Oncology Flashcards
1
Q
What is the role of a GDP in screening and referral?
A
- early detection through soft tissue examination
- photographs
- onward referral
- pre-treatment assessment
2
Q
What guidance is available in reference to head and neck cancer?
A
- Scottish Cancer Referral Guidelines
- NICE: Improving Outcomes in Head & Neck Cancers
- British Association of Head and Neck Oncologies Multidisciplinary Management Guidelines
- Royal College of Surgeons of England/British Society for Disability and Oral Health 2018
- Predicting and Managing Oral & Dental Complications of Surgical and Non-Surgical Treatment for Head and Neck Cancer A Clinical Guideline: RD-UK Consultant and Specialist Group November2016
- ENT UK
3
Q
What is the patient journey for someone with head and neck cancer?
A
- screening and referral
- investigation and diagnosis
- MDT: treatment planning
- dental pre-assessment
- cancer treatment
- dental support during treatment
- end of treatment
- restoration
- maintenance and post-treatment management
- disease recurrence
4
Q
What can constitute a referral for head and neck cancer?
A
- stridor
- high pitched, wheezy breathing
- emergency referral required
- persistent unexplained head and neck lumps
- over 3 weeks
- raised lymph nodes
- ulceration or unexplained swelling of the oral mucosa
- over 3 weeks
- all red or mixed and white patches of oral mucosa
- over 3 weeks
- persistent hoarseness
- over 3 weeks
- request chest x-ray
- dysphagia or odynophagia
- difficulty or pain on swallowing
- over 3 weeks
- persistent throat pain
- over 3 weeks
5
Q
What investigations are available for head and neck cancer?
A
- new patient assessment within oral and maxillofacial surgery
- biopsy to confirm diagnosis
- CT scan to investigate extent of tumour
- lymph node biopsy
- CT scan to investigate metastasis
- baseline medical testing (performance score)
- stage and grade cancer
6
Q
Who make up the multidisciplinary team for head and neck cancer treatment planning?
A
- oncologist
- radiologist
- surgeon (ENT, OMFS, plastics)
- clinical nurse specialist
- speech and language therapist
- dietician
- dentist
- physio
- occupational therapist
- psychologist
7
Q
What does pre-assessment of head and neck cancer involve?
A
- every pre-treatment assessment should include a dental assessment
- full detailed examination
- radiographs
- OPT
- periapicals
- aims
- identify existing oral disease and potential risk of disease
- remove infection/potential infection before cancer therapy
- prepare for side effects of cancer therapy
- establish adequate oral hygiene
- develop plan for maintenance, provide preventive care
- establish necessary MDT collaboration with cancer centre
- plan post-treatment prosthetic oral rehabilitation
8
Q
What is provided during pre-assessment?
A
- detailled oral hygiene advice
- toothbrushing instruction
- interdental cleaning
- fluoride
- topical application
- mouthwash (0.05%, alcohol-free)
- fluoride toothpaste
- GC tooth mousse
- free calcium
- dietary advice
- coincides with dietician
- emphasise oral comfort during treatment
- PMPR
- stabilise periodontal condition
- chlorhexidine mouthwash and gel
- 0.2% concentration
- 10ml rinsed around mouth for 1 minute, twice daily
- diluted 1:1 with water if causing mucosal discomfort
- definitively restore carious teeth
- remove trauma
- adjust sharp edges on teeth and dentures
- impressions
- construct fluoride trays and soft splints
- denture hygiene and advice
- avoid wear during cancer treatment
- extract teeth
- no less than 10 days before starting treatment
- before high dose intravenous bisphosphonate treatment
- teeth is direct association with tumour
- teeth in direct path of radiation beam
- teeth with dubious prognosis (deep caries/perio pockets)
- antibiotic prophylaxis
- low neutrophils and invasive treatment planned
- lease with medics
- orthodontics
- discontinue and remove fixed appliances
- smoking and alcohol advice
- restorative work
- study casts for implant planning
- pre-treatment records
- planning for trismus
9
Q
What are the potential side effects of cancer treatment?
