Oncology Flashcards
What are primary and secondary tumours?
• Primary tumour: The original site where cancer starts.
• Secondary tumour/metastasis: Cancer that has spread to another part of the body.
Name the main cancer treatments.
- Chemotherapy – Uses drugs to kill cancer cells.
- Radiation Therapy – Uses high-energy rays to destroy cancer cells.
- Surgery – Removes cancerous tissue.
- Immunotherapy – Enhances the body’s immune system to attack cancer.
- Hormone Therapy – Blocks hormones that fuel cancer growth.
- Targeted Therapy – Attacks cancer-specific molecules (e.g., monoclonal antibodies).
- Stem Cell Transplant – Replaces blood-forming cells destroyed by chemotherapy/radiation.
How does radiation therapy work?
It damages cancer cell DNA, preventing them from dividing. Cells die over days or weeks, and the body removes them.
Why is a pre-treatment dental assessment crucial?
• Prevents oral infections that could interrupt cancer treatment.
• Reduces the severity of oral side effects.
• Allows dental treatment and healing before cancer therapy starts.
Why is interdisciplinary collaboration important in oncology patients?
It ensures that dental, medical, and oncology teams coordinate to prevent complications
What should a pre-treatment dental assessment include?
• Full oral exam and radiographs.
• Identification and removal of infection sources.
• Dental restorations for teeth at risk.
• Periodontal debridement to reduce inflammation.
• Patient education on oral hygiene.
List the major oral complications of cancer treatment
8
- Oral mucositis – Painful ulcers from chemotherapy/radiation.
- Xerostomia – Dry mouth from salivary gland damage.
- Caries risk – Increased due to lack of saliva and dietary changes.
- Periodontal disease – Can worsen with immunosuppression.
- Candidiasis – Fungal infections due to immunosuppression.
- Herpes reactivation – Viral infections due to weakened immunity.
- Osteoradionecrosis (ORN) – Bone death after radiation.
- Trismus – Fibrosis of jaw muscles, leading to limited mouth opening.
What should a pre-treatment dental assessment include?
• Full oral exam and radiographs.
• Identification and removal of infection sources.
• Dental restorations for teeth at risk.
• Periodontal debridement to reduce inflammation.
• Patient education on oral hygiene.
How does chemotherapy affect blood counts?
It lowers white blood cells (neutropenia), red blood cells (anaemia), and platelets (thrombocytopenia), increasing infection, fatigue, and bleeding risks.
Why is radiation-induced xerostomia problematic?
• Saliva production drops 50–60% in 1st week, worsening over time.
• Consequences: Increased caries risk, periodontal disease, oral discomfort, and difficulty eating/speaking.
How is xerostomia managed?
• Saliva substitutes and stimulants (pilocarpine, sugar-free gum).
• Frequent hydration.
• High-fluoride toothpaste and fluoride varnish to prevent caries.
• Avoid acidic and dry foods.
What is MRONJ?
Necrosis of jawbone due to bisphosphonates, denosumab, or antiangiogenic drugs.
What are the MRONJ stages?
• Stage 0: No exposed bone, but symptoms like pain and sinus inflammation.
• Stage 1: Exposed bone, no symptoms.
• Stage 2: Exposed bone with pain and infection.
• Stage 3: Exposed bone, pathologic fractures, extraoral fistulae, or osteolysis.
What are the dental considerations for MRONJ?
• Avoid extractions unless necessary.
• If needed, stop bisphosphonates and use antibiotics + minimal trauma extraction.
• Prevention: Good oral hygiene, regular check-ups, fluoride use.
What are the common sites of oral cancer?
- Lateral tongue
- Floor of the mouth
- Buccal mucosa
- Oropharynx
- Alveolar mucosa
What are the risk factors for oral cancer?
• Smoking and alcohol (synergistic effect).
• HPV infection (oropharyngeal cancer).
• Poor oral hygiene.
• Betel nut chewing.
• Sun exposure (lip cancer).
How is oral cancer detected while examining
- Extraoral exam: Palpation of lymph nodes, thyroid gland.
- Intraoral exam: Induration, non-healing ulcers, erythroplakia, leukoplakia.
What is the classic appearance of oral squamous cell carcinoma (SCC)?
• Deep ulcer with rolled margins on the lateral tongue.
• Firm indurated base (malignant sign).
• Painless until advanced stage.
How is oral cancer managed?
• Biopsy and histopathology for diagnosis.
• Surgery for resectable tumours.
• Radiotherapy/chemotherapy for advanced cases.
• Dental role: Pre-treatment assessment, mucositis management, fluoride therapy, prosthetic rehabilitation.
What should be monitored post-treatment?
• Recurrence/metastases.
• Xerostomia and caries prevention.
• Mucosal integrity and infections.
• Osteoradionecrosis prevention.
• Trismus management (jaw exercises).
How does radiotherapy affect dental implants?
• Success rates decrease in irradiated bone.
• Avoid placing implants in high-dose radiation fields.
• Hyperbaric oxygen therapy (HBO) may improve healing.
Why is close dental follow-up important?
• Prevention of complications.
• Improving quality of life.
• Long-term monitoring of recurrence.
What is the ideal time for a dental assessment before cancer treatment?
One month before treatment to allow for healing
What is oral mucositis, and how is it managed?
- Inflammation and ulceration of oral mucosa due to cancer therapy. (release of free radicals)
- Prevention: Good oral hygiene, laser therapy, honey, cryotherapy.
- Treatment: Morphine, chlorhexidine, Benzydamine HCL (difflam), saline rinses.
