis
The National Comprehensive Cancer Network Recommendations: What type of treatment is recommended for early stage tumors
Surgery
The National Comprehensive Cancer Network Recommendations: What type of treatment is recommended for advanced staged tumors
Surgery or definitive concurrent chemoradiotherapy
What does radiation therapy accomplish?
- Causes DNA damage in irradiated cells
How is radiation therapy formated?
Fractional formation
Daily treatments over several weeks
1.8 to 2.0 Gy per fraction
Total of 50-70 Gys
What are the three types of radiation therapy
Conventional
Intensity-modulated
3D conformal
When is chemotherapy recommended?
In high risk patients, when combined with radiation therapy (more helpful) vs radiation alone
Give two specific examples of when chemotherapy is recommended
Locally advanced head and neck cancer
Multiple positive lymph node involvement
What are three types of chemotherapy
Cisplatin
Cetuximab
Docetaxel
Which type of chemotherapy is the standard of care in high risk postoperative head and neck cancer?
Cisplatin
Describe how immunotherapy works
Immune checkpoint pathways
Programmed death receptor-1 (PD-1) and its ligand (PD-L1)
What are two examples of immunotherapy
Nivolumab
Pembrolizumab
What does Blocking PD-1 do?
Prevents the inhibition of T cell activity in the tumor -> allows for cytotoxicity of tumor cells
Describe how Brachytherapy works
Involves direct placement of radiation sources into the tumor
What are the advantages of brachytherapy?
Shortened treatment times, reduced dose of external beam radiation therapy
When is brachytherapy usually used?
After a recurrence
Describe how Proton Beam Therapy works
Delivers the radiation dose more precisely to the tumor , reducing dose to surrounding normal tissues
What are the advantages of Proton Beam Therapy?
Dose is delivered at the end of a linear track -> dose then falls quickly to zero after the peak -> limits the scatter dose to the surrounding tissue
Describe treatment time of proton beam therapy
15-30 min per day for five days per week for 4-7 weeks
