Orofacial Pain and Cancer Flashcards
What kind of orofacial pain is seen in cancer?
Acute OFP (due to primary tumour, metastatic disease, systemic cancer, distant non-metastatic cancer, therapy)
Chronic OFP
What is the role of the dentist in OFP caused by cancer?
Recognize cause of the pain and refer promptly and appropriately.
Pain management is multi-factorial and dentist can optimize pre-treatment conditions to reduce chance of mucositis and other complications
What kind of pain is associated with primary tumours?
Can be the presenting complaint of a patient thinking they bit their tongue and it never healed.
Could be advanced stage of disease.
What does pain indicate about a primary tumour?
Pain is a poor prognostic indicator associated with stage 3 or 4 cancers
What does pain in a salivary gland neoplasm indicate?
Pain is usually an indicator of malignancy. A painless lump is often benign
What are the indicators of nasopharyngeal malignancies and which factors mean increased likelihood of finding nasopharyngeal malignancies?
Discomfort in maxilla, oral cavity, and teeth. It is rare and related to ebstein-barr virus.
TMD, odontogenic infections with trismus, and parotid lesions are more likely to have nasopharyngeal malignancies.
Aching, dull, pressing or intermittent pain.
What are the typical signs of osteosarcoma of the jaw?
Swelling of the jaw and pain.
VERY RARE
What are the symptoms of an osteoma?
Always painful
Relieved by aspirin
Benign
How do intracranial malignancies typically present? What imaging should be taken for these?
Most commonly present as trigeminal neuralgia and worsening with time.
Progressive neurological deficits which may be subtle especially if posterior fossa tumour.
MRI for these patients
How does OFP associated with metastases present clinically?
It is rare and when present is most often present in the mandible (39%) on the angle or ramus.
Breast and prostate most common cancers to metastasize to mandible.
Rarely soft tissue metastases from lung or attached gingiva.
Which systemic malignancies can lead to OFP?
Lymphoma
Leukemia
Multiple myeloma
All can affect the head and neck region
What causes pain associated with systemic malignancies?
Periosteum and gingival infiltration.
Multiply myeloma causes multiple osteolytic lesions as well as odontogenic pain adjacent to tooth roots.
What are the features of OFP secondary to non-metastatic malignancy?
Referred pain
Most often lung primary
Facial pain is almost always unilateral
Pain is often severe, aching, continuous, and progressive commonly localized to:
Ear (84%)
Jaws (48%)
Temporal region (38%)
What therapy can cause the pain associated with cancers?
Surgical procedures
Chemo
Radiotherapy
Infection
What pain management is given pre-operatively to patients undergoing surgery?
Pre-op are given lyrica to reduce post op pain.
