Oncology Flashcards

Question

Oral side effects of chemotherapy

Answer 1

-Infections and bleeding due to PANCYTOPENIA – red/white cells & platelets REDUCED -Ulcers and mucositis -Lip cracking -Xerostomia -Delayed/abnormal development in child/ pregnant woman -Candida, herpetic infection -Inability to perform OH

Answer 2

-Stabalise oral health before radiotherapy due to increased risk of infection and osteoradionecrosis. Extract any teeth prior to tx. Prevention -Use sponges or gauze soaked in CHX if cannot brush -Difflam mouthwash (aqueous) -Advise analgesics, oral cooling methods, suck ice, lidocaine lollypops -mucosal lubrication (olive oil around teeth) -Saliva stimulants, gum -Toothpaste prescription, OHI -Avoid hard bristle brush, strong flavoured toothpaste, spicy food -Jaw exercises -For ulcers-topical folic acid -Manage increased risk of infection (candida, viral) and bleeding -Nystatin 100,000 per ml 4x daily for at least 7 days and 2 days after ressolution. Miconazole is another option -Follow-up (xerostomia can be long term, and FBC abnormal months-years after chemo)

Answer 3

-Widespread inflammed erythema with erosions and ulcers on mucosa. Soreness, bleeding, painful. Due to xerostomia, chemo, radiotherapy -WHO Mucositis Scale 1. Soreness / Erythema 2. Erythema & Ulcers / Able to eat solids 3. Ulcers / Requires liquid diet 4. Oral intake not possible = HOSPITALISED. Need tube feeding

Answer 4

Send to OMFS or ENT Urgent 2 weeks if a suspected cancer: -persistent unexplained hoarseness if > 45 years old -unexplained neck lump -unexplained ulceration in the oral cavity lasting > 3 weeks. -a lump on the lip or oral cavity -has a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia -Refer to OMFS

Answer 5

-Excise entire primary neoplastic lesion with a CLEAR MARGIN around 1cm (cut around normal tissue) -Remove margin of adjacent normal tissue in anticipation of microscopic spread (selective neck dissection to remove draining lymph nodes) -Remove potential channels of metastasis e.g. lymphatics, nerves -Promote rapid healing and rapid restoration of function (primary closure/ reconstruction, rehabilitation, psychological and social)

Answer 6

FNA=thin needle to collect cells from fluid filled mass. Quick and easy eg. for cysts -it won't pick up cancerous cells on the wall of a cyst -Core= gets tissue using needle. Helpful for viral investigation (HPV, EBV) Common for breast tissue

Answer 7

-Curative – aim is to cure you of disease -Palliative = in elderly patients or extensive disease, less extensive treatment, aim to prolong life, decrease symptoms, reduce burden of disease, not curing them, giving patients a dignified death -Consider age, life expectancy, general health, medical facilities available, patient's wishes, compliance -Type, site, extent of cancer (stage), prognosis -Evidence -Palliation can be months to years

Answer 8

-kills cells with high cell turnover -Metastatic disease can only be cured by systemic treatment as Surgery alone cannot cure widespread disease -inhibits cell proliferation and tumor multiplication, thus avoiding invasion and metastasis. But toxic effects as also affects normal cells. -Also a DXT adjunct as increases effectiveness of radiotherapy -Oral, IM, intrathecal but IV most common

Answer 9

-LOCAL TOXICITY – tissue destruction if accidentally injected out of vessel -BONE MARROW TOXICITY – reduced blood cells (Pancytopenia) = increased bleeding, infection -GI TOXICITY – nausea and vomiting -Hair loss after 18-21 days -Long-term toxicity: Carcinogenesis = long-term alkylating agents can lead to ACUTE LEUKAEMIA -Gonadal damage = infertility

Answer 10

-normal value is 150-400 x109 per litre -absolute cut off for dental treatment is <50 -Best if >100 in primary care for extra caution

Answer 11

nivolumab and pemobrolizumab Help the immune system attack cancer cells but limited use in SCC of head and neck

Answer 12

-curative or palliative tx -Induction, Neoadjuvant or adjuvant tx -destroys cancer cells with localised high doses of high energy radiation. -Targets DNA cells, Displaces an electron from its orbital path, creates an unstable ion, causes cell death if double strand break -External beam or internal methods

Answer 13

-Specific radiation to tumour tissue, Less collateral damage, Higher doses possible -Radioactive iodine (131I) used for thyroid carcinoma -Injectable radioactive phosphorus (32P) for bone marrow cancer -Brachytherapy seeds planted in prostate

Answer 14

-Sievert considers biological quality/ radiosensitivity of the tissue unlike the Gray -Gy= radiation-absorbed dose -Sv= dose equivalent. Equal to Gray times a quality factor. Takes into consideration the biological effectiveness of the radiation. Different for different tissues

Answer 15

-High=bone marrow, gonad, gut mucosa, lymphatic tissue, eye lens -Medium=liver, kidney, lung, skin, breast, gut wall, oral nervous tissue -Low=Bone, connective tissue, muscle

Answer 16

-Acute= radiation sickness, death, skin erythema -Chronic= tiredness, nausea, lost appetite, hair loss, cataracts, infertility, obliterative endarteritis (causing decreased blood supply, poor healing, necrosis), damage to foetus, radiation-induced malignancy

Answer 17

-0.0002 Gy for a PA >50Gy death in a few hours 5-10Gy death within a week

Answer 18

5 days for 6 weeks days off require tissues to heal max 60-70 Gy over this period -started within 6 weeks of surgery. Need to wait for swelling to reduce. Close fitting mask if made to ensure that the patient is reproducibly positioned in the beams

