Week 5- Oncology Management Flashcards
Are all carcinomas epithelial in origin?
Yes
What are the tx options for OSCC?
- No Treatment
- Surgery
- Radiotherapy
- Chemotherapy
What does staging reflect?
Statistical prognosis for given treatment
What is the main route for treating OSCC?
Surgery (often combined with radiotherapy or radiotherapy + chemotherapy)
How would you pre-operatively assess/plan for a patient with OSCC scheduled for surgery and post-operative radiotherapy?
- Patient education on potential oral side effects and strategies to prevent/mitigate occurrence
- Comprehensive oral examination several weeks before radiation begins to provide enough time if invasive procedures are necessary.
- Development of a dental treatment plan that anticipates possible complications during radiation
- Extractions done 10-21 days earlier to avoid risk of ORN.
- OH and dietary counselling
- Fluoride treatment
What is radiotherapy/chemotherapy aimed at?
Aimed at rapidly dividing cells (skin, mucosa, nails, hair, blood cells).
Are chemo and radiotherapy localised or systemic?
- Chemo is systemic
- Radiotherapy is localised.
Why does oral health sometimes not go according to plan during cancer treatment?
- Altered pt priorities
- Pt incapacity
- Altered oral physiology
- Cannot get to dentist
- Financial flow-on
What is assessed in dental pre-operative appt before pt undergoes radiotherapy?
Pt needs to visit dentist to identify problem teeth (clinic exam, pulp testing, radiography and OPG) and perio issues.
How should you manage exo post-radiotherapy?
Refer to OMFS to complete atraumatic exo.
What is the mechanism of action of radiotherapy?
Uses radiation to stop growth of cancer cells (killing or stopping cell division).
What structures are affected by radiotherapy?
- Skin- long term
- Mucosa
- Salivary glands- long term
- Bone- long term
What are side effects of radiotherapy dependent on?
- Dose
- Technique
- Tumour location
Why are salivary glands affected by radiotherapy?
Cells of salivary gland have epithelial cells (rapidly dividing cells) so radiation
affects salivary glands greatly.
What are issues with xerostomia?
- Dental/mucosal issues
- Difficulty eating
- Infection
- Mucosa becomes atrophic
Why should surgery be performed before radiotherapy?
Do surgery first (so it can heal) and then radiotherapy because after radiotherapy, tissues will be permanently affected.
What is the mechanism of action of chemotherapy?
Uses drugs to stop growth of cancer cells (killing or stopping cell division)
What are modes of delivery of chemotherapy?
- Oral
- Injection
- Topical
- IV
What are side effects of chemotherapy?
- Myelosuppression (mucositis)
- Neutropenia (infections)
- Fungal (thrush)
- Viral (herpes simplex, cytomegalovirus)
- Infections
- Pain> cannot eat
What is the nadir point of chemotherapy? (lowest blood cell count during tx cycle)
7-14 days
When is bone marrow recovery after chemotherapy?
3-4 weeks
What are limitaitons of chemotherapy?
- Individual cancer biology
- Pt tolerance
What are oral impacts of chemotherapy?
- Mucositis
Oral thrush
Sloughing of mucosa
What are prophylactic dental measures for pts undergoing chemo or radiotherapy?
Pre-treatment- identify and manage problematic teeth (esp those within field of radiation)
