Oncology - Epidemiology, Screening, Prognosis, Oral side effects of Cancer

Question 1

In which tissues do cancers originate?

Glandular =

Squamous apithelium =

Lymphoid tissue =

Connective tissue =

Answer 1

• all body tissues
• the tissues with the highest turnover rate are more commonly affected

Glandular = adenocarcinoma

Squamous apithelium = squamous cell carcinoma

Lymphoid tissue = lymphoma

Connective tissue = sarcoma

Question 2

What is the most common cancer in females?

Males?

Are head and neck tumours more common in males or females?

What are the 3 UK screening programmes for cancer?

Answer 2

Females - breast cancer

Males - prostate

Head and neck cancer most common in males

Screening programmes:

• Breast cancer - women aged 50-70: mamogram X-ray
• Cervical cancer - all females aged 25-64: speculum exam and cervical brush inserted to take sample
• Colorectal cancer - 50-74 males and females

QFIT - quantitative faecal immunochemical test - detects haemoglobin

Question 3

Prognosis depends upon which factors?

What is the standardised way of determining prognosis?

What cancer has the poorest prognosis in Scotland?

Answer 3

• depends on primary site
• grade and stage of cancer
• patient fitness for treatment

Standardised way of determining is 5 year survival

(%age of people with that cancer still alive after 5 years)

Poorer prognosis: pancreatic cancer, liver, brain, oesophageal, lung cancer

Question 4

How may cancer present to dentists?

Answer 4

• bone metastases may be present in facial bones and cause pain - prostate, breast, renal, lung, myeloma
• anaemia due to blood loss - present on oral exam
• bleeding and bruising - in haematological malignancy with low platelet count
• head and neck lymphadenopathy - in head and neck cancer, lymphoma, breast cancer, lung cancer

Question 5

List some oral side effects of chemotherapy:

Radiotherapy to head and neck:

Answer 5

Chemotherapy:

• mucositis
• oral ulceration
• lip cracking
• candidiasis or HSV due to immune suppression

Radiotherapy:

• misery for patients
• needs specialist support
• xerostomia, salivary gland damage, altered taste, chewing/eating difficulties, dysphagia, osteoradionecrosis of the jaw

Question 6

Medication Related OsteoNecrosis of the Jaw, why can this occur?

Which cancers commonly use bisphosphonates?

Answer 6

MRONJ:

• many cancer treatments use bisphosphonates
• frequent use of corticosteroids in advanced disease

Bisphosphonates most commonly used in:

• metastatic breast/prostate cancer
• myeloma
• pts with malignant hypercalcaemia

Question 7

What are some dental aspects of living with cancer/chemo treatment?

What is cancer cachexia?

Answer 7

• infection risk
• bleeding/bruising risk
• check with oncologist if safe to give dental treatment during chemo

Cancer cachexia:

• weight loss, muscle loss, fat loss, anorexia, fatigue
• inflammatory state caused by cancer

Poorly fitting dentures, worsens oral intake further

Question 8

List some symptoms of advanced disease:

Answer 8

• xerostomia from drug side effects
• candidiasis if frequent (steroids)
• altered taste
• fatigue, weakness and poor oral hygiene
• halitosis
• frequent use of corticosteroids and bisphosphonates - MRONJ risk!

Question 9

Dental aspects of treating patients with cancer:

Answer 9

• be kind, compassionate, involve family members too
• treat people how you would wish to be treated yourself
• look after yourself and your colleagues