Oral Complications Associated with Radiation and Chemotherapy

Question 1

Cancer
Definition

Answer 1

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

Question 2

— million people living with cancer
 Approx. – million male
 Approx. – million female

Answer 2

11.7
5.4
6.3

Question 3

– million people diagnosed with cancer every year
 Approx. – male
 Approx. – female

Answer 3

1.5
760,000
740,000

Question 4

— diagnosed with oral cavity or pharynx cancer
every year
 – men vs. – women
 – with oral cancer
 – tongue cancer
 – pharynx cancer

Answer 4

36,540
25,000
11,000

11,000
11,000
12,000

Question 5

 Head and Neck Cancers make up –% of all cancers
 – most common cancer in men
 Not in the top – for women

Answer 5

3
8th
10

Question 6

Squamous Cell Carcinoma
2 Areas

Answer 6

 Oral Cavity
 Oropharynx

Question 7

The Oral Cavity
(6)

Answer 7

 Gingiva
 Floor of the Mouth
 Anterior portion of the Tongue
 Buccal Mucosa
 Hard Palate
 Teeth

Question 8

Oral Cavity SCC
Risk Factors
(6)

Answer 8

 Smoking
 Alcohol
 Smokeless tobacco
 Marijuana
 Betel quid (India and SE Asia)
 Chronic irritation

Question 9

Decreased – use has has a
significant effect on the incidence of SSC in the oral
cavity

Answer 9

alcohol and tobacco

Question 10

–% decrease every year from 1973-2004 for non-HPV
related oral cavity SSC

Answer 10

1.9

Question 11

The survival rates of oral cavity non-HPV SSC has not
improved dramatically
 In 1999, the 5 year survival rate for oral cavity cancer
was
 Men – –%
 Women – –%

Answer 11

48
55

Question 12

Why the Poor Survival Rate?
(3)

Answer 12

 LATE DETECTION
 Proximity to the cervical lymph nodes
 The oral SCC may be a metastatic lesion and not the
primary

Question 13

The Oropharynx
(4)

Answer 13

 Soft palate
 Tonsils
- Lingual
- Palatine
 Base of the tongue
 Pharynx
- Lateral
- Posterior

Question 14

Oropharyngeal SCC Risk Factors
(3)

Answer 14

 Human Papilloma Virus (HPV)
 Alcohol
 Tobacco

Question 15

The Human Papilloma Virus
– million Americans infected (14 million per year)

Answer 15

79

Question 16

HPV
Over – types
 – subtypes

Answer 16

40
120

Question 17

HPV (2) associated with oropharyngeal SSC

Answer 17

16 and 18

Question 18

Over – men and – women diagnosed with HPV-
positive SSC yearly

Answer 18

9000
2300

Question 19

Getting Tested

Answer 19

 OraRisk HPV Testing
- Rinse with saline and expectorate
 What information is provided?

Question 20

HPV Positive SCC
(3)

Answer 20

 E6 and E7 oncoprotiens from HPV dysregulate the
function of tumor suppressor genes (P53 and pRB)
 Non-keratinized lesions with minimal or no epithelial
dysplasia
 Lobular growth

Question 21

The Good News on HPV-Associated
Oropharyngeal SCC
(2)

Answer 21

 Highly responsive to radiation and chemotherapy
 2 year survival rate
 HPV-positive – 94%
 HPV-negative – 58%
 Preventable

Question 22

HPV Vaccinations
(2)

Answer 22

Guardasil
Cervarix

Question 23

Guardasil
(3)

Answer 23

 HPV 6, 11, 16, 18
 Available to boys and girls
 3 injections over 6 months

Question 24

Cervarix
(3)

Answer 24

 HPV 16 and 18
 Available to girls only
 3 injections over 6 months

Question 25

In 1973, oropharyngeal cancers accounted for 18% of
all head and neck cancers, now it accounts for 31%
 —% annual increase for base of the tongue SCC (1973-
2004)
 —% annual increase for tonsillar SCC (1973-2004)

Answer 25

1.3
0.6

Question 26

Why the shift from the oral cavity to
the oropharynx?
(2)

Answer 26

 Widespread education on the ills of smoking and
alcohol
 Changes in sexual behavior
- Increase in the number of sexual partners
- Oral sex

Question 27

The Bad News On HPV Associated
Oropharyngeal SCC
Onset
 Significant long term oral issues related to —

Answer 27

 Early Onset
 40-59 yoa
radiation
therapy

Question 28

The Six Step Oral Cancer Screening

Answer 28

 Tongue ‘n Gauze
 Lip & Cheek Roll
 Double-Digit Probe
 Palate Tickle
 Neck Caress
 Tonsil Ahhhhhhhh

Question 29

Adjunctive aids
(4)

Answer 29

 Vital Tissue Staining
 Transepithelial Brush Test
 Tissue Auto fluorescence
 Tissue Reflectance (chemiluminescence)

Question 30

Vital Tissue Staining
(4)

Answer 30

 Toluidine blue
 Pre and post rinse with 1% acetic acid
 TB stains acidic components of the cells
 Dysplastic tissues contain increased levels of nucleic
acids (increased cell replication)
Vital Tissue Staining

Question 31

Transepithelial Brush test
(2)

Answer 31

 OralCDx test
 Press the brush on the suspect areas and rotate until
bleeding occurs

Question 32

OralCDx Report
 Positive:
 Atypical:
 Negative:

Answer 32

Dysplasia or carcinoma
Abnormal changes
Normal epithelium

Question 33

Tissue Auto fluorescence
(2)

Answer 33

 VELscope
 Utilizes blue excitation light (430 nM)

Question 34

 Utilizes blue excitation light (430 nM)
Based on the absorptive and reflective pattern of
— in the tissue
 Components of cellular metabolism
(2)

Answer 34

fluorophores

 Nicotine adenine dinucleotide
 Flavin adenine dinucleotide

Question 35

“Other Dark Spots”
(6)

Answer 35

 Lichen planus
 Migratory glossitis
 Amalgam tattoos
 Racial pigmentation
 Traumatic fibroma
 Nicotine stomatitis

Question 36

Tissue Reflectance
(Chemiluminescence)
(2)

Answer 36

 Orascoptic DK
 MicroLux/DL

Question 37

Tissue reflectance

Answer 37

Rapid replication of DNA in pre-cancerous and
cancerous lesions results in large nuclei that occupy a
majority of the cell and reflect white light

Question 38

Tissue Reflectance
(3)

Answer 38

 Rinse with 1% acetic acid
 Illuminate with blue-white light
- 440 nM
 Suspect lesions are “acetowhite”

Question 39

Tissue Reflectance
ViziLite Tblue
(4)

Answer 39

 Rinse with 1% acetic acid
 Evaluate with blue-white light
 Mark suspect lesions with Tblue
 Re-evaluate under normal light

Question 40

Identafi 3000
Provides – different wavelengths of light

Answer 40

3

Question 41

Provides 3 different wavelengths of light

Answer 41

 White light
 Violet light-excited fluorescence (405 nM)
 Green-amber reflected light

Question 42

 White light

Answer 42

 Conventional oral examination

Question 43

 Violet light-excited fluorescence (405 nM)

Answer 43

 Same concept as Velscope auto-fluorescence

Question 44

 Green-amber reflected light

Answer 44

 Hemoglobin absorb the light and present as dark areas
 Normal – delineated blood vessels
 Abnormal – disorganized “fuzzy” appearance