Oral Cancer Flashcards
what would a patient present with that would be an emergency referral for oral cancer
stridor
what would a patient present with to need an urgent referral for oral cancer
persistent head and neck lumps for more than 3 weeks
unexplained ulceration or unexplained swelling of oral mucosa for more than 3 weeks
unexplained red or mixed red and white patches persisting more than 3 wees
persistent hoarseness lasting for more than 3 weeks
persistent pain in throat or pain on swallowing for more than 3 weeks
unexplained tooth mobility not associated with periodontal disease
what is the effect of both drinking and smoking in relation to oral cancer development called
synergistic effect
what tests are done to confirm cancer diagnosis and extent in OMFS
biopsy
CT scan
lymph node biopsy
stage and grade cancer
who is part of the MDT for cancer
oncologist
radiologist
OMF surgeon
dentist
dietician
how long should it take between referral from GDP for suspected oral cancer and patient starting their definitive treatment
28-31 days
what preventative treatment should be given to patients who have been given a diagnosis of oral cancer
OHI specific to them
fluoride topical application
dietary advice
PMPR to stabilise any perio disease
chlorhexidine mouthwash
restoration of carious teeth
removal of trauma
what treatment should be provided to make a patient dentally fit before starting cancer treatment
avoid denture wear during cancer treatment
XLA of teeth with dubious prognosis no less than 10 days before
antibiotic prophylaxis if neutrophils are low
discontinue orthodontic appliances
smoking and alcohol cessation
name the three options for oral cancer treatment
surgical resection with or without reconstruction
radiotherapy
chemotherapy
or combination of above
name some side effects from cancer treatment
alterations from normal anatomy from surgical resection
radiotherapy causes unavoidable radiation to normal tissues
chemotherapy causes acute mucosal toxicity
adverse effect on respiration, mastication, speech, swallowing
what is the role of the dentist while a patient is receiving cancer therapy
hygienist support
oral and denture hygiene
antibacterial mouthwash
diet advice
treat xerostomia
how is oral mucositis managed and prevented in patients receiving oral cancer therapy
calcium phosphate mouth rinse (Caphosol)
mucoadhesive oral rinse
benzydamine hydrochloride (difflam)
2% lidocaine mouthwash used prior to eating
how is oral mucositis scored
out of 1, 2 or 3
what aspects are considered when assessing oral mucositis
voice
swallowing
lips
tongue
saliva
mucous membranes
what dental issues can occur during Cancer treatment
oral mucositis
candidal infections
traumatic ulceration
reactivation of herpes simplex
xerostomia
trismus
erosion
caries and periodontal disease
ORN
how are candidal infections during cancer treatment treated
chlorhexidine mouthwash
miconazole
fluconazole
nystatin
how is saliva affected during Cancer treatment
saliva consistency and character
it becomes more viscous and acidic
why does xerostomia occur in patients receiving cancer treatment
ionising radiation damage to salivary tissue in the radiotherapy fields
what can enhance salivary flow in patients with some function in their salivary glands
pilocarpine HCl
what saliva substitute should be avoided in dentate patients
Glandosane - acidic saliva replacement
name three saliva substitutes you can suggest for use
saliva orthana
biotene oral balance gel
bioXtra gel
why may patients receiving cancer therapy suffer from trismus
post surgical inflammation
fibrosis of the tissues
try to exclude tumour recurrence
what is ORN
exposed area of bone of at least 3 months duration in an irradiated side and not due to tumour recurrence
how can ORN be prevented
remove teeth of doubtful prognosis
prevention
extractions completed at least 10 days before radiation treatment
encourage healing with primary closure/ sutures where possible
hyperbaric oxygen therapy (HBOT)
antibiotic prophylaxis
when are patients at risk of ORN
total radiation dose exceeds 60Gy
trauma as a result of tooth extraction
person is immunocompromised
person is malnourished
what may be used prophylactically in patients that are at high risk of ORN
pentoxyfylline and Vitamin E
how is ORN staged
