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FINALS > Oral Cancer > Flashcards

Oral Cancer Flashcards

1
Q

what would a patient present with that would be an emergency referral for oral cancer

A

stridor

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2
Q

what would a patient present with to need an urgent referral for oral cancer

A

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

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3
Q

what is the effect of both drinking and smoking in relation to oral cancer development called

A

synergistic effect

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4
Q

what tests are done to confirm cancer diagnosis and extent in OMFS

A

biopsy
CT scan
lymph node biopsy
stage and grade cancer

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5
Q

who is part of the MDT for cancer

A

oncologist
radiologist
OMF surgeon
dentist
dietician

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6
Q

how long should it take between referral from GDP for suspected oral cancer and patient starting their definitive treatment

A

28-31 days

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7
Q

what preventative treatment should be given to patients who have been given a diagnosis of oral cancer

A

OHI specific to them
fluoride topical application
dietary advice
PMPR to stabilise any perio disease
chlorhexidine mouthwash
restoration of carious teeth
removal of trauma

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8
Q

what treatment should be provided to make a patient dentally fit before starting cancer treatment

A

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

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9
Q

name the three options for oral cancer treatment

A

surgical resection with or without reconstruction
radiotherapy
chemotherapy
or combination of above

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10
Q

name some side effects from cancer treatment

A

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

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11
Q

what is the role of the dentist while a patient is receiving cancer therapy

A

hygienist support
oral and denture hygiene
antibacterial mouthwash
diet advice
treat xerostomia

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12
Q

how is oral mucositis managed and prevented in patients receiving oral cancer therapy

A

calcium phosphate mouth rinse (Caphosol)
mucoadhesive oral rinse
benzydamine hydrochloride (difflam)
2% lidocaine mouthwash used prior to eating

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13
Q

how is oral mucositis scored

A

out of 1, 2 or 3

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14
Q

what aspects are considered when assessing oral mucositis

A

voice
swallowing
lips
tongue
saliva
mucous membranes

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15
Q

what dental issues can occur during Cancer treatment

A

oral mucositis
candidal infections
traumatic ulceration
reactivation of herpes simplex
xerostomia
trismus
erosion
caries and periodontal disease
ORN

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16
Q

how are candidal infections during cancer treatment treated

A

chlorhexidine mouthwash
miconazole
fluconazole
nystatin

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17
Q

how is saliva affected during Cancer treatment

A

saliva consistency and character
it becomes more viscous and acidic

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18
Q

why does xerostomia occur in patients receiving cancer treatment

A

ionising radiation damage to salivary tissue in the radiotherapy fields

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19
Q

what can enhance salivary flow in patients with some function in their salivary glands

A

pilocarpine HCl

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20
Q

what saliva substitute should be avoided in dentate patients

A

Glandosane - acidic saliva replacement

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21
Q

name three saliva substitutes you can suggest for use

A

saliva orthana
biotene oral balance gel
bioXtra gel

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22
Q

why may patients receiving cancer therapy suffer from trismus

A

post surgical inflammation
fibrosis of the tissues
try to exclude tumour recurrence

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23
Q

what is ORN

A

exposed area of bone of at least 3 months duration in an irradiated side and not due to tumour recurrence

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24
Q

how can ORN be prevented

A

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

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25
Q

when are patients at risk of ORN

A

total radiation dose exceeds 60Gy
trauma as a result of tooth extraction
person is immunocompromised
person is malnourished

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26
Q

what may be used prophylactically in patients that are at high risk of ORN

A

pentoxyfylline and Vitamin E

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27
Q

how is ORN staged

A

0 - mucosal defects only
1 - radiological evidence of necrotic bone
2 - positive radiographic findings above ID canal
3 - clinically exposed radionecrotic bone

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28
Q

how is ORN prevented and treated

A

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

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29
Q

how should a patient with oral cancer be managed in the reconstruction and maintenance phase

A

implants
dentures

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30
Q

what should be kept in mind when planning implants for cancer patients

A

less success rate in irradiated bone
requires maintenance

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31
Q

what are instructions for obturators

A

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

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32
Q

when are oral cancer patients discharged to their GDP

A

initial side effects have settled
frequent intake of carious food/ drink stopped
good oral hygiene established

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33
Q

what should be part of your treatment regime for patients with oral cancer who have been discharged back to GDP

A

more frequent follow up appointments

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34
Q

what is the international classifications for defining oncology

A

ICD-O

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35
Q

what are the two distinct disease patterns for oral cancer

A

oral cavity cancer
oro-pharyngeal cancer

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36
Q

name four high risk sites for mouth cancer

A

floor of mouth
lateral border of tongue
retromolar region
soft and hard palate

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37
Q

what three sites are more predisposed to developing SCC in drinkers and smokers

A

floor of mouth
lateral border of tongue
soft palate

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38
Q

what is the risk factor for oral cancer in smokers who dont drink

A

x 2 risk

39
Q

what is the risk factor for oral cancer in drinkers that have never drank alcohol

A

x 2 risk

40
Q

what is the risk factor for oral cancer in patients who smoke and drink

A

x 5 risk

41
Q

what is the increase in risk of oral cancer for patients who are of a low socioeconomic status

A

x 2 risk

42
Q

what is the term used for pre-malignant or pre-cancerous lesions

A

potentially malignant

43
Q

give four examples of potentially malignant lesions

A

white lesions
red lesions
lichen planus
oral submucous fibrosis

44
Q

name six cytological features of oral dysplasia

A

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

45
Q

name five architectural signs of oral dysplasia

A

irregular epithelial stratification
drop-shaped rete ridges
increased and abnormal mitoses
abnormal keratinisation
loss of epithelial cell cohesion or adhesion

46
Q

what is the description of a low grade dysplasia (5 aspects)