A
- alterations to normal anatomy
- result of surgical tumour resection
- adverse effect on function and appearance
- radiation damage to tissues surrounding tumour
- result of radiotherapy
- affects function of tissue
- acute mucosal and haematological toxicity
- result of chemotherapy
- mucosal toxicity accentuated if concurrent with radiotherapy
- adverse effects on respiration, mastication, swallowing, speech, taste, salivary gland function, mouth opening and outward appearance
10
Q
What is the role of the dentist during cancer therapy?
A
- hygienist support
- oral and denture hygiene
- if brushing too painful use soft brush
- especially for those with low platelet levels (chemotherapy)
- dentures rinsed after meals
- dentures cleansed daily
- dentures soaked in chlorhexidine mouthwash overnight
- antibacterial mouthwash (alcohol free)
- chlorhexidine (short term alternative to brushing)
- diet advice
- fluoride preparations
- topical
- toothpaste
- mouthwash
- fluoride trays
- examine for viral and fungal infections
- high risk
- prophylaxis and treatment where required
- treatment and symptom relief
- mucositis
- xerostomia
- emergency dental treatment
- lease with cancer team
- avoid treatment where possible
11
Q
What is oral mucositis?
A
- extremely painful oral mucosa
- begins 1-2 weeks after treatment starts
- lasts until around 6 weeks after completion
- severe pain can inhibit oral hygiene measures and eating
- NG/PEG fed
12
Q
How can oral mucositis be prevented and managed?
A
- neutral supersaturated calcium phosphate mouth rinse
- caphosol
- polyvinyl pyrrolidine/sodium hyaluronate gel
- gelclair
- mucoadhesive oral rinse
- mugard
- soluble aspirin
- benztdamine hydrochloride
- difflam
- 15ml 4-8 times daily before starting radiotherapy
- 2-3 weeks after starting radiotherapy
- zinc supplements
- prevention
- aloe vera
- cryotherapy
- Manuka honey
- low level laser therapy
- radiotherapy without chemotherapy
- saline and sodium bicarbonate rinses
- good oral hygiene
- helps faster resolution
- intensive
- morphine and opioids
- analgesics
- removal of sharp edges on dentures and teeth
- oral cooling
- ice
- 2% lidocaine mouthwash prior to eating
- tea tree mouthwash
- intravenous keratinocyte growth factor-1
- high dose chemotherapy
- preventative measure
13
Q
Why may candida infections be present during cancer treatment and how should they be managed?
A
- common and uncomfortable
- preventative antifungals may be prescribed by cancer team
- chlorhexidine
- miconazole (topical)
- fluconazole (systemic)
- nystatin
14
Q
What is the relationship between cancer treatment and xerostomia?
A
- reduced salivary flow (50-60%) in the first week
- further 20% in the following 5-6 weeks
- consistency and character of saliva affected
- increased viscosity
- increased acidity
- damage to dentition
- may recover over a number of years or not return at all
- affects chewing, swallowing, speech, test and quality of life
- increased risk of caries, periodontal disease, candida, sialadenitis and prosthodontics difficulties
- fluoride supplementation recommended
- caused by ionising radiation
- damage to salivary tissues in radiotherapy fields
- oral gel or lubricants used to coat soft tissues and lips
- pilocarpine HCl
- enhances salivary secretions
- must have some functional salivary glands
- 5mg 3 times daily
- improvement declines after cessation of treatment
- sweating, headaches and increased urinary frequency
- salivary stimulation by chewing sugar free gum
- some salivary function must be required
15
Q
What saliva replacements are available?
A
- frequent sipping of water
- glandosane
- acidic pH
- not to be used in dentate patients
- gels
- longer duration of benefit
- saliva orphans
- contains fluoride
- contains porcine mucine
- animal served ingredient
- Biotene oral balance gel
- new formulation is not acidic
- contains milk and egg white
- BioXtra gel
- contains milk and egg white
- contains fluoride
