Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

OMFS

Describe cancer grading and how it is diagnosed.

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

OMFS

Define sentinel nodes.

A

Those with direct lymphatic drainage from primary tumour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

OM

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

A

x2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

OM

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

A

x2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

OM

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

A

x5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions