Oncology

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Questions and Answers

What is the role of a Speech Therapist in a Multi-Disciplinary Team (MDT) for cancer treatment?

  • Administering chemotherapy.
  • Providing surgical interventions.
  • Managing communication and swallowing difficulties. (correct)
  • Prescribing dietary plans.

Which of the following is NOT typically included as part of the Multi-Disciplinary Team (MDT) approach in oncology?

  • Cardiologists (correct)
  • Radiologists
  • Surgeons
  • Oncologists

What is the process by which cancer cells move away from the primary tumor and invade other parts of the body?

  • Angiogenesis
  • Local invasion
  • Metastasis (correct)
  • Cellular differentiation

What is the term for the process by which tumors create their own blood vessels to support growth?

<p>Angiogenesis (B)</p> Signup and view all the answers

Which of these options is not a standard treatment modality for cancer?

<p>Acupuncture (B)</p> Signup and view all the answers

Which of the following is typically the first step in evaluating a patient for oral cancer?

<p>Biopsy and measurement (C)</p> Signup and view all the answers

What does 'EUA' stand for in the context of evaluating oral cancer?

<p>Examination Under Anaesthesia (C)</p> Signup and view all the answers

In the TNM staging system for oral cancer, what does 'T' refer to?

<p>Tumor size and extent (D)</p> Signup and view all the answers

According to the TNM classification for oral cancer, what is the defining characteristic of a T2 tumor?

<p>Tumor &lt;4 cm (C)</p> Signup and view all the answers

In the context of the TNM staging system, what does N1 indicate?

<p>Mobile ipsilateral nodes, &lt;3 cm (A)</p> Signup and view all the answers

In oral cancer staging, a patient diagnosed with T1N0M0 would be classified as which stage?

<p>Stage I (D)</p> Signup and view all the answers

A patient with a T4, N2, M0 oral cancer would be classified as which stage according to the oral cancer staging?

<p>Stage IV (A)</p> Signup and view all the answers

What is the primary distinction between curative and palliative treatment planning?

<p>Curative aims to eliminate the disease, while palliative aims to relieve symptoms. (B)</p> Signup and view all the answers

Which of the following factors is LEAST likely to be considered in treatment planning for cancer?

<p>Geographic location of the hospital (B)</p> Signup and view all the answers

Which of the following is NOT considered a significant risk factor for developing cancer?

<p>Low alcohol intake (A)</p> Signup and view all the answers

What is cachexia, as it relates to general signs and symptoms of cancer?

<p>Unexplained weight loss (A)</p> Signup and view all the answers

Which of the general signs and symptoms of cancer is often a late manifestation of the disease?

<p>Pain (C)</p> Signup and view all the answers

What is meant by 'adjuvant' chemotherapy?

<p>Chemotherapy given after surgery/DXT (C)</p> Signup and view all the answers

What is induction chemotherapy?

<p>Chemotherapy used as primary treatment in widespread disease (A)</p> Signup and view all the answers

Which of the following best describes the principle behind how chemotherapy works, assuming that it is effective?

<p>It selectively kills tumor cells, sparing normal tissues. (C)</p> Signup and view all the answers

In the context of tumor cell growth, what occurs during the G1 phase of the cell cycle?

<p>Protein and RNA synthesis (C)</p> Signup and view all the answers

How do non-phase dependent chemotherapy drugs kill cells?

<p>They kill cells exponentially with increasing dose, regardless of the cell cycle phase. (C)</p> Signup and view all the answers

Which of the following chemotherapy drugs is classified as phase-dependent?

<p>Methotrexate (B)</p> Signup and view all the answers

Which of the following is classified as an antimetabolite?

<p>5-Fluorouracil (D)</p> Signup and view all the answers

Which of the following is a common route of administration for chemotherapy?

<p>Intrathecal (D)</p> Signup and view all the answers

Within a Multi-Disciplinary Team (MDT) for cancer, which surgical specialists might be involved in the treatment of oral cancer?

<p>OMFS (Oral and Maxillofacial Surgeons), ENT (Ear, Nose, and Throat surgeons), and plastic surgeons (A)</p> Signup and view all the answers

In the context of cancer development, which process describes the creation of new blood vessels to supply a tumor with nutrients and oxygen?

