Cancer Symposium

Question 1

What are some of the risk factors for oral cancer?

Answer 1

• Smoking
• Alcohol
• HPV (affects oropharyngeal/tonsil)
• Immune suppression

Question 2

How is dysplasia developed?

Answer 2

damage to the normal mucosa repeatedly

Question 3

What is low grade /mild dysplasia limited to?

Answer 3

basal 1/3 of the mucosa

Question 4

What is high grade / severe dysplasia limited to?

Answer 4

top 2/3 of the mucosa

Question 5

What stages of cancer is no longer reversible?

Answer 5

Carcinoma In-situ and Invasive carcinoma

Question 6

What does TNM stand for in the classification?

Answer 6

Tumour
Nodes
Metastases

Question 7

What does symptom mean?

Answer 7

What the patient experiences

Question 8

What does sign mean?

Answer 8

What we can see clinically

Question 9

What are common signs of oral cancer?

Answer 9

White patches (leukoplaplakia)
Red patches (erythroplakia)
Speckled patches (spelled leukoplakia)
Ulcer
Lumps
Unexplained bleeding
Unexplained pain
Osteolytic lesion
Trismus (if cannot open more than 15mm)

Question 10

What is known to be a high risk area for oral cancer and why?

Answer 10

Floor of the mouth
(toxins from tobacco/alcohol - gravity hold them in the floor of the mouth)

Question 11

What is a common site for oral cancer?

Answer 11

Lateral border of the tongue

Question 12

What appearance would a cancerous ulcer have?

Answer 12

big ulcer with raised rolled edge

Question 13

After how long should persistent ulcers be treated with suspicion?

Answer 13

3 weeks

Question 14

What does MDT stand for? What do they do?

Answer 14

Multi-disciplinary team - This is a team of health professionals who work together to decide on the best treatment and care for you. It can include: specialist head and neck surgeons. doctors who specialise in cancer drug treatments (medical oncologist)

Question 15

What appearance does frictional keratosis have in the mouth?

Answer 15

Long occlusal line from cheek biting on buccal mucosa

Question 16

What increased risk does a patinet with high grade/severe dysplasia have of developing oral cancer if untreated?

Answer 16

50%

Question 17

If an individual has been referred to oral surgery, how long should they expect a diagnosis/tx plan and 1st tx?

Answer 17

within 31 days and first tx within 62 days

Question 18

What assessment would you undertake for the primary site of cancer?

Answer 18

• clinical assessment
• radiographic
• scans (MRI/CT)

Question 19

What scan would you take if you suspect bone involvement?

Answer 19

CT

Question 20

What assessment would you undertake for the regional lymph nodes of cancer?

Answer 20

• clinical assessment
• scans (MRI)
• CT scan

Question 21

What assessment is routine to undertake for the distant metastases of cancer?

Answer 21

CT scan of the chest

Question 22

What is the measurement of limited mouth opening (trismus) that would be concerning and a red flag for oral cancer?

Answer 22

cannot open >15mm

Question 23

which lymph nodes tend to metastasis first in cancer?

Answer 23

submandibular lymph nodes

Question 24

How is lymph involvement treated?

Answer 24

Neck dissection

Question 25

How might a white patch with some ulceration on the side of the tongue be treated?

Answer 25

Wide local excision

Question 26

Why is it important to cut out the cancer and get 1cm around it (if possible?)

Answer 26

Due to microscopic disease spreading from the primary tumour into tissues that you cant see - it is done to reduce the risk of recurrent disease

Question 27

What is the treatment for regional metastases?

Answer 27

Surgery/neck dissection/reconstruction/radiotherapy/chemotherapy

Question 28

As radiotherapy affects the salivary glands, what effects can this have on the oral cavity?

Answer 28

Dry mouth

Question 29

What is osteoradionecrosis?

Answer 29

Occurs when radiotherapy affects the fibroblasts and endothelial cells in blood vessels (they tend to get thicker) and you get a condition called endarteritis obliterans (very small arteries in the tissue get blocked and so the bone cannot heal)

Question 30

What is the role of GDP in oral cancer?

Answer 30

promote oral health and oral cancer awareness screening

Question 31

What are the effects of radio treatment?

Answer 31

Loss of teeth Changes in soft tissues/hard tissues Dry mouth Caries risk increased ORN

Question 32

What is the roll of a dentist in the long term follow up of Oral cancer pts?

Answer 32

Recurrent disease Managing tooth loss (dentrure) Managing changes in soft and hard tissues Managing pt caries risk Managing risk of developing osteoradionecrosis

Question 33

What is the period of follow up?

Answer 33

5 years Every month for 1st year Every 2months for 2nd year Every 3 months for 3rd year Every 4-6months for the 5th year

Question 34

How do we reduce patient delay?

Answer 34

Patient awareness Public awareness Populated screening Targeted screening (high risk groups) Opportunistic screening (dental appt)

Question 35

How do we reduce referral delay?

Answer 35

Clinician awareness Guidelines

Question 36

What is populartion screening?

Answer 36

Whole of the at risk popilation

Question 37

What is opportunistic screening?

Answer 37

Dental check up

Question 38

What is targeted screening?

Answer 38

Those at the highest risk