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OSCE CRAM > Oral Cancer > Flashcards

Oral Cancer Flashcards

1
Q

High risk OC sites in oropharynx

A

Base of tongue
Tonsils
Soft palate

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2
Q

High risk OC sites in oral cavity

A

Buccal mucosa
Retromolar pads
Anterior 2/3rds of tongue
FOM
Hard palate
Lips

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3
Q

What are the red flags associated with malignancy

A

Ulcer persists >2wks despite no cause
Rolled margins
Central necrosis
Erythroleukoplakia
Cervical lymphadenopathy (>1cm, firm, fixed)
Worsening pain (neuropathic, dysaesthesia, paraesthesia)
Referred pain
Weight loss
Throat pain >3wks

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4
Q

Investigations for H+N cancer

A

H+N CT scan
OPT
US of enlarged LN

THEN
Biopsy - fine needle/core

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5
Q

How do we reach a diagnosis to allow staging?

A

Tissue histology
Imaging (CT/MRI)
Provides TNM staging

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6
Q

TNM staging components

A

T - tumour size
N - LN involvement (0-3)
M - metastasis

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7
Q

Common area of metastasis

A

Thorax

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8
Q

Broad Tx options for cancer

A

Nil
Surgery alone
Radiotherapy alone
Chemo/radiotherapy
Dual or triple modality

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9
Q

Primary site tx options

A

Resection + packing
Resection + primary closure
Resection + reconstruction (local flap, peddled flap or free flap)

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10
Q

What is ORN

A

Necrotic bone in previously radiotherapies field
Radiotherapy >70gy

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11
Q

Effects of ORN on mandible

A

Hypoxia
Hypovascularity

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12
Q

OPT signs of cancer (7)

A

Unusual bone loss
Non healing sockets
Floating teeth
Widening of PDL
Moth eaten bone
Loss of sinus
Pathological fracture

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13
Q

US signs of cancer (3)

A

Node necrosis
Enlarged rounded LN
Avascular or increased vascularity

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14
Q

Biopsy difference between fine needle and core

A

Fine - only provides cells
Core - provides sample for histopathological diagnosis

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15
Q

Compare CT + MRI scan

A

CT - quick, good for ST+bone, need contrast + bloods before

MRI - no ionsing radiatoi

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16
Q

Imaging of choice when you can’t see the primary tumour

A

CT

17
Q

What is the role of the pathologist

A

Establish diagnosis
Staging TNM
Outline anatomical extent of tumour
Identify other prognostic factors (molecular markers)

18
Q

What happens once the specimen arrives in pathology?

A

Request form checked
Fixed in Formaldehyde for at least 24hrs

19
Q

MDT components

A

Surgeon
Oncologist
Pathologist
Radiologist
Clinical nurse
SALT
Restorative dentist
SC dentist
Psychologist

20
Q

Role of GDP in cancer pts

A

Early detection through ST exam
Photographs
Referral
Pre-tx assessment

21
Q

Aim of a dental pre-assessment

A

Identity existing disease + potential risks
Remove infection + potential infection
Prepare pt for expected oral side effects
OH reinfiroceed

22
Q

What tx can we provide as part of a pre-assessment

A
  • Denture hygiene and instructions to avoid wear during cancer tx
  • XLa poor prognosis teeth no less than 10 days before cancer tx
  • Discontinue ortho tx
  • CHX MW as increased viral/fungal infection risk
  • Symptomatic relief of dry mouth
  • Smoking + alcohol advice
  • OHI - F preparation
23
Q

Radiation side effects to normal surrounding tissues

A

Radiation damage to tissues surrounding tumour affecting their function short term + long term

24
Q

Chemotherapy side effects

A

Acute mucosal + haematological toxicity

25
Q

List dental issues from cancer tx

A

Reactivation of HSV
Trismus
Candida
ORN
Traumatic ulcer
Caries
Mucositits
Perio
Erosion
Xerostomia

26
Q

When and how does oral mucositis present and how do we prevent it?

A

1-2wks after tx starts, lasts 6wks
Severe pain, can inhibit OH
Prevention:
Benzydamina MW
2% Lidocaine MW
Saline rinse
Manuka honey

27
Q

Candida tx

A

Reinforce denture + OH
CHX
Topical Miconazole
Systemic Fluconazole

28
Q

Tx of traumatic ulceration

A

Teeth rubbing delicate I/O ST’s
Soft splint

29
Q

Tx of HSV cold sores

A

Aciclovir during proximal period (pain prior to ulceration)

30
Q

When does Xerostomia present and what does it increase the risk of?

A

Decreased salivary flow 50-60% in first week
Effects on mastication, speech + taste
Caries, perio, candida, sialadenitis

31
Q

Tx of Xerosomtia

A

F supplements
Petroleum J to protect lips
Saliva orthana
Sugar free gum
Pilocarpine if some function (tachycardia/nausea)

32
Q

Trismus causes + tx

A

Post surgical inflammation
Fibrosis of tissues due to radio/chemo

TX:
Stretching exercises
Tongue depressors

33
Q

Prevention of caries

A

Diet, OH, enhanced fluoride

34
Q

Define ORN and its prevention + tx

A

Exposed bone 3mths in radiation site
Remove teeth with poor prognosis
Prevention
XLa’s 10 days before
Sutures
TX:
Reconstruction
Obturator (do not leave out for first 6mths)

35
Q

RF’s for developing ORN

A

Total radiation >60gy
Malnourished
Immunodeficient

36
Q

What drugs are given for high risk ORN pts

A

Pentoxyfylline + VIT E

OSCE CRAM (40 decks)

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