<p>Angiogenesis (C)</p> Signup and view all the answers

A patient's biopsy results show a tumor that is 3.5 cm in size without any signs of spread to nearby lymph nodes or distant sites. According to the TNM staging system, how would this tumor be classified?

<p>T3N0M0 (D)</p> Signup and view all the answers

A patient presents with a tumor that has spread to one ipsilateral (same side) mobile lymph node, which is less than 3 cm in size. There is no evidence of distant metastasis. According to the TNM classification, what is the appropriate 'N' stage?

<p>N1 (C)</p> Signup and view all the answers

A patient is diagnosed with a T2N1M0 oral cancer. Based on the oral cancer staging guidelines, which overall stage would this cancer be classified as?

<p>Stage III (B)</p> Signup and view all the answers

A patient presents with an oral tumor infiltrating deep structures, with mobile nodes on the opposite side of the neck, ranging from 3-6cm, but no distant metastases. According to the TNM staging, which stage is this?

<p>Stage IV (A)</p> Signup and view all the answers

What is the primary aim of palliative treatment in cancer care?

<p>Slowing disease progression while alleviating symptoms and improving quality of life (B)</p> Signup and view all the answers

Which of the following considerations is most crucial when determining between surgery and radiotherapy as a cancer treatment?

<p>The location and extent of the tumor, as well as the patient's overall health (A)</p> Signup and view all the answers

Which dietary factor is associated with an increased risk of developing cancer?

<p>Diet low in antioxidants and fiber (A)</p> Signup and view all the answers

What systemic effect of cancer is characterized by loss of muscle mass, weight loss, and overall weakness?

<p>Cachexia (D)</p> Signup and view all the answers

A patient with parotid cancer exhibits sensory/motor dysfunction affecting the trigeminal nerve. What might this indicate about the tumor's progression?

<p>Advanced stage with nerve involvement (B)</p> Signup and view all the answers

Which of the following scenarios describes the use of 'neo-adjuvant' chemotherapy?

<p>Chemotherapy used as the primary treatment to achieve local control before surgery (B)</p> Signup and view all the answers

What distinguishes induction chemotherapy from adjuvant chemotherapy in cancer treatment?

<p>Induction chemotherapy is the primary treatment for widespread disease, while adjuvant chemotherapy is used after primary treatments like surgery. (C)</p> Signup and view all the answers

Which of the following best describes the ideal mechanism of action for chemotherapy drugs?

<p>Selectively kills tumor cells while sparing normal tissues (C)</p> Signup and view all the answers

During which phase of the cell cycle does DNA synthesis primarily occur?

<p>S phase (A)</p> Signup and view all the answers

How does the cell-killing mechanism of non-phase dependent chemotherapy drugs differ from that of phase-dependent drugs?

<p>Non-phase dependent drugs kill exponentially with increasing dose and are equally toxic in any phase, including G0 (C)</p> Signup and view all the answers

Methotrexate exerts its cytotoxic effects during which phase of the cell cycle, making it a phase-dependent drug?

<p>S phase (D)</p> Signup and view all the answers

Which of the following is an example of an antimetabolite chemotherapy drug?

<p>5-Fluorouracil (D)</p> Signup and view all the answers

What is the significance of considering the cell cycle when selecting chemotherapy drugs?

<p>To maximize cancer cell death by targeting specific phases of the cell cycle (C)</p> Signup and view all the answers

A patient is receiving chemotherapy through a 'Hickman line.' What does this imply about the route of administration?

<p>Intravenous via a catheter placed in the right atrium (C)</p> Signup and view all the answers

When is it most appropriate to consider inserting a pump mechanism into the common hepatic artery for chemotherapy administration?

<p>In cases where the tumor is primarily localized in the liver (C)</p> Signup and view all the answers

A patient is diagnosed with melanoma, and imaging reveals multiple metastases throughout both lungs. Which of the following statements best describes this situation?

<p>The cancer has spread through the bloodstream to distant sites. (C)</p> Signup and view all the answers

What role do MacMillan nurses play within the Multi-Disciplinary Team (MDT) approach to cancer care?

