Oral Cancer Flashcards
What guideline can be used in accordance to referrals of suspected head & neck cancers?
- SIGN 90 (“3 week rule”); WITHDRAWN Dec 2016
- NICE (“2 week rule”)
What other conditions are associated with H&N cancers?
- Heartburn & aerodigestive tract SCC
- Perio disease, OH & mw & HN SCC
What may be some EARLY presentations of oral cancer?
- Nothing
- Non-healing ulcer
- Red/ white patch
- Lump/ rough bit
- Change in lump/ patch
- Crusted/ non-healing lesion on lip
- Persistent soreness
- Earache
What may be some LATE presentations of oral cancer?
- Numbness
- Difficulty swallowing
- Dentures ill fitting
- Loosening of teeth
- Non-healing extr site
- Lump in neck
- Bleeding
- Friable (bits break off)
- Pain
What are some indications of cancer from a PMH?
- Hx of areodigestive tract cancer
- Iron deficiency (cancers –> bleeding)
- Long-term immunosuppression (incl imminosupressing drugs) –> lip cancer risk
What are some social risk factors for cancer?
- Alcohol and tobacco smoking
- Betel quid
- UV exposure = occupation, sun-bed, outdoor habits (cycling)
What are the 5 yr survival rates for localised and metastatic disease?
- LOCALISED 82%
- METASTATIC 33%
What are some indications in an E/O exam of cancers?
- Weight loss/ cachexia (weakness/ wasting)
- Facial asymmetry (swellings? n. damage?)
- Lip lesions (crusting? bleeding? red/white patch?)
- Lymph node swelling
What might be seen I/O in a pt with suspected oral cancer?
- White/ red/ speckled patch
- Exophytic growths
- Lump
- Hardening of tissue
- Necrosis (grey slough, bad smell)
- Mobile teeth
- Friable tissues
- Signs of fractures
What special tests may be carried out in aid of diagnosis of oral cancers?
- Clinical photographs
- Biopsy
What would you do if a mild suspicion of oral cancer?
- Tell pt concerns
- Adjust any potential causes
- Clinical photos and record all in notes
- FOLLOW 2/3 week rule
What would you do if a high suspicion of oral cancer?
- Follow local referral pathways
- Contact OMFS, OM, ENT department
- Rapid access referral
What is included in a referral letter of a pt with suspected OC?
- Pt identifiers (name, address etc.)
- Contact number (pt and referrer)
- Name of GDP
- Relevant MH. DH, SH
- Hx, reason for referral and urgency
- Clinical findings
- What pt knows/ suspects and their level of anxiety
What is the role of primary HCP in diagnosis of OCs?
- Increase public awareness of OC
- Educate public re OC
- Early diagnosis via opportunistic screening
- Ensure all unexplained lesions referred for biopsy within 2 weeks
What is a specimen fixed in at the pathologist’s lab?
Formaldehyde, at least 24hrs
What is done if the lab wants to see a specimen quicker?
Freeze specimen (-25C)
What are the neck node levels?
I, II, III, IV, V
Who are part of the multidisciplinary team?
- Surgeon
- Oncologist
- Pathologist
- Radiologist
- Clinical nurse specialist
- Speech therapist and dietetics
- Palliative care physician
- Restorative dentist
- Special care dentist
How often should a dentate and edentate patient be screened?
- Dentate = 6 monthly
- Edentate = 12 monthly
How long ideally before cancer treatment should a patient be referred to their dentist?
1 month prior
What are the dental treatment prior cancer therapy?
- Remove any source of infection
- Remove teeth of dubious prognosis
- Restore teeth where appropriate
- Perio therapy
- Caries management
- Denture assessment (ill fitting, risk of infection); smooth dentures
- Smooth sharp teeth/ restorations
How long ideally before cancer treatment should teeth be extracted?
- NO LESS than 10 DAYS prior
- Ideally 3 weeks healing time
What are the principles of teeth extraction prior cancer treatment?
- Remove foci of infection/ poor prognosis
- Atraumatic technique
- Achieve primary closure
- Every measure in place to aid quick healing
What are the principles of restoring teeth prior cancer treatment?
- Restore with definitive materials
- If limited time, GI as provisional
- Teeth and restorations smoothed off
What are the dental implications of surgery?
- Defects (requires grafts, implants, obturator)
- Removal of salivary glands –> xerostomia (affects speech, swallowing, appearance)
What are the dental implications of radiotherapy?
IMMEDIATE
- Mucositis
- Loss of taste
- Xerostomia
- Pain
LONG-TERM
- Xerostomia
- Endarteritis oblierans (inflammation of artery inner lining –> occlusion of lumen)
- Osteonecrosis
- Trismus –> limited access
- Radiation caries
What are the THREE broad factors in dictating dental tx?
- Dose
- Field
- Site
What are the dental implications of chemotherapy?
- Immunosuppression
- Mucositis
- Xerostomia
- Swelling
- Pain
- Altered taste
What are the grading and clinical features of the WHO’s Oral Mucositis Scale?
- Sore/ erythema
- Erythema, ulcer but able to eat solids
- Ulcers, requires liquid diet
- Oral alimentation impossible
What is oral mucositis?
Inflammation of the oral mucosa
What is the onset of mucositis in radio and chemotherapy?
Radio = 2 weeks Chemo = 1 week
What is the management for mucositis?
PREVENTATIVE
- Improve OH
- Adjust restorations/ ill fitting dentures
- Mucosal shield
TREATMENT
- Mw = difflam spray, Gelclair, Caphosol, CHX
- Analgesics
- Ice chips
- IV keratinocyte GF (Palifermin)
How long may xerostomia last after radio and chemotherapy?
Radio = 2yrs or longer, may be permanent Chemo = 2 months
What are the dental implications of xerostomia?
- Saliva becomes thick, acidic and viscous (caries)
- Loss of protective features of saliva
What is the management for xerostomia?
SALIVA STIMULATION
- Gum (if residual function)
- Pilocarpine
- Acupuncture
- Acid pastilles (contrain. in dentate pts)
SALIVA REPLACEMENT
- Sip water
- Saliva orthana
- Biotene
- BioXtra
- Glandsosane (AVOID IN DENTATE)
