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Oral Cancer Flashcards

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1
Q

what would a patient present with that would be an emergency referral for oral cancer

A

stridor

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2
Q

what would a patient present with to need an urgent referral for oral cancer

A

persistent head and neck lumps for more than 3 weeks
unexplained ulceration or unexplained swelling of oral mucosa for more than 3 weeks
unexplained red or mixed red and white patches persisting more than 3 wees
persistent hoarseness lasting for more than 3 weeks
persistent pain in throat or pain on swallowing for more than 3 weeks
unexplained tooth mobility not associated with periodontal disease

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3
Q

what is the effect of both drinking and smoking in relation to oral cancer development called

A

synergistic effect

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4
Q

what tests are done to confirm cancer diagnosis and extent in OMFS

A

biopsy
CT scan
lymph node biopsy
stage and grade cancer

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5
Q

who is part of the MDT for cancer

A

oncologist
radiologist
OMF surgeon
dentist
dietician

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6
Q

how long should it take between referral from GDP for suspected oral cancer and patient starting their definitive treatment

A

28-31 days

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7
Q

what preventative treatment should be given to patients who have been given a diagnosis of oral cancer

A

OHI specific to them
fluoride topical application
dietary advice
PMPR to stabilise any perio disease
chlorhexidine mouthwash
restoration of carious teeth
removal of trauma

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8
Q

what treatment should be provided to make a patient dentally fit before starting cancer treatment

A

avoid denture wear during cancer treatment
XLA of teeth with dubious prognosis no less than 10 days before
antibiotic prophylaxis if neutrophils are low
discontinue orthodontic appliances
smoking and alcohol cessation

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9
Q

name the three options for oral cancer treatment

A

surgical resection with or without reconstruction
radiotherapy
chemotherapy
or combination of above

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10
Q

name some side effects from cancer treatment

A

alterations from normal anatomy from surgical resection
radiotherapy causes unavoidable radiation to normal tissues
chemotherapy causes acute mucosal toxicity
adverse effect on respiration, mastication, speech, swallowing

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11
Q

what is the role of the dentist while a patient is receiving cancer therapy

A

hygienist support
oral and denture hygiene
antibacterial mouthwash
diet advice
treat xerostomia

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12
Q

how is oral mucositis managed and prevented in patients receiving oral cancer therapy

A

calcium phosphate mouth rinse (Caphosol)
mucoadhesive oral rinse
benzydamine hydrochloride (difflam)
2% lidocaine mouthwash used prior to eating

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13
Q

how is oral mucositis scored

A

out of 1, 2 or 3

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14
Q

what aspects are considered when assessing oral mucositis

A

voice
swallowing
lips
tongue
saliva
mucous membranes

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15
Q

what dental issues can occur during Cancer treatment

A

oral mucositis
candidal infections
traumatic ulceration
reactivation of herpes simplex
xerostomia
trismus
erosion
caries and periodontal disease
ORN

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16
Q

how are candidal infections during cancer treatment treated

A

chlorhexidine mouthwash
miconazole
fluconazole
nystatin

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17
Q

how is saliva affected during Cancer treatment

A

saliva consistency and character
it becomes more viscous and acidic

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18
Q

why does xerostomia occur in patients receiving cancer treatment

A

ionising radiation damage to salivary tissue in the radiotherapy fields

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19
Q

what can enhance salivary flow in patients with some function in their salivary glands

A

pilocarpine HCl

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20
Q

what saliva substitute should be avoided in dentate patients

A

Glandosane - acidic saliva replacement

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21
Q

name three saliva substitutes you can suggest for use

A

saliva orthana
biotene oral balance gel
bioXtra gel

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22
Q

why may patients receiving cancer therapy suffer from trismus

A

post surgical inflammation
fibrosis of the tissues
try to exclude tumour recurrence

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23
Q

what is ORN

A

exposed area of bone of at least 3 months duration in an irradiated side and not due to tumour recurrence

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24
Q

how can ORN be prevented

A

remove teeth of doubtful prognosis
prevention
extractions completed at least 10 days before radiation treatment
encourage healing with primary closure/ sutures where possible
hyperbaric oxygen therapy (HBOT)
antibiotic prophylaxis

