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Dr Curtin > Week 5- Oncology Management > Flashcards

Week 5- Oncology Management Flashcards

1
Q

Are all carcinomas epithelial in origin?

A

Yes

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2
Q

What are the tx options for OSCC?

A
  • No Treatment
  • Surgery
  • Radiotherapy
  • Chemotherapy
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3
Q

What does staging reflect?

A

Statistical prognosis for given treatment

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4
Q

What is the main route for treating OSCC?

A

Surgery (often combined with radiotherapy or radiotherapy + chemotherapy)

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5
Q

How would you pre-operatively assess/plan for a patient with OSCC scheduled for surgery and post-operative radiotherapy?

A
  1. Patient education on potential oral side effects and strategies to prevent/mitigate occurrence
  2. Comprehensive oral examination several weeks before radiation begins to provide enough time if invasive procedures are necessary.
  3. Development of a dental treatment plan that anticipates possible complications during radiation
  4. Extractions done 10-21 days earlier to avoid risk of ORN.
  5. OH and dietary counselling
  6. Fluoride treatment
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6
Q

What is radiotherapy/chemotherapy aimed at?

A

Aimed at rapidly dividing cells (skin, mucosa, nails, hair, blood cells).

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7
Q

Are chemo and radiotherapy localised or systemic?

A
  • Chemo is systemic
  • Radiotherapy is localised.
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8
Q

Why does oral health sometimes not go according to plan during cancer treatment?

A
  • Altered pt priorities
  • Pt incapacity
  • Altered oral physiology
  • Cannot get to dentist
  • Financial flow-on
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9
Q

What is assessed in dental pre-operative appt before pt undergoes radiotherapy?

A

Pt needs to visit dentist to identify problem teeth (clinic exam, pulp testing, radiography and OPG) and perio issues.

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10
Q

How should you manage exo post-radiotherapy?

A

Refer to OMFS to complete atraumatic exo.

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11
Q

What is the mechanism of action of radiotherapy?

A

Uses radiation to stop growth of cancer cells (killing or stopping cell division).

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12
Q

What structures are affected by radiotherapy?

A
  • Skin- long term
  • Mucosa
  • Salivary glands- long term
  • Bone- long term
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13
Q

What are side effects of radiotherapy dependent on?

A
  • Dose
  • Technique
  • Tumour location
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14
Q

Why are salivary glands affected by radiotherapy?

A

Cells of salivary gland have epithelial cells (rapidly dividing cells) so radiation
affects salivary glands greatly.

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15
Q

What are issues with xerostomia?

A
  • Dental/mucosal issues
  • Difficulty eating
  • Infection
  • Mucosa becomes atrophic
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16
Q

Why should surgery be performed before radiotherapy?

A

Do surgery first (so it can heal) and then radiotherapy because after radiotherapy, tissues will be permanently affected.

17
Q

What is the mechanism of action of chemotherapy?

A

Uses drugs to stop growth of cancer cells (killing or stopping cell division)

18
Q

What are modes of delivery of chemotherapy?

A
  • Oral
  • Injection
  • Topical
  • IV
19
Q

What are side effects of chemotherapy?

A
  • Myelosuppression (mucositis)
  • Neutropenia (infections)
  • Fungal (thrush)
  • Viral (herpes simplex, cytomegalovirus)
  • Infections
  • Pain> cannot eat
20
Q

What is the nadir point of chemotherapy? (lowest blood cell count during tx cycle)

A

7-14 days

21
Q

When is bone marrow recovery after chemotherapy?

A

3-4 weeks

22
Q

What are limitaitons of chemotherapy?

A
  • Individual cancer biology
  • Pt tolerance
23
Q

What are oral impacts of chemotherapy?

A
  • Mucositis
    Oral thrush
    Sloughing of mucosa
24
Q

What are prophylactic dental measures for pts undergoing chemo or radiotherapy?

A

Pre-treatment- identify and manage problematic teeth (esp those within field of radiation)

25
Q

What are treatments for patients with xerostomia?

A
  • Sialagogues (drug that makes more saliva)
  • Salivary gland substitutions
  • Cold water and crushed ice
26
Q

Why should exos during chemo or radiotherapy be proceeded with caution?

A
  • Bleeding issues
  • Healing issues
  • Long term bone impacts

Dr Curtin (4 decks)

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