Cancer Flashcards
What are the referral guidelines for cancer
The following should be referred as an emergency referral
* Stridor
Other
Persistent unexplained head and neck lumps for >3 weeks
Unexplained ulceration or unexplained swelling/induration of the oral mucosa persisting for >3 weeks
All unexplained red or mixed red and white patches of the oral mucosa persisting for >3 weeks
Persistent (not intermittent) hoarseness lasting for >3 weeks. If other symptoms are present to suggest suspicion of lung cancer, refer via lung cancer guideline
Persistent pain in the throat or pain on swallowing lasting for >3 weeks
How should you assess px due to go through cancer tx
- Thorough oral and dental assessment prior to cancer therapy
- Radiographs (OPT/PA)
- Carry out any necessary tx, want px to be dentally fit prior
- Hygiene appointment
- Impressions for fluoride tray
- Start fluoride therapy for dentate patients
How should you reduce cancer tx complications
- Want to avoid unscheduled interruption of chemotherapy regimen
- Avoid exacerbation of mucositis
- Remove potential sources of infection
How do we reduce post-tx complications
Remove teeth of dubious prognosis prior as going to be harder to remove post radiotherapy
Institute preventative regime
Plan rehabilitation
What are the oral side effects of cancer tx
ulceration
mucositis
oral candida
reactivation of herpes
xerostomia
trismus
How do we manage mucositis
- Topical lidocaine
- Saline mouthwash
- Tea tree oil mouthwash
How do we avoid mucositis
Smoking
Spirits
Spicy foods
Tea & coffee
Non prescription MW
How do we prevent mucositis
CHX
Cryotherapy
Keratinocyte growth
What is the treatment for mucositis
Low level laser light therapy
Morphine
How do we grade mucositis
0 (none) = none
1 (mild) = oral soreness & erythema
2 (moderate) = oral erythema, ulcers and solid diet tolerated
3 (severe) = oral ulcers, liquid diet only
4 (life threatening
How does HSV present in cancer px
Tends to be intra-oral and clinically atypical
Painful ulceration of sudden onset
More extensive, slow healing and aggressive
High index of clinical suspicion
Why do cancer px experience xerostomia
- Reduced salivary flow
- Saliva consistency increases in viscosity and reduces in pH
- Doesn’t tend to go back to normal
- Results in following problems
- Dysphagia
- Dysarthria (difficulty speaking)
- Dysgeusia (metallic taste)
- Increased risk of caries, periodontal disease, candida
- Prosthodontic difficulties
Why do cancer px get trismus
Due to fibrosis of the muscle
How do we manage cancer px post treatment
Salivary replacements for xerostomia
High fluoride
Radiation induced caries common
Periodontal disease common
Aim to use modern caries management and avoid extractions due to risk of ORN
