Oral Complications Associated with Radiation and Chemotherapy Flashcards
Cancer
Definition
An abnormal growth of cells which tend
to proliferate in an uncontrolled way
and, in some cases, to metastasize
(spread).
— million people living with cancer
Approx. – million male
Approx. – million female
11.7
5.4
6.3
– million people diagnosed with cancer every year
Approx. – male
Approx. – female
1.5
760,000
740,000
— diagnosed with oral cavity or pharynx cancer
every year
– men vs. – women
– with oral cancer
– tongue cancer
– pharynx cancer
36,540
25,000
11,000
11,000
11,000
12,000
Head and Neck Cancers make up –% of all cancers
– most common cancer in men
Not in the top – for women
3
8th
10
Squamous Cell Carcinoma
2 Areas
Oral Cavity
Oropharynx
The Oral Cavity
(6)
Gingiva
Floor of the Mouth
Anterior portion of the Tongue
Buccal Mucosa
Hard Palate
Teeth
Oral Cavity SCC
Risk Factors
(6)
Smoking
Alcohol
Smokeless tobacco
Marijuana
Betel quid (India and SE Asia)
Chronic irritation
Decreased – use has has a
significant effect on the incidence of SSC in the oral
cavity
alcohol and tobacco
–% decrease every year from 1973-2004 for non-HPV
related oral cavity SSC
1.9
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 – –%
48
55
Why the Poor Survival Rate?
(3)
LATE DETECTION
Proximity to the cervical lymph nodes
The oral SCC may be a metastatic lesion and not the
primary
The Oropharynx
(4)
Soft palate
Tonsils
- Lingual
- Palatine
Base of the tongue
Pharynx
- Lateral
- Posterior
Oropharyngeal SCC Risk Factors
(3)
Human Papilloma Virus (HPV)
Alcohol
Tobacco
The Human Papilloma Virus
– million Americans infected (14 million per year)
79
HPV
Over – types
– subtypes
40
120
HPV (2) associated with oropharyngeal SSC
16 and 18
Over – men and – women diagnosed with HPV-
positive SSC yearly
9000
2300
Getting Tested
OraRisk HPV Testing
- Rinse with saline and expectorate
What information is provided?
HPV Positive SCC
(3)
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
The Good News on HPV-Associated
Oropharyngeal SCC
(2)
Highly responsive to radiation and chemotherapy
2 year survival rate
HPV-positive – 94%
HPV-negative – 58%
Preventable
HPV Vaccinations
(2)
Guardasil
Cervarix
Guardasil
(3)
HPV 6, 11, 16, 18
Available to boys and girls
3 injections over 6 months
Cervarix
(3)
HPV 16 and 18
Available to girls only
3 injections over 6 months
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)
1.3
0.6
Why the shift from the oral cavity to
the oropharynx?
(2)
Widespread education on the ills of smoking and
alcohol
Changes in sexual behavior
- Increase in the number of sexual partners
- Oral sex
The Bad News On HPV Associated
Oropharyngeal SCC
Onset
Significant long term oral issues related to —
Early Onset
40-59 yoa
radiation
therapy
The Six Step Oral Cancer Screening
Tongue ‘n Gauze
Lip & Cheek Roll
Double-Digit Probe
Palate Tickle
Neck Caress
Tonsil Ahhhhhhhh
Adjunctive aids
(4)
Vital Tissue Staining
Transepithelial Brush Test
Tissue Auto fluorescence
Tissue Reflectance (chemiluminescence)
Vital Tissue Staining
(4)
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
Transepithelial Brush test
(2)
OralCDx test
Press the brush on the suspect areas and rotate until
bleeding occurs
OralCDx Report
Positive:
Atypical:
Negative:
Dysplasia or carcinoma
Abnormal changes
Normal epithelium
Tissue Auto fluorescence
(2)
VELscope
Utilizes blue excitation light (430 nM)
Utilizes blue excitation light (430 nM)
Based on the absorptive and reflective pattern of
— in the tissue
Components of cellular metabolism
(2)
fluorophores
Nicotine adenine dinucleotide
Flavin adenine dinucleotide
“Other Dark Spots”
(6)
Lichen planus
Migratory glossitis
Amalgam tattoos
Racial pigmentation
Traumatic fibroma
Nicotine stomatitis
Tissue Reflectance
(Chemiluminescence)
(2)
Orascoptic DK
MicroLux/DL
Tissue reflectance
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
Tissue Reflectance
(3)
Rinse with 1% acetic acid
Illuminate with blue-white light
- 440 nM
Suspect lesions are “acetowhite”
Tissue Reflectance
ViziLite Tblue
(4)
Rinse with 1% acetic acid
Evaluate with blue-white light
Mark suspect lesions with Tblue
Re-evaluate under normal light
Identafi 3000
Provides – different wavelengths of light
3
Provides 3 different wavelengths of light
White light
Violet light-excited fluorescence (405 nM)
Green-amber reflected light
White light
Conventional oral examination
Violet light-excited fluorescence (405 nM)
Same concept as Velscope auto-fluorescence
Green-amber reflected light
Hemoglobin absorb the light and present as dark areas
Normal – delineated blood vessels
Abnormal – disorganized “fuzzy” appearance