0 - mucosal defects only
1 - radiological evidence of necrotic bone
2 - positive radiographic findings above ID canal
3 - clinically exposed radionecrotic bone
how is ORN prevented and treated
at risks individuals check ups less than 6 months apart
avoid invasive treatment that could traumatise the bone
consider decoronating and leaving roots in situ
how should a patient with oral cancer be managed in the reconstruction and maintenance phase
implants
dentures
what should be kept in mind when planning implants for cancer patients
less success rate in irradiated bone
requires maintenance
what are instructions for obturators
review regularly
do not leave out at night for first 6 months after treatment
may be worn at night for comfort and function after 6 months too
daily cleaning mandatory
when are oral cancer patients discharged to their GDP
initial side effects have settled
frequent intake of carious food/ drink stopped
good oral hygiene established
what should be part of your treatment regime for patients with oral cancer who have been discharged back to GDP
more frequent follow up appointments
what is the international classifications for defining oncology
ICD-O
what are the two distinct disease patterns for oral cancer
oral cavity cancer
oro-pharyngeal cancer
name four high risk sites for mouth cancer
floor of mouth
lateral border of tongue
retromolar region
soft and hard palate
what three sites are more predisposed to developing SCC in drinkers and smokers
floor of mouth
lateral border of tongue
soft palate
what is the risk factor for oral cancer in smokers who dont drink
x 2 risk
what is the risk factor for oral cancer in drinkers that have never drank alcohol
x 2 risk
what is the risk factor for oral cancer in patients who smoke and drink
x 5 risk
what is the increase in risk of oral cancer for patients who are of a low socioeconomic status
x 2 risk
what is the term used for pre-malignant or pre-cancerous lesions
potentially malignant
give four examples of potentially malignant lesions
white lesions
red lesions
lichen planus
oral submucous fibrosis
name six cytological features of oral dysplasia
abnormal variation in nuclear size
abnormal variation in nuclear size
abnormal variation in cell size
abnormal variation in cell shape
atypical mitosis figures
nuclear hyperchromatism
name five architectural signs of oral dysplasia
irregular epithelial stratification
drop-shaped rete ridges
increased and abnormal mitoses
abnormal keratinisation
loss of epithelial cell cohesion or adhesion
what is the description of a low grade dysplasia (5 aspects)
easy to identify the tumour originates from squamous epithelium
architectural change into lower 1/3rd
evidence of stratification
well-formed basal cell layer surrounding tumour islands
what is the description of a high grade dysplasia
show little resemblance
architectural change in upper third
considerable atypia
mitotic figures prominent and abnormal
how are oral dysplasias graded
low grade
high grade
carcinoma in situ
what is the description of a carcinoma in situ
cytologically malignant but not invading
abnormal architecture in the full thickness
cytological atypia is severe
frequent mitotic abnormalities
is the prognosis of bulbous rete ridges infiltrating at same level better or worse than widely infiltrating small islands and single cells
better
at what length of tumour are metastases greater in
more than 4mm
what are the four factors that can be used for histological prognosis of dysplasia
pattern of invasion
depth of invasion
perineural invasion
invasion of vessels
what is the radius of high risk around a primary tumour in the mouth
5cm
what is meant by synchronous lesions
malignancies that occur within 6 months of the diagnosis of first malignancy
what is meant by a metachronous
malignancies that develop more than 6 months after the original malignancy has been diagnosed
what are the three aspects of oral cancer staging
site
size (T)
spread (N and M)
what is lip cancer separated from
oro-pharyngeal cancer
what is lip cancer
non healing ulcer or swelling on lip
slow growing, local invasion and rarely metastasise
what is the aetiology of lip cancer
sunlight UV-B
smoking
name four ways oral cancer can be detected
HPV16 screening
toluidine blue
VELscope
what is toluidine blue