<p>Providing specialized nursing care, support, and information to patients and their families (C)</p> Signup and view all the answers

What is the role of restorative dentistry in the context of oral cancer treatment and the Multi-Disciplinary Team (MDT)?

<p>Rehabilitating and restoring oral function and aesthetics after cancer treatment (B)</p> Signup and view all the answers

What is the relationship between genetic inheritance and the risk of developing cancer?

<p>Inheriting certain gene mutations can significantly increase the risk of cancer. (D)</p> Signup and view all the answers

Why is regular monitoring with a full blood count (FBC) and differential essential during chemotherapy?

<p>To detect and manage potential bone marrow toxicity. (A)</p> Signup and view all the answers

When local toxicity occurs due to chemotherapy administration, what is the primary concern?

<p>Tissue destruction due to extravasation of the drug. (D)</p> Signup and view all the answers

What is the most likely cause of nausea and vomiting as an acute toxicity during chemotherapy?

<p>Stimulation of the CT zone, the gut, and the cerebral cortex. (C)</p> Signup and view all the answers

Why would sucking on ice cubes be recommended for a patient prone to stomatitis during chemotherapy, especially with 5-FU?

<p>To reduce mucositis by causing vasoconstriction and reducing drug delivery to oral mucosa. (D)</p> Signup and view all the answers

What is the primary reason for avoiding aspirin in patients undergoing chemotherapy with methotrexate?

<p>Aspirin increases the toxicity of methotrexate. (A)</p> Signup and view all the answers

How does long-term exposure to alkylating agents potentially lead to carcinogenesis?

<p>By increasing the risk of acute leukemia. (D)</p> Signup and view all the answers

Which of the following interventions is most appropriate for managing established mucositis during chemotherapy?

<p>Optimizing oral hygiene and considering benzydamine hydrochloride. (D)</p> Signup and view all the answers

Why is it critical to aggressively treat infections in patients undergoing chemotherapy?

<p>Because infections can quickly become systemic due to immunosuppression. (D)</p> Signup and view all the answers

What dental consideration is most important before commencing a patient on chemotherapy?

<p>Ensuring the patient is dentally fit to minimize potential complications. (B)</p> Signup and view all the answers

Why would a dentist consult a patient's full blood count (FBC) before performing a surgical procedure?

<p>To determine the patient's risk of bleeding and infection. (D)</p> Signup and view all the answers

A patient undergoing chemotherapy has a platelet count of 40x10^9/litre. What implications does this have for dental surgery?

<p>Surgical procedures will likely cause bleeding if platelets are not supplemented. (A)</p> Signup and view all the answers

If a patient's granulocyte count is less than 2x10^9/litre during chemotherapy, what preventative measure is typically required?

<p>Administration of prophylactic antibiotics. (C)</p> Signup and view all the answers

What is the main target of radiotherapy in cancer treatment?

<p>DNA of the cancer cells. (C)</p> Signup and view all the answers

Why is radiotherapy typically given in fractions over a period of 4-6 weeks?

<p>To allow normal tissue to recover between treatments. (D)</p> Signup and view all the answers

Which phase of the cell cycle is most susceptible to damage from radiotherapy?

<p>Mitosis (B)</p> Signup and view all the answers

What is the primary purpose of neoadjuvant radiotherapy?

<p>To shrink the tumor before surgery. (D)</p> Signup and view all the answers

What is the key goal of adjuvant radiotherapy?

<p>To eradicate any remaining cancer cells after surgery. (B)</p> Signup and view all the answers

Why is multi-field technique used in radical external beam irradiation?

<p>To reduce collateral damage to surrounding healthy tissues. (D)</p> Signup and view all the answers

A patient is scheduled for a surgical procedure, and their full blood count reveals a platelet count of 60x10^9/litre. What dental management is generally appropriate??

<p>Routine dental management can be followed, as the platelet count is adequate. (B)</p> Signup and view all the answers

Why are patients undergoing head and neck radiotherapy at increased risk of oral infections and ulcerations?

<p>Radiotherapy damages the oral mucosa and reduces saliva production, disrupting the natural oral flora. (D)</p> Signup and view all the answers

Which of the following tissues is considered highly radiosensitive, increasing its risk of damage during radiotherapy?

