Oncology Flashcards

1
Q

What is the role of GDP in head and neck cancer?

A
  • Early detection through soft tissue examinations
  • Photographs
  • Onward referral
  • Pre-treatment assessment
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2
Q

What instances should you refer for suspected head and neck cancer?

A
  • Stridor (Emergency referral)
  • Persistent unexplained head and neck lumps >3weeks
  • Ulceration or unexplained swelling of oral mucosa >3weeks
  • Red or mixed red and white patches of oral mucosa persisting >3weeks
  • Persistent hoarseness lasting >3weeks
  • Dysphagia of odynophagia >3weeks
  • Persistent pain in throat >3weeks
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3
Q

What is the aim of multidisciplinary team?

A
  • Provide collaborative, multi-professional environment facilitating effective care
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4
Q

How is included in multidisciplinary team?

A
  • Oncologist
  • Radiologist
  • Surgeon ENT, OMFs, Plastics
  • Clinical nurse specialist
  • SALT
  • Dietician
  • Dentist
  • Physio
  • OT
  • Psychologist
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5
Q

What are the aims of pre-treatment assessment before a pt begins cancer treatment?

A
  • Aim to get as dentally fit as feasible within the time range
  • Identify any oral disease and potential risks of disease
  • Remove infection and potential infection before start of cancer therapy
  • Establish good oral hygiene to meet increasing challenges during cancer therapy
  • Develop plan to maintain oral hygiene, Provide preventative care, complete oral rehabilitation and follow up
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6
Q

What are some things you can do in the pre-treatment assessment?

A
  • Detailed OHI inc TBI and interdental cleaning
  • Fluoride i.e. topical application, mouthwash 0.05% alcohol free, fluoride toothpaste
  • GC tooth mouse free of calcium
  • PMPR to stabilise periodontal condition
  • Consider chlorhexidine 0.2% mouthwash 10ml rinsed round mouth for 1 min that spat out twice daily (leave for 30 mins before brushing)
  • Definitively restore carious teeth
  • Removal of trauma like adjust sharp edges on teeth/dentures
  • Impressions to construct fluoride trays, soft splints
  • Denture hygiene and instruction to avoid wear during cancer treatment
  • XLA teeth with poor prognosis no less that 10 days before starting cancer txt
  • Antibiotic prophylaxis is neutrophils below 1
  • Smoking and alcohol advice
  • Restorative study casts for implant planning, pre treatment records and planning for trismus
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7
Q

What is a surgical tumour resection side effect?

A
  • Alter normal anatomy which may affect function and outward appearance
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8
Q

What are some side effects of radiotherapy?

A
  • Radiation damage to normal tisssues surrounding tumour
  • Affects function of these tissues short and long term
  • Adverse affects on respiration, mastication, swallowing, speech, taste, salivary gland function, mouth opening and appearance of head and neck
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9
Q

What is a side effect of chemotherapy?

A
  • Acute mucosal and haematological toxicity
  • Results in coagulation defects and anaemia
  • Reduction in white cells (impaired immune status)
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10
Q

What is oral mucositis?

A
  • Inflammation of the oral tissues
  • Side effect of chemotherapy
  • Severe pain and may inhibit oral hygienic measure
  • Severe impact of eating
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11
Q

When does oral mucositis occur?

A
  • Begins 1-2 weeks after txt starts
  • lasts until 6weeks after txt complete
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12
Q

What is the prevention and management of oral mucositis?

A
  • Neutral supersaturated calcium phosphate mouth rinse (Caphosol)
  • Mucoadhesive oral rinse ( Mugard)
  • Soluble aspirin
  • Manuka honey
  • Morphine and opioids needed as analgesics
  • 2% lidocaine mouthwash prior to eating
  • Intense oral hygiene
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13
Q

What is the WHO oral mucositis grading scale?

A

0 = none
I = Mild = Oral soreness and erythema
II = Moderate = Oral erythema, ulcers, solid diet tolerated
III = Severe = Oral ulcers, liquid diet only
IV = Life threatening = Oral alimentation imposssible

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14
Q

What antifungals can help prevent candida infections?

A
  • Chlorhexidine mouthwash, gel
  • Miconazole - topical
  • Fluconazole - systemic
  • Nystatin (not ass effective)
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15
Q

What are some dental issues during cancer treatment?

A
  • Oral mucositis
  • Xerostomia
  • Traumatic ulceration
  • Candida infection
  • Reactivation of herpes simplex
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16
Q

What are some dental issues following cancer treatment?

A
  • Xerostomia
  • Trismus
  • Dental erosion
  • Caries
  • Radiation induced caries
  • Periodontal disease
  • ORN
  • Infected ORN
17
Q

What are some dental issues following cancer treatment?

A
  • Xerostomia
  • Trismus
  • Dental erosion
  • Caries
  • Radiation induced caries
  • Periodontal disease
  • ORN
  • Infected ORN
18
Q

What are some xerostomia affects?

A
  • Harder to chew, swallow (dysphagia), speech (dysarthria), taste (dysgeusia) and quality of life
  • Higher risk of caries, periodontal disease, candida, sialadenitis, prosthodontic difficulties
19
Q

How is xerostomia caused by cancer treatment?

A
  • By ionising radiation damage to salivary tissue in radiotherapy fields
20
Q

What are some treatments for Xerostomia?

A
  • Petroleum jelly useful for lips and soft tissues
  • Sugar free chewing gum and regular sips of water
  • Saliva replacements like Saliva orthana or biotene or BioXtra
21
Q

What is trismus?

A
  • Restricted or limited mouth opening
22
Q

What are the causes of trismus?

A
  • Post-surgical inflammation
  • Fibrosis of tissues as result of chemotherapy and radiotherapy
23
Q

What is the treatment of Trismus?

A
  • Physical therapy modalities like passive and active stretching exercises and Therabite to stretch MOM
24
Q

What are radiation induced caries?

A
  • Indirect effect of non-surgical treatment of chemo/radiotherapy
  • Widespread caries often circumferentially around teeth and incisal edges
  • Hard to restore
25
Q

What is ORN?

A
  • Area of exposed bone of at least 3 months duration in an irradiated site and not due to tumour recurrence
26
Q

Should you give a cancer pt antibiotic prophylaxis to decrease risk of ORN?

A
  • Recommend antibiotic prophylaxis and continued antibiotics until completion of healing
  • Coamoxiclav/ amoxicillin
  • Metronidazole if allergic to penicillins
27
Q

When are pt at particular risk of developing ORN?

A
  • Total radiation dose exceeded 60Gy
  • Dose fraction was large with high number of fractions
  • Local trauma as result of tooth XLA, uncontrolled PD disease and ill fitting prothesis
  • Person is immunodeficient
  • Person is malnourished
28
Q

What is Stage 0 of ORN?

A
  • Mucosal defects only, bone exposed
29
Q

What is stage 1 of ORN?

A
  • Radiological evidence of necrotic bone, dento-alveolar only
30
Q

What is stage II of ORN?

A
  • Positive radiographic findings above ID canal with denuded bone IO
31
Q

What is stage III of ORN?

A
  • Clinically exposed radionecrotic bone
  • Verified with imaging techniques
  • Skin fistulas and infection
  • Radiological evidence of bone necrosis within radiation field where tumour has been excluded
32
Q

When are implants more likely to succeed after radiotherapy?

A
  • Failure less likely with radiation dose lower than 45Gy