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BDS4 CDS Oral Surgery > ORAL CANCER > Flashcards

ORAL CANCER Flashcards

Combined - OM, OMFS, SCD

1
Q

OMFS

What are some general intra and extra-oral signs and symptoms of oral cancer ?

A
  • Mobility of teeth.
  • Trismus.
  • Dysarthria.
  • Jaw fracture.
  • Numbness/paraesthesia.
  • Acquired malocclusion.
  • Dysphagia.
  • Unexplained weight loss.
  • Pain.
  • Persisting head or neck lump.
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2
Q

OMFS

Describe what a oral cavity cancer might be like clinically.

A
  • Red or mixed red-white patch.
  • Ulceration.
  • Bleeding.
  • Non-healing.
  • Indurated (firm).
  • Immobile from underlying tissues.
  • Rolled margins.
  • Asymptomatic.
  • Verrocous appearance.
  • Pre-dysplastic lesion.
  • Uneven surface.
  • Exophytic.
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3
Q

OMFS

What signs would alarm you and cause a 2 week referral to be made ?

A
  • Unexplained head/neck lump persisting for >2 weeks.
  • Unexplained non-healing ulcer/indurated lesion of mucosa persisting for >2 weeks.
  • All red and red-white mixed patches persisting for >2 weeks.
  • Persistent hoarseness or throat pain or dysphagia persisting for >2 weeks.
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4
Q

OMFS

Describe cancer staging and how it is diagnosed.

A

How big is the primary tumour and has it spread to regional lymph nodes or distant organs ?
Diagnosed from imaging & clinical examination.

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5
Q

OMFS

Describe cancer grading and how it is diagnosed.

A

How abnormal are the cells and tissue ?
Diagnosed from histopathology biopsy.

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6
Q

OMFS

How would a cN0 patient be managed surgically ?

A

No lymph node involvement.
Will have microscopic metastases removed during primary resection with macroscopic margin of resection.
Resection of level I, II, III cervical lymph nodes during primary surgery.

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7
Q

OMFS

How would a cN+ve patient be managed surgically ?

A

Requires secondary surgery to removal specific affected lymph nodes, confirmed through PET scan.

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8
Q

OMFS

Define sentinel nodes.

A

Those with direct lymphatic drainage from primary tumour.

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9
Q

OM

What are the most common sites affected by oral cavity cancer (OCC) ?

A
  • Floor of mouth.
  • Lateral border of the tongue.
  • Retormolar regions.
  • Hard and soft palate.
  • Gingivae.
  • Buccal mucosa.
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10
Q

OM

OCC - smokers who don’t drink - at what risk are they at for development of OCC ?

A

x2

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11
Q

OM

Drinkers who have never smoked - at how much greater risk are they at for development of OCC ?

A

x2

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12
Q

OM

Smokers who do drink - how much greater risk are they at for development of OCC ?

A

x5

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13
Q

OM

What are the main risk factors for OCC ?

A

Smoking - frequency, duration of use.
Alcohol - frequency.
Betel quid (paan) - x3.
Socioeconomic status - x2.

Possible - FH, poor OH, sexual activity/partners.

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14
Q

OM

List some potentially malignant conditions.

A
  • Leukoplakia.
  • Erythroplakia.
  • Lichen planus - erosive and ulcerated subtypes.
  • Chronic hyperplastic candidasis.
  • Oral submucous fibrosis.
  • Iron deficiency.
  • Tertiary syphilis.
  • HPV.
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15
Q

OM

Define leukoplakia.

A

Undiagnosed white patch which cannot be rubbed off or attributed to any other disease.

Lower malignancy potential (<4%).
Proliferative verrucous leukoplakia - highest malignant transformation potential.

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16
Q

OM

Define erythroplakia.

A

Unexplained, undiagnosed red patch which cannot be attributed to any other disease.

High malignancy potential (50%).
Erythema indicative of vascular change.

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17
Q

OM

What are the two factors which dysplasia categorisation is based upon (grading) ?

A
  • Cellular atypia i.e. cytological.
  • Epithelial architectural organisation i.e. architectural.
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18
Q

OM

What are some examples of dysplastic cytological changes in cells ?