<p>Marrow (A)</p> Signup and view all the answers

Which malignancy listed is typically considered relatively insensitive to radiotherapy?

<p>Melanoma (D)</p> Signup and view all the answers

In a patient undergoing chemotherapy, which oral complication is specifically associated with Methotrexate?

<p>Mucositis (A)</p> Signup and view all the answers

How does scalp cooling aim to minimize alopecia during chemotherapy?

<p>By causing vasoconstriction, reducing drug delivery to hair follicles. (C)</p> Signup and view all the answers

When herpetic infections occur during chemotherapy, which antiviral medication is typically prescribed?

<p>Acyclovir (B)</p> Signup and view all the answers

Why do patients undergoing chemotherapy need regular full blood counts (FBC) and differentials?

<p>To detect and manage bone marrow toxicity, a dose-limiting factor (B)</p> Signup and view all the answers

What is the primary reason tissue destruction occurs when chemotherapy drugs are injected outside the vessel?

<p>The drugs directly damage tissues, causing local toxicity (A)</p> Signup and view all the answers

What is a common gastrointestinal (GI) side effect of chemotherapy, and what physiological process causes this?

<p>Nausea and vomiting, due to stimulation of the CT zone, gut, and cerebral cortex (C)</p> Signup and view all the answers

Which specific oral complication is commonly associated with Methotrexate?

<p>Mucositis (D)</p> Signup and view all the answers

How does scalp cooling reduce alopecia during chemotherapy?

<p>By constricting blood vessels in the scalp, reducing drug delivery to hair follicles (A)</p> Signup and view all the answers

Approximately when does hair loss typically begin after the first chemotherapy injection?

<p>18-21 days (D)</p> Signup and view all the answers

What potential long-term effect is associated with prolonged exposure to alkylating agents used in chemotherapy?

<p>Acute leukemia (B)</p> Signup and view all the answers

Beyond carcinogenesis, what other potential long-term toxicity is directly associated with chemotherapy?

<p>Gonadal damage, potentially leading to sterility (D)</p> Signup and view all the answers

Which of the following is a dental-related oral complication associated with chemotherapy?

<p>Abnormal dental development (A)</p> Signup and view all the answers

What is one of the most important aspects of dental management before a patient starts chemotherapy?

<p>Getting dentally 'fit' to minimize potential complications (B)</p> Signup and view all the answers

Why is aspirin typically avoided in patients undergoing chemotherapy, particularly those taking methotrexate?

<p>It increases the toxicity of methotrexate (D)</p> Signup and view all the answers

Why might suxamethonium be used with caution in patients also taking methotrexate?

<p>It can increase the toxicity (D)</p> Signup and view all the answers

Why might sucking on ice cubes or drinking cold water be recommended to patients prone to stomatitis during chemotherapy, especially with 5-FU?

<p>To cause vasoconstriction, reducing drug delivery to oral mucosa (B)</p> Signup and view all the answers

What is a suitable initial approach for managing established mucositis during chemotherapy?

<p>Optimizing oral hygiene and considering benzydamine hydrochloride (C)</p> Signup and view all the answers

If a patient undergoing chemotherapy develops candidiasis, which antifungal medication is typically prescribed?

<p>Fluconazole (C)</p> Signup and view all the answers

If a patient undergoing chemotherapy develops a herpetic infection, which medication is typically used?

<p>Acyclovir (D)</p> Signup and view all the answers

Why is aggressive treatment of infections critical in patients undergoing chemotherapy?

<p>To prevent infections from rapidly becoming systemic (D)</p> Signup and view all the answers

What is a primary dental management consideration prior to commencing a patient on chemotherapy?

<p>Ensuring all necessary dental work is completed to minimize potential complications (A)</p> Signup and view all the answers

What dental management is generally appropriate if a patient's platelet count is >50x10^9/litre before a surgical procedure?

<p>Routine management with standard hemostatic techniques (C)</p> Signup and view all the answers

What action is typically required if a patient’s granulocyte count is less than 2x10^9/litre during chemotherapy before invasive dental treatment?

