Head & Neck Cancer Flashcards
What are some general side-effects of chemotherapy?
Bone marrow suppression - higher risk of bleeding
High-turnover cells are lost/ attacked - hair, skin, oral mucosa
Immunosuppression - WBC are lost - infection risk is higher.
Xerostomia
Nausea
Fatigue
What is oral mucositis?
Severe inflammation and ulceration of the oral mucosa as a result of chemotherapy/ radiotherapy (attacking high-turnover oral mucosa cells)
Extremely painful - can stop patient being able to take food/ drink orally.
Begins 1-2 weeks after treatment starts
Sometimes have to stop treatment to cure/ relieve symptoms.
In the TNM cancer staging and grading system, what does the T, N and M mean?
T - refers to size and extent of main tumour - main tumour is usually called primary tumour
N - refers to number of nearby lymph nodes that have cancer
M - refers to whether cancer has metastasised or not.
What are the main aims of a dental pre-cancer assessment?
Identify existing disease and potential risk of disease.
Remove infection and potential infection before start of cancer therapy.
Establish adequate OH
Develop plan for maintaining OH, provide preventative care and follow-up.
Establish multi-disciplinary collaboration with cancer specialists/ patient’s cancer team.
Plan post-treatment prosthetic oral rehabilitation.
Why would you take impressions of patient pre-cancer treatment?
To make fluoride trays in case of oral mucositis or soft splints for example.
What are the main dental issues during cancer treatment?
Oral mucositis
Candida infections
Traumatic ulceration - due to increased xerostomia, teeth/ restorations may cause increased trauma in the mouth that otherwise would not have caused problems.
Re-activation of herpes simplex virus - can spread across whole mouth/ face. More extensive, slower healing.
What is the difference in effect on salivary glands/ dry mouth between radiotherapy and chemotherapy treatment?
Chemotherapy - dry mouth DURING TREATMENT - because everything is run-down and toxified in body. Saliva should eventually return to normal post-treatment.
Radiotherapy - irradiates saliva glands. 50-60% saliva loss. Long-term side-effects of radiation. Saliva glands may stop working entirely, a few years post-treatment.
Saliva will increase in viscosity and decrease in pH
What are priorities in management of patient pre-cancer treatment?
Immediate - removal of infection/ pain
Initial/ stabilisation - extractions
Reconstructive
Maintenance
What is the role of the dentist during a patient’s cancer treatment?
Hygienist support
Oral and denture hygiene
Diet advice
Antibacterial MW - chlorhexidine - short-term alternative to brushing
Examine for high-risk of viral and fungal infections
Treatment/ symptomatic relief of mucositis/ xerostomia etc.
Emergency dental treatment - liaise with cancer team.
Which anti-fungal medication does NOT appear to be effective in preventing fungal infections?
Nystatin
What medications are prescribed in prevention and treatment of candida infections?
Chlorhexidine mouthwash/ gel.
Miconazole - topical
Fluconazole - systemic
What is radiation caries?
Caries is not DIRECTLY induced by the radiation but an INDIRECT effect of radiation, that causes xerostomia (reducing salivary buffering), change in diet, increased oral sensitivity leading to difficult maintenance of OH.
What is osteoradionecrosis?
Osteoradionecrosis of the jaw (ORN) is a rare complication of radiation therapy.
The bone dies because radiation damages its blood vessels.
Patient’s are at an increased risk if they take bisphosphonates - anti-resorptive bone drugs.
What is the role of the GDP in terms of screening and referral
Early detection through soft tissue exam
Photographs
Onward referral
Pre-treatment assessment
How should a H&N cancer be investigated and diagnosed?
New pt. assessment within OMFS
Biopsy to confirm diagnosis
CT scan to investigate extent of tumour
Lymph node biopsy
CT scan investigate metastasis
Stage and grade cancer
