Oral Cancer Flashcards
(27 cards)
High risk OC sites in oropharynx
Tonsils + soft palate
High risk OC sites in oral cavity
Buccal mucosa
Retromolar pads
Anterior 2/3rds of tongue
FOM
Hard palate
Lips
What are the red flags associated with malignancy (8)
- Ulcer >2wks
- Red+white lesion
- Firm, rolled margins
- Referred pain
- Worsening pain
- Throat pain >3wks
- Difficulty swallowing
- Weight loss
- Cervical LN
Features of a malignant cervical LN
> 1cm
Firm, fixed, tethered, non tender
Investigations for H+N cancer
H+N CT scan
OPT
US of enlarged LN
Punch/incisional biopsy
How do we reach a diagnosis to allow staging?
Biopsy + imaging
provides TNM staging
TNM staging components
T - tumour size
N - LN involvement (0-3)
M - metastasis
Broad Tx options for cancer
Surgery
Radiotherapy
Chemo +radio
Dual or triple modality
What is ORN
Necrotic bone in previous radiothetherapy field
Radiotherapy >70gy
Effects of ORN on mandible
Lack of o2 + bf
OPT signs of cancer (6)
Unusual bone loss
Non healing sockets
Floating teeth
Moth eaten bone
Loss of sinus
Pathological fracture
US signs of cancer (3)
Node necrosis
Enlarged rounded LN
Avascular or increased vascularity
Biopsy difference between fine needle and core
Fine - only provides cells
Core - provides sample
What is the role of the pathologist
Establish diagnosis
Staging TNM
Outline anatomical extent of tumour
Identify prognostic factors (molecular markers)
What is specimen fixed in?
Fixed in Formaldehyde for at least 24hrs
MDT components
Surgeon
Oncologist
Pathologist
Radiologist
Clinical nurse
SALT
Restorative dentist
SC dentist
Psychologist
Role of GDP in cancer pts
- Early detection + referral
- Cessation
- OPT
- Remove all dubious/poor prognosis teeth 10 days prior to tx
- Provide advice + tx on oral side effects
Pneumonic for oral cancer side effects
How many cancer Drs unfortunately treat every cheek, palate and orifice!
How would you tx plan a cancer patient?
- XLa poor prognosis no less than 10 days before cancer tx
- OHI - CHX MW (inc risk of viral/fungal infections)
- Take out/clean dentures
- Smoking+alcohol advice
- F toothpaste/FV
- Symptomatic relief of dry mouth
List dental issues from cancer tx
HSV
Mucositis
Candida
Dry mouth
Ulcers
Trismus
Erosion
Caries
Periodontal disease
ORN
When and how does oral mucositis present and how do we prevent it?
1-2wks after tx starts, lasts 6wks
Severe pain, can inhibit OH
Prevention:
Benzydamina MW
2% Lidocaine MW
Saline rinse
Manuka honey
Candida tx
Reinforce denture + OH
CHX
Topical Miconazole
Systemic Fluconazole
Tx of traumatic ulceration
Teeth rubbing delicate I/O ST’s
Soft splint
Tx of Xerosomtia
F supplements
Petroleum J to protect lips
Saliva orthana
Sugar free gum
Pilocarpine if some function (tachycardia/nausea)