<p>A course of prophylactic antibiotics (D)</p> Signup and view all the answers

Why is radiotherapy typically delivered in fractions over 4-6 weeks rather than a single high dose?

<p>To allow normal tissue to recover (D)</p> Signup and view all the answers

According to the information provided, in which phase of the cell cycle does radiotherapy cause the most damage?

<p>Mitosis (D)</p> Signup and view all the answers

Radiation can cause collateral damage, what does collateral damage mean in the context of radiotherapy?

<p>Damage to normal tissue surrounding the cancer (C)</p> Signup and view all the answers

Why is a full blood count (FBC) with differential regularly monitored in patients undergoing chemotherapy?

<p>To detect and manage potential bone marrow toxicity. (D)</p> Signup and view all the answers

Why might sucking on ice chips or drinking cold water be recommended for a patient prone to stomatitis during chemotherapy, especially with 5-FU?

<p>To cause local vasoconstriction, reducing drug delivery to oral mucosa. (C)</p> Signup and view all the answers

What is the potential long-term consequence of exposure to alkylating agents during chemotherapy?

<p>Secondary malignancy, such as acute leukemia. (C)</p> Signup and view all the answers

A patient undergoing chemotherapy develops oral ulcerations that are attributed to methotrexate. Which of the following interventions is most appropriate?

<p>Applying topical folinic acid. (C)</p> Signup and view all the answers

What is the rationale for aggressive treatment of infections in patients undergoing chemotherapy?

<p>To prevent the infection from becoming systemic due to immunosuppression. (A)</p> Signup and view all the answers

What is a critical dental consideration before commencing a patient on chemotherapy?

<p>Addressing existing dental infections and potential sources of oral sepsis. (D)</p> Signup and view all the answers

Why would a dentist need to consult a patient's full blood count (FBC) before performing a surgical procedure?

<p>To determine the patient's risk of bleeding and infection. (D)</p> Signup and view all the answers

Which of the following statements best describes the acute side effect of 'local toxicity' from chemotherapy?

<p>It involves tissue destruction due to extravasation of the drug. (B)</p> Signup and view all the answers

Why is radiotherapy typically administered in fractions over a period of 4-6 weeks?

<p>To allow normal tissues to recover from radiation damage. (D)</p> Signup and view all the answers

Which oral complication is specifically associated with Methotrexate?

<p>Mucositis (A)</p> Signup and view all the answers

What is the primary reason why a dentist should avoid prescribing aspirin to patients undergoing chemotherapy, particularly those on methotrexate?

<p>Aspirin is a contraindication because it increases the toxicity of methotrexate. (C)</p> Signup and view all the answers

What is the primary mechanism by which osteoradionecrosis (ORN) develops following radiotherapy?

<p>Endarteritis obliterans leading to reduced blood supply. (A)</p> Signup and view all the answers

Before initiating head and neck radiotherapy, how does removing poor prognosis teeth help prevent complications?

<p>Minimizes the chance of osteoradionecrosis by eliminating potential infection foci. (B)</p> Signup and view all the answers

Which intervention would be most appropriate for managing xerostomia following radiotherapy involving the salivary glands?

<p>Frequent use of fluoride supplements and saliva substitutes. (A)</p> Signup and view all the answers

What is the rationale for using silver markers in brachytherapy seeds, as shown in the image?

<p>Improve the visibility of the seeds on radiographic imaging for accurate placement. (A)</p> Signup and view all the answers

Why are children more susceptible to craniofacial defects following radiotherapy?

<p>Radiotherapy interferes with active bone growth and development in children. (A)</p> Signup and view all the answers

Which long-term effect is associated with radiotherapy due to damage to the vasculature?

<p>Endarteritis obliterans (B)</p> Signup and view all the answers

If a patient who has undergone radiotherapy to the jaws requires dental extractions, what is the most appropriate management approach?

<p>Referral to a specialist, with consideration for antibiotics and possibly hyperbaric oxygen therapy. (A)</p> Signup and view all the answers

A patient reports a persistent loss of taste after receiving radiotherapy for oral cancer. What is the most likely cause?

<p>Damage to the taste buds from direct radiation exposure. (D)</p> Signup and view all the answers

Why is fluoride supplementation particularly important for patients undergoing head and neck radiotherapy?

