Oral Cancer Flashcards
High risk OC sites in oropharynx
Base of tongue
Tonsils
Soft palate
High risk OC sites in oral cavity
Buccal mucosa
Retromolar pads
Anterior 2/3rds of tongue
FOM
Hard palate
Lips
What are the red flags associated with malignancy
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
Investigations for H+N cancer
H+N CT scan
OPT
US of enlarged LN
THEN
Biopsy - fine needle/core
How do we reach a diagnosis to allow staging?
Tissue histology
Imaging (CT/MRI)
Provides TNM staging
TNM staging components
T - tumour size
N - LN involvement (0-3)
M - metastasis
Common area of metastasis
Thorax
Broad Tx options for cancer
Nil
Surgery alone
Radiotherapy alone
Chemo/radiotherapy
Dual or triple modality
Primary site tx options
Resection + packing
Resection + primary closure
Resection + reconstruction (local flap, peddled flap or free flap)
What is ORN
Necrotic bone in previously radiotherapies field
Radiotherapy >70gy
Effects of ORN on mandible
Hypoxia
Hypovascularity
OPT signs of cancer (7)
Unusual bone loss
Non healing sockets
Floating teeth
Widening of PDL
Moth eaten bone
Loss of sinus
Pathological fracture
US signs of cancer (3)
Node necrosis
Enlarged rounded LN
Avascular or increased vascularity
Biopsy difference between fine needle and core
Fine - only provides cells
Core - provides sample for histopathological diagnosis
Compare CT + MRI scan
CT - quick, good for ST+bone, need contrast + bloods before
MRI - no ionsing radiatoi
Imaging of choice when you can’t see the primary tumour
CT
What is the role of the pathologist
Establish diagnosis
Staging TNM
Outline anatomical extent of tumour
Identify other prognostic factors (molecular markers)
What happens once the specimen arrives in pathology?
Request form checked
Fixed in Formaldehyde for at least 24hrs
MDT components
Surgeon
Oncologist
Pathologist
Radiologist
Clinical nurse
SALT
Restorative dentist
SC dentist
Psychologist
Role of GDP in cancer pts
Early detection through ST exam
Photographs
Referral
Pre-tx assessment
Aim of a dental pre-assessment
Identity existing disease + potential risks
Remove infection + potential infection
Prepare pt for expected oral side effects
OH reinfiroceed
What tx can we provide as part of a pre-assessment
- 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
Radiation side effects to normal surrounding tissues
Radiation damage to tissues surrounding tumour affecting their function short term + long term
Chemotherapy side effects
Acute mucosal + haematological toxicity
List dental issues from cancer tx
Reactivation of HSV
Trismus
Candida
ORN
Traumatic ulcer
Caries
Mucositits
Perio
Erosion
Xerostomia
When and how does oral mucositis present and how do we prevent it?
1-2wks after tx starts, lasts 6wks
Severe pain, can inhibit OH
Prevention:
Benzydamina MW
2% Lidocaine MW
Saline rinse
Manuka honey
Candida tx
Reinforce denture + OH
CHX
Topical Miconazole
Systemic Fluconazole
Tx of traumatic ulceration
Teeth rubbing delicate I/O ST’s
Soft splint
Tx of HSV cold sores
Aciclovir during proximal period (pain prior to ulceration)
When does Xerostomia present and what does it increase the risk of?
Decreased salivary flow 50-60% in first week
Effects on mastication, speech + taste
Caries, perio, candida, sialadenitis
Tx of Xerosomtia
F supplements
Petroleum J to protect lips
Saliva orthana
Sugar free gum
Pilocarpine if some function (tachycardia/nausea)
Trismus causes + tx
Post surgical inflammation
Fibrosis of tissues due to radio/chemo
TX:
Stretching exercises
Tongue depressors
Prevention of caries
Diet, OH, enhanced fluoride
Define ORN and its prevention + tx
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)
RF’s for developing ORN
Total radiation >60gy
Malnourished
Immunodeficient
What drugs are given for high risk ORN pts
Pentoxyfylline + VIT E