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25
when are patients at risk of ORN
total radiation dose exceeds 60Gy trauma as a result of tooth extraction person is immunocompromised person is malnourished
26
what may be used prophylactically in patients that are at high risk of ORN
pentoxyfylline and Vitamin E
27
how is ORN staged
0 - mucosal defects only 1 - radiological evidence of necrotic bone 2 - positive radiographic findings above ID canal 3 - clinically exposed radionecrotic bone
28
how is ORN prevented and treated
at risks individuals check ups less than 6 months apart avoid invasive treatment that could traumatise the bone consider decoronating and leaving roots in situ
29
how should a patient with oral cancer be managed in the reconstruction and maintenance phase
implants dentures
30
what should be kept in mind when planning implants for cancer patients
less success rate in irradiated bone requires maintenance
31
what are instructions for obturators
review regularly do not leave out at night for first 6 months after treatment may be worn at night for comfort and function after 6 months too daily cleaning mandatory
32
when are oral cancer patients discharged to their GDP
initial side effects have settled frequent intake of carious food/ drink stopped good oral hygiene established
33
what should be part of your treatment regime for patients with oral cancer who have been discharged back to GDP
more frequent follow up appointments
34
what is the international classifications for defining oncology
ICD-O
35
what are the two distinct disease patterns for oral cancer
oral cavity cancer oro-pharyngeal cancer
36
name four high risk sites for mouth cancer
floor of mouth lateral border of tongue retromolar region soft and hard palate
37
what three sites are more predisposed to developing SCC in drinkers and smokers
floor of mouth lateral border of tongue soft palate
38
what is the risk factor for oral cancer in smokers who dont drink
x 2 risk
39
what is the risk factor for oral cancer in drinkers that have never drank alcohol
x 2 risk
40
what is the risk factor for oral cancer in patients who smoke and drink
x 5 risk
41
what is the increase in risk of oral cancer for patients who are of a low socioeconomic status
x 2 risk
42
what is the term used for pre-malignant or pre-cancerous lesions
potentially malignant
43
give four examples of potentially malignant lesions
white lesions red lesions lichen planus oral submucous fibrosis
44
name six cytological features of oral dysplasia
abnormal variation in nuclear size abnormal variation in nuclear size abnormal variation in cell size abnormal variation in cell shape atypical mitosis figures nuclear hyperchromatism
45
name five architectural signs of oral dysplasia
irregular epithelial stratification drop-shaped rete ridges increased and abnormal mitoses abnormal keratinisation loss of epithelial cell cohesion or adhesion
46
what is the description of a low grade dysplasia (5 aspects)
easy to identify the tumour originates from squamous epithelium architectural change into lower 1/3rd evidence of stratification well-formed basal cell layer surrounding tumour islands
47
what is the description of a high grade dysplasia
show little resemblance architectural change in upper third considerable atypia mitotic figures prominent and abnormal
48
how are oral dysplasias graded
low grade high grade carcinoma in situ
49
what is the description of a carcinoma in situ
cytologically malignant but not invading abnormal architecture in the full thickness cytological atypia is severe frequent mitotic abnormalities
50
is the prognosis of bulbous rete ridges infiltrating at same level better or worse than widely infiltrating small islands and single cells
better
51
at what length of tumour are metastases greater in
more than 4mm
52
what are the four factors that can be used for histological prognosis of dysplasia
pattern of invasion depth of invasion perineural invasion invasion of vessels
53
what is the radius of high risk around a primary tumour in the mouth
5cm
54
what is meant by synchronous lesions
malignancies that occur within 6 months of the diagnosis of first malignancy
55
what is meant by a metachronous
malignancies that develop more than 6 months after the original malignancy has been diagnosed
56
what are the three aspects of oral cancer staging
site size (T) spread (N and M)
57
what is lip cancer separated from
oro-pharyngeal cancer
58
what is lip cancer
non healing ulcer or swelling on lip slow growing, local invasion and rarely metastasise
59
what is the aetiology of lip cancer