<p>Fluoride protects against radiation caries due to reduced salivary flow and altered pH. (A)</p> Signup and view all the answers

A patient undergoing radiotherapy complains of skin soreness (erythema) at the site of beam entry. What is the underlying mechanism?

<p>Inflammatory response due to radiation-induced damage to skin cells. (D)</p> Signup and view all the answers

What is the purpose of liaison with other clinicians (MDT) in the dental care of a head and neck radiotherapy patient?

<p>To ensure comprehensive and coordinated care, addressing both medical and dental needs. (C)</p> Signup and view all the answers

How might radiotherapy contribute to the development of dental hypersensitivity?

<p>Radiotherapy can lead to enamel erosion and dentin exposure due to xerostomia. (B)</p> Signup and view all the answers

What preventative measure can be taken to minimize radiation caries in patients undergoing radiotherapy?

<p>Use fluoride supplements and maintain excellent oral hygiene. (D)</p> Signup and view all the answers

Why is optimizing dental treatment prior to starting chemotherapy or radiotherapy important?

<p>Both A and B. (D)</p> Signup and view all the answers

Radiotherapy can affect the blood vessels in the jaw, and increase the risk of osteoradionecrosis (ORN). What is this effect on blood vessels called?

<p>Endarteritis obliterans. (C)</p> Signup and view all the answers

Why is dental management, including the removal of poor prognosis teeth, particularly crucial before a patient undergoes head and neck radiotherapy?

<p>To reduce the risk of osteoradionecrosis and manage potential oral complications effectively (C)</p> Signup and view all the answers

A patient who has undergone radiotherapy involving the salivary glands is experiencing a drastically reduced salivary flow. Which of the following strategies is MOST appropriate for managing this condition, known as xerostomia?

<p>Recommending frequent use of fluoride supplementation and salivary substitutes (A)</p> Signup and view all the answers

What is the underlying mechanism by which osteoradionecrosis (ORN) develops following radiotherapy to the head and neck region?

<p>Progressive obliteration of blood vessels in bone tissue, resulting in hypoxia and necrosis (D)</p> Signup and view all the answers

Following head and neck radiotherapy, a patient exhibits signs of rampant caries, particularly at the cervical margins of the teeth. What is the MOST likely contributing factor to this condition?

<p>Reduced salivary flow leading to decreased buffering capacity and clearance of fermentable carbohydrates (B)</p> Signup and view all the answers

Why are silver markers incorporated into brachytherapy seeds, as depicted in the diagram?

<p>To allow for radiographic visualization and accurate placement of the seeds (C)</p> Signup and view all the answers

After radiation therapy, what vascular change directly contributes to the development of osteoradionecrosis?

<p>Endarteritis obliterans (A)</p> Signup and view all the answers

Why are children especially vulnerable to developing craniofacial defects following radiotherapy involving the head and neck area?

<p>Radiotherapy targets actively dividing cells, and children's craniofacial structures are still developing (D)</p> Signup and view all the answers

A patient who underwent radiotherapy now presents with a complete loss of taste sensation. What is the MOST likely underlying cause of this sensory deficit?

<p>Destruction of taste receptor cells in the taste buds (A)</p> Signup and view all the answers

A patient undergoing head and neck radiotherapy reports that their skin in the irradiated area has become intensely sore and red (erythematous). What is the primary mechanism behind this skin reaction?

<p>Damage to basal keratinocytes leading to inflammation (B)</p> Signup and view all the answers

What is the MOST important reason for maintaining close communication and collaboration with other healthcare professionals within a Multi-Disciplinary Team (MDT) when managing the dental care of a patient undergoing head and neck radiotherapy?

<p>To provide comprehensive, coordinated care that addresses both the oncological and oral health needs of the patient (C)</p> Signup and view all the answers

Radiation can cause collateral damage, in the context of radiotherapy, what does collateral damage mean?

<p>Damage to healthy tissues surrounding the tumor (B)</p> Signup and view all the answers

Why is optimizing dental treatment prior to starting chemotherapy or radiotherapy so critical for patients with cancer?

