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Oral Oncology > Oral Complications Associated with Radiation and Chemotherapy > Flashcards

Oral Complications Associated with Radiation and Chemotherapy Flashcards

1
Q

An abnormal growth of cells which tend
to proliferate in an uncontrolled way
and, in some cases, to metastasize
(spread).

A

Cancer

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2
Q

T/F: Decreased alcohol and tobacco use has has a
significant effect on the incidence of SSC in the oral
cavity

A

True

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3
Q

What is the number 1 risk factor for oropharyhgeal cancer?

A

HPV

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4
Q

Which HPV types are associated with oropharyngeal SCC?

A

HPV 16 and 18

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5
Q

Does HPV cancers occur early or later in life?

A

Earlier: 40-59 yrs

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6
Q 
THE ONLY WAY TO 
DEFINITIVELY
DIAGNOSE ORAL
PATHOLOGY
IS WITH A
\_\_\_\_\_\_
A

BIOPSY

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7
Q

All the tissue between the portals receives the same

dose

A

Fixed beam radiation

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8
Q

 A constantly moving beam administers different
amounts of radiation to the tissues
 The tumor receives the highest amount of
radiation.
 Minimal amounts of radiation are applied to vital
structures. (spinal cord, salivary glands)

A

Intensity Modulated Radiation

Therapy

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9
Q

 The application of radiation therapy in smaller
consecutive doses to minimize the lethal effects and limit
the side effects of the therapy.
 The dose is usually administered 5 times a week for 5 to
7 consecutive weeks.

A

Fractionation

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10
Q

What are the 5 Rs of fractionation?

A 
 Repair
 Redistribution
 Repopulation
 Reoxygenation 
 Radiosensitivity
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11
Q

What radiation complication is the biggest issue in pts?

A

Xerostomia and dental caries

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12
Q

Hypofunction can occur when exposed radiation

doses as low as ___ Gy

A

25 Gy

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13
Q

Are Serous glands or mucous glands more sensitive to radiation?

A

Serous

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14
Q

Do dental caries progress more quickly or slower in radiation pts?

A

Quicker

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15
Q

 Sugar alcohol originally derived from birch trees
 Commercially produced from corn cobs (xylan)
 Caries causing bacteria are unable to metabolize it
 Ingesting 6-8 grams daily can decreased caries
 Frequency of use more important than quantity
 Available as a packaged sweetener or in gums, mints,
candies and oral rinses

A

Xylitol

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16
Q

 Cholinergic agonist

 5-10mg tid
 Max dose 30mg/day
 May take 12 weeks to see results

  • Affects bp and HR
  • Best tx for xerostomia
A

 Pilocarpine hydrochloride

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17
Q

 Oral mucosa exposed to radiation becomes
edematous, erythematous, and ulcerated.
 The condition can be extremely painful and cause
issues with mastication and swallowing.
 The signs and symptoms often arise after the
second week of therapy and may last a few weeks
after the completion of treatment

18
Q 
 Mild Pain
 Maintain oral hygiene
 Use bland oral rinses
 Baking soda/water
 With/without salt
 Use topical oral pain management
 Caphosol
 Magic Mouthwash
 Viscous lidocaine, Maalox, diphenhydramine
 With/without nystatin
 Mild analgesics (OTC)

 Moderate pain
 Addition of moderate strength opioids
 Hydrocodone and oxycodone
 Altered diet (soft)

 Severe pain
 Addition of strong opioids
 Oxycodone, morphine, oxymorphone
 May need nasogastric or PEG tube

A

Mucositis tx

19
Q

 Viscous lidocaine, Maalox, diphenhydramine

 With/without nystatin

A

Magic Mouthwash

20
Q

 Radiation results in vascular changes in the bone
limiting the blood supply and the ability to heal
after trauma or extractions
 Associated with radiation doses above 50 Gy
 More common with the mandible

21
Q

What Gy of radiation are associated with ORN?

22
Q

Is ORN more common in mand or max?

23
Q

Stage ___ ORN
 No exposed bone, but pt. is symptomatic
 Radiographic changes may be present
 Treatment
 Periodic monitoring
 Systemic management (antibiotics and pain meds)

24
Q

Stage ___ ORN

 Bone is exposed, asymptomatic, no infection present
 Treatment:
 Monitor closely for 8 weeks
 If no changes, continue to monitor quarterly
 Meticulous home care
 Antimicrobial oral rinses
 Remove loose sequestra if present

A

 Stage 1:

25
Q

Stage ___ ORN

 Exposed bone with associated pain 
 Purulent exudate may be present
 Treatment:
 Same treatment as Stage 1
 Addition of systemic antibiotics(Penicillin, Clindamycin, 
Doxycycline)
 Superficial debridement to relieve soft tissue irritation
 Possible hyperbaric oxygen therapy?
A

 Stage 2:

26
Q

Stage ___ ORN

 Exposed bone with pain and one of the following:
 Pathologic fracture
 Extra-oral fistula
 Necrotic lesion extends to the inferior border
 Treatment:
 Surgical debridement or resection
 Antibiotic therapy
 Possible hyperbaric oxygen?
A

 Stage 3:

27
Q

 Primarily occurs when the pterygoid region is irradiated
 Usually noticed near the completion of radiation therapy
 Radiation may cause spasms or fibrosis of the TMJ
and muscles of mastication resulting in a limited
range of motion
 The effects of trismus usually are not permanent,
but may last for several months after the
completion of radiation therapy
 Treatment:
 Warm, moist heat
 Massage
 Physical therapy
 Tongue depressors
 TheraBite
 Dynasplint

28
Q

Permanent taste loss may occur with a cumulative dose

of ___ Gy.

29
Q

Wait __-__ months after the completion of radiation to

fabricate dentures and RPDs

A

6-9 months

30
Q

 a form of cancer treatment that involves taking one or
more of a type of drug that interferes with the DNA
(genes) of fast-growing cells. These drugs are further
subdivided into specific classes such as alkylating
agents, antimetabolites, anthracyclines, and
topoisomerase inhibitors.

A

Chemotherapy

31
Q

Effects of ______:

 Immune system suppression
 Mucositis
 Xerostomia
 Bleeding
 Hypogeusia/Dysgeusia
A

Chemotherapy

32
Q

T/F: Avoid any dental treatment if possible during

chemotherapy

33
Q

Pts usually reach their “nadir”(lowest blood counts) __-___

days after a course of chemo

34
Q

T/F: If treatment is needed, blood counts are usually best just
prior to their next course of chemo

35
Q

What do you want ANC count to be for OS in chemo pts?

A

Above 1000

36
Q

What do you want platelet count to be for OS in chemo pts?

37
Q

 Chemotherapy is used to destroy the bone marrow
 Hematopoietic stem cells are then transplanted to
repopulate the bone marrow

A

Bone marrow transplant

38
Q

 The pts own bone marrow or stem cells are removed

and preserved for transplantation.

A

Autologous

39
Q

 Bone marrow or stem cells from a HLA (Human
leukocyte antigen) matched individual are used for
transplantation.

A

Allogeneic

40
Q

 Bone marrow or stem cells from an identical twin are

used for transplantation.

41
Q

How long do you want to wait to do any routine dental care after a bone. marrow transplant?

42
Q

 Occurs primarily with allogeneic transplants
 Treatment involves severe immunosuppression
 Oral manifestations:
 Mucositis
 Infections (bacterial, fungal, viral)
 Mucosal atrophy
 Xerostomia

A

Graft versus host disease

Oral Oncology (4 decks)

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