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Oral Medicine > Oral Cancer > Flashcards

Oral Cancer Flashcards

1
Q

What guideline can be used in accordance to referrals of suspected head & neck cancers?

A
  • SIGN 90 (“3 week rule”); WITHDRAWN Dec 2016

- NICE (“2 week rule”)

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2
Q

What other conditions are associated with H&N cancers?

A
  • Heartburn & aerodigestive tract SCC

- Perio disease, OH & mw & HN SCC

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3
Q

What may be some EARLY presentations of oral cancer?

A
  • Nothing
  • Non-healing ulcer
  • Red/ white patch
  • Lump/ rough bit
  • Change in lump/ patch
  • Crusted/ non-healing lesion on lip
  • Persistent soreness
  • Earache
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4
Q

What may be some LATE presentations of oral cancer?

A
  • Numbness
  • Difficulty swallowing
  • Dentures ill fitting
  • Loosening of teeth
  • Non-healing extr site
  • Lump in neck
  • Bleeding
  • Friable (bits break off)
  • Pain
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5
Q

What are some indications of cancer from a PMH?

A
  • Hx of areodigestive tract cancer
  • Iron deficiency (cancers –> bleeding)
  • Long-term immunosuppression (incl imminosupressing drugs) –> lip cancer risk
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6
Q

What are some social risk factors for cancer?

A
  • Alcohol and tobacco smoking
  • Betel quid
  • UV exposure = occupation, sun-bed, outdoor habits (cycling)
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7
Q

What are the 5 yr survival rates for localised and metastatic disease?

A
  • LOCALISED 82%

- METASTATIC 33%

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8
Q

What are some indications in an E/O exam of cancers?

A
  • Weight loss/ cachexia (weakness/ wasting)
  • Facial asymmetry (swellings? n. damage?)
  • Lip lesions (crusting? bleeding? red/white patch?)
  • Lymph node swelling
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9
Q

What might be seen I/O in a pt with suspected oral cancer?

A
  • White/ red/ speckled patch
  • Exophytic growths
  • Lump
  • Hardening of tissue
  • Necrosis (grey slough, bad smell)
  • Mobile teeth
  • Friable tissues
  • Signs of fractures
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10
Q

What special tests may be carried out in aid of diagnosis of oral cancers?

A
  • Clinical photographs

- Biopsy

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11
Q

What would you do if a mild suspicion of oral cancer?

A
  • Tell pt concerns
  • Adjust any potential causes
  • Clinical photos and record all in notes
  • FOLLOW 2/3 week rule
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12
Q

What would you do if a high suspicion of oral cancer?

A
  • Follow local referral pathways
  • Contact OMFS, OM, ENT department
  • Rapid access referral
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13
Q

What is included in a referral letter of a pt with suspected OC?

A
  • Pt identifiers (name, address etc.)
  • Contact number (pt and referrer)
  • Name of GDP
  • Relevant MH. DH, SH
  • Hx, reason for referral and urgency
  • Clinical findings
  • What pt knows/ suspects and their level of anxiety
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14
Q

What is the role of primary HCP in diagnosis of OCs?

A
  • Increase public awareness of OC
  • Educate public re OC
  • Early diagnosis via opportunistic screening
  • Ensure all unexplained lesions referred for biopsy within 2 weeks
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15
Q

What is a specimen fixed in at the pathologist’s lab?

A

Formaldehyde, at least 24hrs

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16
Q

What is done if the lab wants to see a specimen quicker?

A

Freeze specimen (-25C)

17
Q

What are the neck node levels?

A

I, II, III, IV, V

18
Q

Who are part of the multidisciplinary team?

A
  • Surgeon
  • Oncologist
  • Pathologist
  • Radiologist
  • Clinical nurse specialist
  • Speech therapist and dietetics
  • Palliative care physician
  • Restorative dentist
  • Special care dentist
19
Q

How often should a dentate and edentate patient be screened?

A
  • Dentate = 6 monthly

- Edentate = 12 monthly

20
Q

How long ideally before cancer treatment should a patient be referred to their dentist?

A

1 month prior

21
Q

What are the dental treatment prior cancer therapy?

A
  • Remove any source of infection
  • Remove teeth of dubious prognosis
  • Restore teeth where appropriate
  • Perio therapy
  • Caries management
  • Denture assessment (ill fitting, risk of infection); smooth dentures
  • Smooth sharp teeth/ restorations
22
Q

How long ideally before cancer treatment should teeth be extracted?

A
  • NO LESS than 10 DAYS prior

- Ideally 3 weeks healing time

23
Q

What are the principles of teeth extraction prior cancer treatment?

A
  • Remove foci of infection/ poor prognosis
  • Atraumatic technique
  • Achieve primary closure
  • Every measure in place to aid quick healing
24
Q

What are the principles of restoring teeth prior cancer treatment?

A
  • Restore with definitive materials
  • If limited time, GI as provisional
  • Teeth and restorations smoothed off
25
Q

What are the dental implications of surgery?

A
  • Defects (requires grafts, implants, obturator)

- Removal of salivary glands –> xerostomia (affects speech, swallowing, appearance)

26
Q

What are the dental implications of radiotherapy?

A

IMMEDIATE

  • Mucositis
  • Loss of taste
  • Xerostomia
  • Pain

LONG-TERM

  • Xerostomia
  • Endarteritis oblierans (inflammation of artery inner lining –> occlusion of lumen)
  • Osteonecrosis
  • Trismus –> limited access
  • Radiation caries
27
Q

What are the THREE broad factors in dictating dental tx?

A
  1. Dose
  2. Field
  3. Site
28
Q

What are the dental implications of chemotherapy?

A
  • Immunosuppression
  • Mucositis
  • Xerostomia
  • Swelling
  • Pain
  • Altered taste
29
Q

What are the grading and clinical features of the WHO’s Oral Mucositis Scale?

A
  1. Sore/ erythema
  2. Erythema, ulcer but able to eat solids
  3. Ulcers, requires liquid diet
  4. Oral alimentation impossible
30
Q

What is oral mucositis?

A

Inflammation of the oral mucosa

31
Q

What is the onset of mucositis in radio and chemotherapy?

A 
Radio = 2 weeks
Chemo = 1 week
32
Q

What is the management for mucositis?

A

PREVENTATIVE

  • Improve OH
  • Adjust restorations/ ill fitting dentures
  • Mucosal shield

TREATMENT

  • Mw = difflam spray, Gelclair, Caphosol, CHX
  • Analgesics
  • Ice chips
  • IV keratinocyte GF (Palifermin)
33
Q

How long may xerostomia last after radio and chemotherapy?

A 
Radio = 2yrs or longer, may be permanent
Chemo = 2 months
34
Q

What are the dental implications of xerostomia?

A
  • Saliva becomes thick, acidic and viscous (caries)

- Loss of protective features of saliva

35
Q

What is the management for xerostomia?

A

SALIVA STIMULATION

  • Gum (if residual function)
  • Pilocarpine
  • Acupuncture
  • Acid pastilles (contrain. in dentate pts)

SALIVA REPLACEMENT

  • Sip water
  • Saliva orthana
  • Biotene
  • BioXtra
  • Glandsosane (AVOID IN DENTATE)

Oral Medicine (13 decks)

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