<p>To reduce the need for complex dental work during periods of immunosuppression and increased risk of complications (B)</p> Signup and view all the answers

Why is it crucial to consult a patient's full blood count (FBC) before proceeding with a dental extraction, especially in patients undergoing chemotherapy or radiotherapy?

<p>To evaluate the patient's risk of bleeding and infection due to potential thrombocytopenia or neutropenia (D)</p> Signup and view all the answers

What is the primary mechanism by which radiotherapy leads to osteoradionecrosis (ORN)?

<p>Progressive reduction in bone blood supply due to endarteritis obliterans (A)</p> Signup and view all the answers

Why is it crucial to extract teeth with a poor prognosis before initiating head and neck radiotherapy?

<p>To minimize the risk of osteoradionecrosis (ORN) and infection following radiotherapy (A)</p> Signup and view all the answers

A patient undergoing radiotherapy involving the salivary glands reports a persistent dry mouth. Which of the following is the MOST appropriate initial management strategy?

<p>Saliva substitutes and frequent sips of water (C)</p> Signup and view all the answers

What is the likely cause of radiation caries following radiotherapy?

<p>Changes in the oral microbiome and reduced salivary flow (A)</p> Signup and view all the answers

What is the role of silver markers in the brachytherapy seeds?

<p>Provide radiopacity for accurate seed localization on imaging (C)</p> Signup and view all the answers

Why are children considered more susceptible to craniofacial defects following radiotherapy to the head and neck region?

<p>Children's craniofacial structures are still developing, making them more vulnerable to radiation damage (C)</p> Signup and view all the answers

What vascular change associated with radiotherapy increases the risk of osteoradionecrosis?

<p>Endarteritis obliterans (D)</p> Signup and view all the answers

Following radiotherapy for oral cancer, a patient reports a complete loss of taste. What is the MOST probable underlying cause?

<p>Damage to the taste buds (A)</p> Signup and view all the answers

A patient undergoing head and neck radiotherapy reports skin soreness (erythema) in the irradiated area. What is the primary cause of this reaction?

<p>Inflammation and damage to skin cells caused by radiation (C)</p> Signup and view all the answers

What is the MOST crucial reason for maintaining close coordination with the Multi-Disciplinary Team (MDT) in the dental management of a patient undergoing head and neck radiotherapy?

<p>To facilitate comprehensive care and address the complex needs of the patient (A)</p> Signup and view all the answers

Following radiotherapy, a patient exhibits rampant caries, particularly at the cervical margins of the teeth. What is the MOST likely contributing factor to this condition?

<p>Alterations in saliva composition and decreased salivary flow (C)</p> Signup and view all the answers

Collateral damage is a potential side effect of radiotherapy. In this context, what does 'collateral damage' refer to?

<p>Damage to healthy tissues surrounding the tumor during radiation treatment (C)</p> Signup and view all the answers

Why is fluoride supplementation an important part of dental care for patients undergoing head and neck radiotherapy?

<p>To strengthen the enamel and prevent radiation caries (D)</p> Signup and view all the answers

What is the primary underlying cause of osteoradionecrosis (ORN) following radiotherapy?

<p>Progressive restriction of blood supply due to damage to blood vessels. (A)</p> Signup and view all the answers

Why are dental extractions a significant concern following DXT (deep X-ray therapy) to the jaws?

<p>They can predispose the bone to osteoradionecrosis due to compromised healing. (C)</p> Signup and view all the answers

What is the most important reason for removing poor prognosis teeth before commencing head and neck radiotherapy?

<p>To minimize the potential for osteoradionecrosis and infection in compromised tissues. (A)</p> Signup and view all the answers

Which of the following is the most likely reason for a patient experiencing a persistent loss of taste after radiotherapy involving the salivary glands?

<p>Damage to the salivary glands leading to reduced saliva, affecting taste. (B)</p> Signup and view all the answers

Why is liaising with other clinicians emphasized in the dental care of a patient undergoing head and neck radiotherapy?

<p>To facilitate a coordinated, multidisciplinary approach to manage complex needs. (D)</p> Signup and view all the answers

Following head and neck radiotherapy, rampant caries is often observed at the cervical margins of teeth. What factor MOST contributes to this increased caries risk?