sunlight UV-B smoking
60
name four ways oral cancer can be detected
HPV16 screening toluidine blue VELscope
61
what is toluidine blue
dye which is applied and stains particular markers in cells shows areas of dysplasia and trauma
62
what is a VELscope
auto-fluorescence of tissue with blue light if there is a loss of fluorescence it equates to change
63
how should patients with ulcers of unknown cause be monitored
monitor with photographs and education to patient surrounding alcohol and smoking cessation removal of local factors that could be causing ulcer
64
what is a potentially malignant lesion
altered tissue in which cancer is more likely to form
65
what is the special stain required to diagnose a candidal infection
periodic schiff stain
66
how is chronic hyperplastic candidosis treated
systemic antifungals - fluconazole capsules 50mg - once daily for 14 days biopsy smoking cessation observe
67
what are the clinical predictors of malignancy in leukoplakia
age and gender site clinical appearance
68
what is the gold standard for assessing malignancy potential of lesions
biopsy for histopathological investigation
69
what is dysplasia
disordered maturation in a tissue
70
what is the WHO classification for grading epithelial dysplasia (2005)
hyperplasia mild moderate severe carcinoma in situ
71
what is basal hyperplasia
increased basal cell numbers regular stratification no cellular atypia
72
what is mild dysplasia
changes in lower third of architecture mild atypia hyperchromotism
73
what is moderate dysplasia
change in architecture expands into middle moderate atypia hyperchromatism
74
what is severe dysplasia
architecture changes expand into upper third severe atypia and numerous mitoses hyperchromatism
75
what is carcinoma in situ
a theoretic concept malignant but not invasive abnormal architecture affecting full thickness pronounced cytological atypia
76
name four genes associated with cancer
oncogenes tumour suppressor genes Tp53 mutation or inactviation genes regulating apoptosis
77
what are the 6 hallmarks of cancer
self sufficiency in growth signals evading apoptosis insensitivity to anti-growth signals tissue invasion and metastasis limitless replicate potential sustained angiogenesis
78
what are the three report points of oral cancer pathology
differentiation and grading pattern of invasion related to nodal spread local extension of the disease
79
what are the ways oral cancer can spread
bone spread nerve spread lymphatic spread haematogenous spread
80
what is the TNM system
t - size of tumour n - lymph node involvement m - distant metastasis
81
name 8 signs and symptoms of oral cancer
pain on eating difficulty swallowing unilateral earache sensory loss unexplained loosening of teeth coughing blood trismus unexplained weight loss
82
for excision of cancer - what is the margin that should be taken
1cm around the cancer
83
name 5 options of cancer treatment
surgical chemotherapy radiotherapy combination palliative care
84
name side effects of surgery for cancer
local infection lymphatic oedema DVT cosmetic and functional deficit
85
what is oral mucositis
inflammation and ulceration of the oral cavity severe pain can be caused by chemotherapy
86
what are the treatment options for oral mucositis
topical lidocaine benzydamine mouthwash calphosol
87
how is oral mucositis graded
0 - none 1 - oral soreness and erythema 2 - oral erythema and ulcers but solid diet tolerated 3 - oral ulcers and a liquid diet required 4 - oral alimentation is impossible
88
why can trismus occur following radiotherapy
causes fibrosis of the muscles of mastication
89
what dental prevention therapy should patients undergoing cancer treatment be given
toothbrushing instruction higher fluoride toothpastes interdental brushes denture hygiene mouthwashes
90
what is the role of the pathologist in oral cancer
to establish a subtype and grade outline anatomical extent of the tumour identify prognostic factors final staging of disease
91
what are the 5 levels of lymph nodes in the neck
I - submental and sublingual triangle II - occipital and posterior auricular glands III - middle portion of IJV IV - extends from clavicle to cricoid cartilage V - posterior triangle of neck, behind the SCM
92
what is a microtome
an instrument for cutting extremely thin sections of material for examination under a microscope
93
why is it advised to remove dentures during cancer treatment
cancer treatment can make the mouth sore (mucositis) side effects of cancer treatment can be worsened by the denture

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