A

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

47
Q

what is the description of a high grade dysplasia

A

show little resemblance
architectural change in upper third
considerable atypia
mitotic figures prominent and abnormal

48
Q

how are oral dysplasias graded

A

low grade
high grade
carcinoma in situ

49
Q

what is the description of a carcinoma in situ

A

cytologically malignant but not invading
abnormal architecture in the full thickness
cytological atypia is severe
frequent mitotic abnormalities

50
Q

is the prognosis of bulbous rete ridges infiltrating at same level better or worse than widely infiltrating small islands and single cells

A

better

51
Q

at what length of tumour are metastases greater in

A

more than 4mm

52
Q

what are the four factors that can be used for histological prognosis of dysplasia

A

pattern of invasion
depth of invasion
perineural invasion
invasion of vessels

53
Q

what is the radius of high risk around a primary tumour in the mouth

A

5cm

54
Q

what is meant by synchronous lesions

A

malignancies that occur within 6 months of the diagnosis of first malignancy

55
Q

what is meant by a metachronous

A

malignancies that develop more than 6 months after the original malignancy has been diagnosed

56
Q

what are the three aspects of oral cancer staging

A

site
size (T)
spread (N and M)

57
Q

what is lip cancer separated from

A

oro-pharyngeal cancer

58
Q

what is lip cancer

A

non healing ulcer or swelling on lip
slow growing, local invasion and rarely metastasise

59
Q

what is the aetiology of lip cancer

A

sunlight UV-B
smoking

60
Q

name four ways oral cancer can be detected

A

HPV16 screening
toluidine blue
VELscope

61
Q

what is toluidine blue

A

dye which is applied and stains particular markers in cells
shows areas of dysplasia and trauma

62
Q

what is a VELscope

A

auto-fluorescence of tissue with blue light
if there is a loss of fluorescence it equates to change

63
Q

how should patients with ulcers of unknown cause be monitored

A

monitor with photographs and education to patient surrounding alcohol and smoking cessation
removal of local factors that could be causing ulcer

64
Q

what is a potentially malignant lesion

A

altered tissue in which cancer is more likely to form

65
Q

what is the special stain required to diagnose a candidal infection

A

periodic schiff stain

66
Q

how is chronic hyperplastic candidosis treated

A

systemic antifungals - fluconazole capsules 50mg - once daily for 14 days
biopsy
smoking cessation
observe

67
Q

what are the clinical predictors of malignancy in leukoplakia

A

age and gender
site
clinical appearance

68
Q

what is the gold standard for assessing malignancy potential of lesions

A

biopsy for histopathological investigation

69
Q

what is dysplasia

A

disordered maturation in a tissue

70
Q

what is the WHO classification for grading epithelial dysplasia (2005)

A

hyperplasia
mild
moderate
severe
carcinoma in situ

71
Q

what is basal hyperplasia

A

increased basal cell numbers
regular stratification
no cellular atypia

72
Q

what is mild dysplasia

A

changes in lower third of architecture
mild atypia
hyperchromotism

73
Q

what is moderate dysplasia

A

change in architecture expands into middle
moderate atypia
hyperchromatism

74
Q

what is severe dysplasia

A

architecture changes expand into upper third
severe atypia and numerous mitoses
hyperchromatism

75
Q

what is carcinoma in situ

A

a theoretic concept
malignant but not invasive
abnormal architecture affecting full thickness
pronounced cytological atypia

76
Q

name four genes associated with cancer

A

oncogenes
tumour suppressor genes
Tp53 mutation or inactviation
genes regulating apoptosis

77
Q

what are the 6 hallmarks of cancer

A

self sufficiency in growth signals
evading apoptosis
insensitivity to anti-growth signals
tissue invasion and metastasis
limitless replicate potential
sustained angiogenesis

78
Q

what are the three report points of oral cancer pathology

A

differentiation and grading
pattern of invasion related to nodal spread
local extension of the disease

79
Q

what are the ways oral cancer can spread

A

bone spread
nerve spread
lymphatic spread
haematogenous spread

80
Q

what is the TNM system

A

t - size of tumour
n - lymph node involvement
m - distant metastasis

81
Q

name 8 signs and symptoms of oral cancer

A

pain on eating
difficulty swallowing
unilateral earache
sensory loss
unexplained loosening of teeth
coughing blood
trismus
unexplained weight loss

82
Q

for excision of cancer - what is the margin that should be taken

A

1cm around the cancer

83
Q

name 5 options of cancer treatment

A

surgical
chemotherapy
radiotherapy
combination
palliative care

84
Q

name side effects of surgery for cancer

A

local infection
lymphatic oedema
DVT
cosmetic and functional deficit

85
Q

what is oral mucositis

A

inflammation and ulceration of the oral cavity
severe pain
can be caused by chemotherapy

86
Q

what are the treatment options for oral mucositis

A

topical lidocaine
benzydamine mouthwash
calphosol

87
Q

how is oral mucositis graded

A

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

88
Q

why can trismus occur following radiotherapy

A

causes fibrosis of the muscles of mastication

89
Q

what dental prevention therapy should patients undergoing cancer treatment be given

A

toothbrushing instruction
higher fluoride toothpastes
interdental brushes
denture hygiene
mouthwashes

90
Q

what is the role of the pathologist in oral cancer

A

to establish a subtype and grade
outline anatomical extent of the tumour
identify prognostic factors
final staging of disease

91
Q

what are the 5 levels of lymph nodes in the neck

A

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

92
Q

what is a microtome

A

an instrument for cutting extremely thin sections of material for examination under a microscope

93
Q

why is it advised to remove dentures during cancer treatment

A

cancer treatment can make the mouth sore (mucositis)
side effects of cancer treatment can be worsened by the denture

FINALS (25 decks)

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