Module 16 Exam 3 Flashcards
What is benin
not malignant
what is malignant
tending to become progressively worse, and to result in death, having the properites of anaplasia, invasiveness, and metastasis, said of tumors
what does cancer refer to
- group of neoplastic diseases in which there is transformation of normal cells into malignant ones
- as cancer cells proliferate, the mass of abnormal tissue that is formed enlarges until it takes over the host site then it metastasizes
how are cancers classified
- origin of the tissue involved: carcinoma (epithelial tissue), sarcomas (conn. tissue))
- type of cell from which they arise
what are characteristics of benin neoplasms
- resemble normal cells
- tumor grows by expansion and doesnt infiltrate
- slow
- doesnt metastasize
- doesnt recurr
- localized
- doesnt usually cause tissue damage
- doesnt usually cause death
what are characteristics of a malignant neoplasm
- bears little resemblance to normal cells
- tumor grows at the periphery and sends out processes that inflitrate
- rapid growth
- gains access to blood and lymph
- recurs when removed
- generalized effects
- extensive tissue damabe
- usually causes death unless controlled
what are risk factors for cancer
tobacco, alcohol, sunlight, environmental/occupational, viruses (epstein barr- burketts lymphoma, Hep C liver cancer, HPV) socioeconomic
what are the most common types of cancer in men
prostate, lung and bronchus, colon and rectum
what are the most common types of cancer in women
-breast, lung and bronchus, colon and rectum
what is chemotherapy
involves the use of drugs that affect the rapidly dividing cancer cell at different points in the cell cycle
what are the objectives of chemotherapy
- destroy cancer cells, prevent metastasizing
- prevent cancer from recurring
- provide and improved quality of life
what are indications of chemotherapy
- eliminate tumor too large for surgery
- treat cancer that has metastasized
- prevent from reoccurence
- make tumor easier to surgically remove
- extend life
what are the types of agents used for chemotherapy
-alkylating agents, antibiotics, antimetabolites, plant alkaloids, steroids/hormones
what are the side effects of chemotherapy
-alopecia
-mylosupression
-immunosuppression
-nausea, vomiting, diarhha
loss of apetite
GI mucositis
what are the oral complications of chemotherapy
- oral mucositis/stomatitis
- xeriostomia
- infections:bacterial, viral (herpes simplex, vaicella zoster, cytomegalovirus), fungal (candida albicans)
- bleeding
- neurotoxicity (mimics T.A)
what is radiation?
uses ionizing radiation to treat cancer, impacts the cancer cells ability to replicate and survive, cant be used on all tumors,
what are indications for radiation
- treat a small localized tumor
- shrink a large tumor
- assist chemo
- prevent spread of cancer
- prevent recurrence of cancer
- provide symptom/pain relief
what are the two types of radiation
external beam and internal
what is external beam radiation
-applied outside the body
what is internal radiation
-source of the radiation is placed within the body, less radiation is delivered to the surrounding tissues
what does the dose of radiation depend on?
type of tumor, tx goals, ablity to tolerate
what is the approximate dose of radiation given
3,000 to 7,000 centigreys, divided into equal doses per day
what are the systemic effects of radiation
- skin reactions- looks like a bad sunburn
- fatigue
- nausea, vomitting, diarhhea, constipation
what are the oral complications of radiation
- mucositis/stomatitis
- xerostomia
- taste loss
- radiation caries
- infection
- trismus
- osteoradionecrosis
what is a hematopoietic cell transplantation
- used to treat a varitety of blood diseases, including leukemia
- purpose is to substitute blood stem cells or bone marrow from a healthy, compatible donor to replace the dieseased bone marrow of the patient
what are 3 types of transplants
- autolgous- self
- allogenic- matched donor
- syngenic- identical twin
what are the indications for a transplant
-patient not responsive to chemo alone, relapse occurs after one or more remission
what is evaluated for a transplant
medical and dental assessments to ensure patient is free of infection, and pysically able to undergo
where is the bone marrow aspiriated from
iliac crest, ribs, or sternum
how is the patient prepared to recieve a bone marrow graft
- high dose immunosupressive regiment, chemo or total body radiation
- to kill malignant cells
how long does it take for the new marrow to function after a transplant
10 to 20 days
what is the immune recovery from a transplant? long term?
3 to 12 months, 1-3 years
what is acute graft vs host disease
-t lymphocytes see the host cell antigens as foreign and react against the host tissue
what are symptoms of host vs graft disease
- during first 100 days
- painful red skin rash
- severe persistent diarhhea
- jaundice
what are oral complications of acute graft vs host disease
oral mucositis: 10-14 days post transplant
xerostomia
viral and fungal infections
what is chronic graft vs host disease
-affects all organs of the body, can appear up to 2 years post transplant
what are oral complications of chronic graft vs host disease
-oral mucosits
-oral infection, perio infection
-xeriostomia
poor OH
what are the objectives of oral health and cancer
- asses for any infection
- eliminate sources of infection
- instruct pt in preventive oral care measures
what should you do with a patient who is going to recieve radiaion
- monitor personal daily care
- once daily fl2 gel
- monitor for trismus
- instruct pt to exercise opening and closing mouth 3 times per day
what should you do in tx after radiation therapy
- first 6 mo, non surgical perio therapy
- reinforce personal OH
- after mucositis subsides, talk to MD about when to make dentures
- watch for trismus, demineralization, caries
- advise against oral surgery on irradiatied bone
what does the extent of oral complications of chemotherapy depend on
- degree of infection present
- drugs used and their dosages
- concurrent radiation therapy
- pts personal OH
During chemotherapy before invasive work is completed what does the platelet and neutrophil count need to bw
- platelet more than 50,000 mm3
- neutrophil more than 1,000 mm3
should you premed if completing work during chem
yes
what should you watch for after the hematopoietic cell transplantation
- watch for oral infections
- monitor oral health
- delay elective dental procedures for 1 year
- follow for long term complication
- follow for second malignancies in oral region
how soon should oral surgery procedures be completed in a patient who is going to undergo cancer therapy
at least 2 weeks prior
what should you instruct your pt about daily biofilm removal
-gently brush with an extrasoft tb every meal and at bedtime, floss gently
what should you instruct your pt about mouthrinsing
- every 2 to 3 hours while awake with baking soda and water
- avoid alcohol containing mouthrinses
what should you instruct your patient about xerostomia
- sip on water
- suck on ice chips
- saliva substitute
- avoid lemon glycerine swabs
- avoid hot spicy salty or sharp food
- moisten food
what should you instruct your pt about oral pain managment
-swish gargle and spit a capful of prescribed mouthrinse containing topical anesthetic 30 min before eating