dye which is applied and stains particular markers in cells
shows areas of dysplasia and trauma
what is a VELscope
auto-fluorescence of tissue with blue light
if there is a loss of fluorescence it equates to change
how should patients with ulcers of unknown cause be monitored
monitor with photographs and education to patient surrounding alcohol and smoking cessation
removal of local factors that could be causing ulcer
what is a potentially malignant lesion
altered tissue in which cancer is more likely to form
what is the special stain required to diagnose a candidal infection
periodic schiff stain
how is chronic hyperplastic candidosis treated
systemic antifungals - fluconazole capsules 50mg - once daily for 14 days
biopsy
smoking cessation
observe
what are the clinical predictors of malignancy in leukoplakia
age and gender
site
clinical appearance
what is the gold standard for assessing malignancy potential of lesions
biopsy for histopathological investigation
what is dysplasia
disordered maturation in a tissue
what is the WHO classification for grading epithelial dysplasia (2005)
hyperplasia
mild
moderate
severe
carcinoma in situ
what is basal hyperplasia
increased basal cell numbers
regular stratification
no cellular atypia
what is mild dysplasia
changes in lower third of architecture
mild atypia
hyperchromotism
what is moderate dysplasia
change in architecture expands into middle
moderate atypia
hyperchromatism
what is severe dysplasia
architecture changes expand into upper third
severe atypia and numerous mitoses
hyperchromatism
what is carcinoma in situ
a theoretic concept
malignant but not invasive
abnormal architecture affecting full thickness
pronounced cytological atypia
name four genes associated with cancer
oncogenes
tumour suppressor genes
Tp53 mutation or inactviation
genes regulating apoptosis
what are the 6 hallmarks of cancer
self sufficiency in growth signals
evading apoptosis
insensitivity to anti-growth signals
tissue invasion and metastasis
limitless replicate potential
sustained angiogenesis
what are the three report points of oral cancer pathology
differentiation and grading
pattern of invasion related to nodal spread
local extension of the disease
what are the ways oral cancer can spread
bone spread
nerve spread
lymphatic spread
haematogenous spread
what is the TNM system
t - size of tumour
n - lymph node involvement
m - distant metastasis
name 8 signs and symptoms of oral cancer
pain on eating
difficulty swallowing
unilateral earache
sensory loss
unexplained loosening of teeth
coughing blood
trismus
unexplained weight loss
for excision of cancer - what is the margin that should be taken
1cm around the cancer
name 5 options of cancer treatment
surgical
chemotherapy
radiotherapy
combination
palliative care
name side effects of surgery for cancer
local infection
lymphatic oedema
DVT
cosmetic and functional deficit
what is oral mucositis
inflammation and ulceration of the oral cavity
severe pain
can be caused by chemotherapy
what are the treatment options for oral mucositis
topical lidocaine
benzydamine mouthwash
calphosol
how is oral mucositis graded
0 - none
1 - oral soreness and erythema
2 - oral erythema and ulcers but solid diet tolerated
3 - oral ulcers and a liquid diet required
4 - oral alimentation is impossible
why can trismus occur following radiotherapy
causes fibrosis of the muscles of mastication
what dental prevention therapy should patients undergoing cancer treatment be given
toothbrushing instruction
higher fluoride toothpastes
interdental brushes
denture hygiene
mouthwashes
what is the role of the pathologist in oral cancer
to establish a subtype and grade
outline anatomical extent of the tumour
identify prognostic factors
final staging of disease
what are the 5 levels of lymph nodes in the neck
I - submental and sublingual triangle
II - occipital and posterior auricular glands
III - middle portion of IJV
IV - extends from clavicle to cricoid cartilage
V - posterior triangle of neck, behind the SCM
what is a microtome
an instrument for cutting extremely thin sections of material for examination under a microscope
why is it advised to remove dentures during cancer treatment
cancer treatment can make the mouth sore (mucositis)
side effects of cancer treatment can be worsened by the denture