Answer 19

-Ressection= incising the primary tumour with scalpel or laser, with clear margins -Neck dissection= remove diseased lymph nodes and potentially invading structures -Reconstructive= restoring function and form with primary closure, grafts, flaps (eg. radial forearm flap), free tissue transfer

Answer 20

good blood supply, high cell turnover, saliva

Answer 21

-Buccal fat pad -Tongue flap – U shaped flap on dorsum of tongue and stitch onto palatal defect -Pharyngeal wall -Skin graft from different sites -Nasolabial flap -Complex skin flap -Regional cutaneous flap -Microvascular tissue transfer (eg.radial forearm free flap) -Mycocutaneous pedicles flaps

Answer 22

Infective - soft lumps

Answer 23

-TB, syphylis=bilateral -Lymphoma=unilateral, single lump -Developmental =unilateral -Bacterial sialdenitis= unilateral -Mumps= bilateral -Sialosis (swelling of saliva gland)= bilateral -Pleomorphic adenoma= unilateral -Warthin's tumour= bilateral

Answer 24

-History -Examine neck lump -Examine oral cavity and head and neck region -Referral to OMFS or ENT -Primary site biopsy -Neck lump biopsy =FNA or core biopsy -Imaging: MRI, CT, PET-CT, chest x-ray -MDT meeting for treatment plan -Pre-op assessment, anaesthetic review -Surgery/ radiotherapy -Follow-up

Answer 25

-OMFS + ENT surgeons -Head and neck radiologists (diagnose scans), pathologists (diagnoses under microscope), oncologists (radiotherapy, chemo) -dietician, clinical nurse specialist (gives info, supports), Speech and language therapist (communication and swallowing problems), MacMillan cancer nurse -sometimes dental team -Multidisciplinary approach for managing head and neck cancer. Meet up every week

Answer 26

-age, race, genetic (BRCA1 or 2 mutation), ovarian cancer history, oestrogen exposure (pill, HRT), obesity, alcohol -Types: Ductal or Lobular Carcinoma (either in situ or invasive), Inflammatory -new lumps, thickening in breast under the arm, nipple tenderness, discharge, physical change, skin irritation or changes, warm/red/swollen breast. Sometimes asymptomatic -Mammography, US, MRI, FNA cytology or core biopsy, blood test -Masectomy, excision, radiotherapy, chemo, hormone therapy, targeted therapy, BISPHOPSHONATES

Answer 27

-smoking, former smoking, passive smoking, pollution, asbestos, occupational exposures -Adenocarcinoma, SCC, small cell, large cell -persistent cough getting worse, haemoptysis, chest pain, SOB, wheezing, hoarseness, respiratory infections -CT scan, bronchosoppy, biopsy

Answer 28

-Behavioural = Very Brief Advice, full social support, Hypnotherapy, acupuncture, let family and friends know etc. -Pharmacological  “as part of an abstinence contingent treatment”  Nicotine replacement therapy (patches, sprays)  Varenicline (Champix) o Unlicensed (anxiolytics, antidepressants etc.)

Answer 29

1=not spread 2=small +/- spread to lymph nodes within tissue 3=spread to lymph nodes outside tissue 4=spread to distant sites - metastatic

Answer 30

-Kidney -Ureter -Bladder -Prostate -Testicular -blood in urine (haematuria), urgency to pee, poor stream of pee, weak pee

Answer 31

-age, family history, obesity, race -adenocarcinoma most common, transitional, SCC, small cell -surgery, radiation, brachytherapy (internal radiotherapy), cryotherapy, hormone therapy, chemo

Answer 32

prostate cancer (1 in 6 will get it in their lifetime)

Answer 33

-male, age, smoking, obesity, on dialysis, genetics, family history, hypertension, thyroid cancer -Surgery, cryotherapy, immunotherapy. Don't respond well to chemo and radiotherapy so less common

Answer 34

malignant nephroblastoma in kidney, occurring in children (peak 2 years) spreads to lymph nodes and via the renal vein to the lungs

Answer 35

-Anti-resorptive. Promote osteoclast apoptosis -Osteoporosis, Paget's disease -used in breast cancer to reduce risk of spreading to bone -prevent osteoporosis in patients taking hormone therapy -treat hypercalcamia (high level of Ca in blood)

Answer 36

cancer in skin or mucous membranes of GI tract -Common in advanced immunosupression -HHV8, HIV -Oral: Red/ purple macule that progress to plaques or nodules which may ulcerate. common on palate

Answer 37

-treating misaligned jaws -removing oral, head and neck cancer, cysts -reconstructive surgery -implants -removing impacted teeth -treating TMD, cleft lip and palate, facial trauma

Answer 38

-Suspected Cancer Pathway Referral- NICE (2015) - 2-week urgent referral for a suspected melanoma (ABCDE, weighted Glasgow 7 point checklist) or SCC -BCCs usually require routine referral as it is deemed low-risk. Only consider 2-week urgent referral if there is a particular concern that a delay may have a significant impact (due to its site or size etc.) -Refer to secondary care- eg. OMFS department

Answer 39

Gorlin Goltz syndrome Also fontal bossing, bifid/fused ribs

Answer 40

-biopsy of the node that the cancer would spread to first to assess if cancer has spread and assess the stage -inject dye into cancer then CT scan to locate the sentinel nodes -Node can be removed, compared to a full neck dissection which is. much more invasive

Answer 41

-28 day faster diagnosis standard - diagnosis within 28 days of being referred by GP -Used to be the 2 week wait referral pathway - NICE -Refer to OMFS (not oral surgery or Oral medicine)

Answer 42

cells look the same. -Dysplasia= above the basement membrane -Cancer =below membrane as invaded into tissues

Answer 43

TB ulcer, traumatic ulcer, leishmaniosis, follicular bullous etc.