Oncology Flashcards
What is the role of GDP in head and neck cancer?
- Early detection through soft tissue examinations
- Photographs
- Onward referral
- Pre-treatment assessment
What instances should you refer for suspected head and neck cancer?
- 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
What is the aim of multidisciplinary team?
- Provide collaborative, multi-professional environment facilitating effective care
How is included in multidisciplinary team?
- Oncologist
- Radiologist
- Surgeon ENT, OMFs, Plastics
- Clinical nurse specialist
- SALT
- Dietician
- Dentist
- Physio
- OT
- Psychologist
What are the aims of pre-treatment assessment before a pt begins cancer treatment?
- 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
What are some things you can do in the pre-treatment assessment?
- 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
What is a surgical tumour resection side effect?
- Alter normal anatomy which may affect function and outward appearance
What are some side effects of radiotherapy?
- 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
What is a side effect of chemotherapy?
- Acute mucosal and haematological toxicity
- Results in coagulation defects and anaemia
- Reduction in white cells (impaired immune status)
What is oral mucositis?
- Inflammation of the oral tissues
- Side effect of chemotherapy
- Severe pain and may inhibit oral hygienic measure
- Severe impact of eating
When does oral mucositis occur?
- Begins 1-2 weeks after txt starts
- lasts until 6weeks after txt complete
What is the prevention and management of oral mucositis?
- 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
What is the WHO oral mucositis grading scale?
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
What antifungals can help prevent candida infections?
- Chlorhexidine mouthwash, gel
- Miconazole - topical
- Fluconazole - systemic
- Nystatin (not ass effective)
What are some dental issues during cancer treatment?
- Oral mucositis
- Xerostomia
- Traumatic ulceration
- Candida infection
- Reactivation of herpes simplex
What are some dental issues following cancer treatment?
- Xerostomia
- Trismus
- Dental erosion
- Caries
- Radiation induced caries
- Periodontal disease
- ORN
- Infected ORN
What are some dental issues following cancer treatment?
- Xerostomia
- Trismus
- Dental erosion
- Caries
- Radiation induced caries
- Periodontal disease
- ORN
- Infected ORN
What are some xerostomia affects?
- Harder to chew, swallow (dysphagia), speech (dysarthria), taste (dysgeusia) and quality of life
- Higher risk of caries, periodontal disease, candida, sialadenitis, prosthodontic difficulties
How is xerostomia caused by cancer treatment?
- By ionising radiation damage to salivary tissue in radiotherapy fields
What are some treatments for Xerostomia?
- 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
What is trismus?
- Restricted or limited mouth opening
What are the causes of trismus?
- Post-surgical inflammation
- Fibrosis of tissues as result of chemotherapy and radiotherapy
What is the treatment of Trismus?
- Physical therapy modalities like passive and active stretching exercises and Therabite to stretch MOM
What are radiation induced caries?
- Indirect effect of non-surgical treatment of chemo/radiotherapy
- Widespread caries often circumferentially around teeth and incisal edges
- Hard to restore
What is ORN?
- Area of exposed bone of at least 3 months duration in an irradiated site and not due to tumour recurrence
Should you give a cancer pt antibiotic prophylaxis to decrease risk of ORN?
- Recommend antibiotic prophylaxis and continued antibiotics until completion of healing
- Coamoxiclav/ amoxicillin
- Metronidazole if allergic to penicillins
When are pt at particular risk of developing ORN?
- 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
What is Stage 0 of ORN?
- Mucosal defects only, bone exposed
What is stage 1 of ORN?
- Radiological evidence of necrotic bone, dento-alveolar only
What is stage II of ORN?
- Positive radiographic findings above ID canal with denuded bone IO
What is stage III of ORN?
- 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
When are implants more likely to succeed after radiotherapy?
- Failure less likely with radiation dose lower than 45Gy