A
  • Abnormal variation in nuclear size, number and shape.
  • Pleomorphism - variation in cell size and shape.
  • Nuclear hyperchromatism - increased DNA staining in nuclei.
  • Increased/altered nuclear-cytoplasmic ratio.
  • Atypical mitotic figures.
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19
Q

OM

Provide some examples of architerctural changes in dysplastic lesions.

A
  • Irregular epithelial stratification.
  • Loss/disturbed polarity of basal cells.
  • Drop chaped rete pegs.
  • Increased and abnormal mitoses.
  • Premature keratinisation.
  • Abnormal keratinisation.
  • Loss of epithelial cell cohesion/adhesion.
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20
Q

OM

Define low grade dysplasia.

A

Architerctural changes into lower 1/3.
Cytological atypia may not be prominent.

21
Q

OM

Define high grade dysplasia.

A

Architectural changes in middle third.
Cytological atypia evident.

22
Q

OM

Define carcinoma in situ.

A

Abnormal architecture of full thickness.
Severe cytological atypia.

23
Q

OM

What are some histological prognostic factors which will influence how the cancer is managed ?

A
  • Pattern of invasion - small islands and single cells associated with poorer prognosis vs. bulbous rete pegs.
  • Depth of invasion - >4mm poorer prognosis.
  • Perineural invasion - poor prognosis if secondary tumour in large nerve distant from primary tumour.
  • Invasion of vessels - associated with lymph node involvement & poorer prognosis.
24
Q

OM

Explain field cancerisation concept.

A
  • Whole mouth exposed to aetiological factor.
  • Same changes in cells might be occuring in different locations in the mouth at different rates.
  • i.e. not always metachronous lesions (secondary tumours), can be synchronous lesions.
25
Q

OM

What are the aetiological factors for lip cancer ?

A

Sunlight and smoking.

Good prognosis & slow growth and rarely metastesises.

26
Q

OM

What are different forms of oral cancer screening ?

A
  • HPV16 screening.
  • Toluidene blue.
  • VELscope.
  • Clinical judgement.
27
Q

OM

What is national procedures in place to aid cancer screening ?

A

Scotland - free routine examinations for all patients.
Free available smoking cessation and alcohol cessation services as part of NHS.
Included in Caring for Smiles OH programme - making carers aware of signs of OCC and OPC.

28
Q

ORAL HISTOLOGY

Explain how iron deficiency can be deemed a potentially malignant condition.

A

Causes atrophy of oral epithelium, reduced barrier to carcinogens.

29
Q

ORAL HISTOLOGY

What are the three general histopathological predictors for malignant change orally ?

A

Atrophy.
Candida infection.
Dysplasia.

30
Q

ORAL HISTOLOGY

What two genes manage cellular growth ?

A

Oncogenes.
Tumour suppressor genes.
Tp53 - regulates apoptosis.

31
Q

SPECIAL CARE DENTISTRY

What are some radiographic signs of oral cancer seen on an OPT ?

A
  • Moth eaten bone.
  • Pathological fractures.
  • Non-healing sockets.
  • Floating teeth.
  • Unusual periodontal bone loss or RR.
  • Spiculated periosteal reaction.
  • Widening of PDL space.
  • Loss of bony outlines of anatomical features.
  • Thinning of cortical margin of lower border of the mandible.
  • Loss of lamina dura surrounding multiple teeth.
32
Q

SPECIAL CARE DENTISTRY

What are the signs of lymph nodes metastases seen on a US ?

A
  • Rounded, enlarged lymph nodes.
  • Necrosis of lymph nodes.
  • Conglomerate nodes.
  • Increased vascularity.
  • Loss of hilum.
  • Internal calcification.
33
Q

SPECIAL CARE DENTISTRY

What advice would you give if prescribing chlorhexidine gluconate 0.2% MW ?

A
  • 10ml rinsed around the mouth for 1 min.
  • Spat out (not swallowed).
  • Use 2x daily.
  • 30 mins allowed between toothbrushing.
  • Can be diluted 1:1 with water if causing mucosal discomfort.
34
Q

SPECIAL CARE DENTISTRY

What are some signs of poor prognosis teeth ?

A

Deep caries, non-vital teeth, deep periodontal pockets, directly in path of radiation beam, associated with tumour.

35
Q

SPECIAL CARE DENTISTRY

How low should a patient’s neutrophil count be for you to consider antibiotic prophylaxis ?

A

<1000 cells/mm³
Neutropenia.

36
Q

SPECIAL CARE DENTISTRY

What are the side effects of surgical resection of cancer ?

A

Change in appearance.
Reduced function.

37
Q

SPECIAL CARE DENTISTRY

What is oral mucositis ?

A
  • Erythema, oedema and ulceration of the mucosa.
  • Caused by radiotherapy, chemotherapy and stem cell transplants.
  • Causing severe pain.
  • Begins 1-2 weeks after starting treatment.
  • Lasts 6 weeks after stopping treatment.
  • Can inhibit eating and OH measures.
38
Q

SPECIAL CARE DENTISTRY

How can oral mucositis be managed ?

A
  • MW - Caphosol, Difflam (bezydamine hydrochloride), aloe vera, saline, 2% lidocaine.
  • Soluble aspirin.
  • Cryotherapy.
  • Low level laser therapy.
  • Morphine or opioids.
39
Q

SPECIAL CARE DENTISTRY

How can candida infections be managed ?

A
  • Chlorhexidine MW.
  • Miconazole topical gel.
  • Fluconazole systemic.
  • Nystatin MW.
40
Q

SPECIAL CARE DENTISTRY

How can oral ulceration be managed ?

A
  • Benzydamine hydrochloride MW or spray (0.15%).
  • Chlorhexidine gluconate MW (0.2%).
  • Soft splint.
  • Remove traumatic causes.
41
Q

SPECIAL CARE DENTISTRY

What oral conditions are patients who are undergoing cancer treatment predisposed to ?

A
  • Ulceration.
  • Candida infection.
  • Xerostomia.
  • Reactivation of Herpes Simplex.
  • Oral mucositis.
  • Caries.
  • Periodontal disease.
  • Trismus.
  • ORN.
  • MRONJ.
42
Q

SPECIAL CARE DENTISTRY

What are the treatments available for xerostomia ?

A
  • Saliva substitutes - Saliva Orthana, Biotene, Glandosane, BioXtra.
  • Saliva stimulants - Prilocarpine 5mg 3x daily.
  • Frequent sips of water.
  • Vaseline.
43
Q

SPECIAL CARE DENTISTRY

Why do patients who have undergone cancer treatment suffer trismus ?

A
  • Post-surgical inflammation near jaw joint.
  • Fibrosis of tissues.
  • Tumour recurrence.
44
Q

SPECIAL CARE DENTISTRY

How can trismus be managed ?

A
  • Therabite.
  • Stacked tongue depressors.
  • Passive and active stretching exercises.
45
Q

SPECIAL CARE DENTISTRY

How can ORN be prevented ?

A
  • Dental assessment prior to starting treatment - XLA hopeless teeth, consider SDA.
  • XLAs 10 days before starting radiotherapy.
  • Prevention - fluoride, OHI.
  • Primary closure/sutures.
  • Hyperbaric oxygen therapy.
46
Q

SPECIAL CARE DENTISTRY

What makes a patient more susceptible to ORN ?

A

Total radiation dose >60Gys.
Dose fraction was large with high number of fractions.
Local trauma i.e. XLA, ill-fitting prosthesis.
Immunodeficient.
Malnourishment.

47
Q

SPECIAL CARE DENTISTRY

Explain preventative treatment for oral cancer patients.

A

Regular exams (every 3 months) with dentist & hygienist.
Avoid invasive treatment.
Consider decoronation.
Resin restorations, SSC.

48
Q

SPECIAL CARE DENTISTRY

Name two treatments which reduce likelihood of developing ORN.

A

Pentoxifylline.
Vit E supplements.

BDS4 CDS Oral Surgery (18 decks)

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