<p>Reduced salivary flow leading to decreased buffering capacity. (B)</p> Signup and view all the answers

Why are silver markers used within brachytherapy seeds, as illustrated in the image?

<p>To allow for easy identification and tracking of the seeds via imaging techniques. (A)</p> Signup and view all the answers

Which mechanism primarily explains why children are more prone to craniofacial defects as a result of radiotherapy?

<p>Their craniofacial structures are still developing, making tissues more vulnerable. (A)</p> Signup and view all the answers

What vascular change is considered a direct contributor to the development of osteoradionecrosis (ORN) after radiation therapy?

<p>Endarteritis obliterans reduces blood supply. (C)</p> Signup and view all the answers

A patient undergoing head and neck radiotherapy reports intense skin soreness (erythema). What is the primary mechanism behind this reaction?

<p>Direct damage to epidermal cells leading to inflammation. (B)</p> Signup and view all the answers

Which measure is most appropriate for managing xerostomia following radiotherapy involving the major salivary glands?

<p>Frequent use of saliva substitutes, sips of water, and salivary stimulants. (A)</p> Signup and view all the answers

What preventative dental measure is most important to minimize radiation caries in a patient undergoing radiotherapy?

<p>Intensive fluoride therapy. (C)</p> Signup and view all the answers

Why is optimizing dental treatment prior to starting head and neck radiotherapy so critical?

<p>To reduce any potential sources of infection or inflammation in the irradiated field. (D)</p> Signup and view all the answers

Why is it important to be aware of potential blood count changes in patients undergoing chemotherapy?

<p>Chemotherapy often suppresses bone marrow function, affecting blood cell production. (B)</p> Signup and view all the answers

Flashcards

MDT Approach

A multi-disciplinary team approach in medicine involves surgeons, oncologists, radiologists, speech therapists, restorative dentistry, Macmillan nurses, and dieticians.

Oncology

The study of cancer, focusing on its development and spread.

Metastasis

The process by which cancer cells move away from the primary tumor and invade other parts of the body.

Cancer Treatment Modalities

Treatment options for cancer including surgery, radiotherapy, chemotherapy, hormone therapy and immunotherapy.

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Evaluation of Oral Cancer

Biopsy, examination under anaesthesia, endoscopy, imaging, and staging are ways to assess oral cancer.

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Oral Cancer TNM System

TNM system classifies tumor size, node involvement, and metastasis.

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T Stages of Oral Cancer

T1: Tumor <2 cm; T2: Tumor <4 cm; T3: Tumor >4 cm; T4: Infiltrating.

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N Stages of Oral Cancer

N1: Mobile nodes, <3 cm, ipsilateral; N2: Mobile nodes, 3-6 cm contra or bilateral; N3: Fixed nodes >6 cm.

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M Stages of Oral Cancer

M1: Distant metastases present.

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Stages of Oral Cancer

Stage I: T1N0M0; Stage II: T2N0M0; Stage III: T3N0M0 or T1/T2/T3/N1M0; Stage IV: Any T N2/N3M0 or Any T Any N M1.

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Curative vs. Palliative

Curative aims to eliminate cancer; Palliative aims to relieve symptoms.

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Cancer Risk Factors

Increasing age , smoking, high alcohol intake, hormones, genetic inheritance, environmental exposure, diet, and previous viral infections are all risk factors.

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General Cancer Symptoms

Unexplained loss of weight, anorexia, anemia, sensory/motor dysfunction, pain, and impaired immune response.

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Chemotherapy

Using drugs to kill dividing cancer cells.

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Adjuvant Chemotherapy

Given after surgery/radiotherapy.

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Neo-adjuvant Chemotherapy

Used as primary treatment for local control.

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Induction Chemotherapy

Primary treatment for widespread disease.

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Chemotherapy Principle

Selectively kill tumour cells - spares normal tissues.

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Cell Cycle

The cell cycle includes G0 (stimulus), M (mitosis), G1(protein/RNA synthesis), G0 (resting), S (DNA synthesis), and G2 (RNA synthesis).

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Non-phase Dependent

Kills cells exponentially with increasing dose – equally toxic in cycle or G0.

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Phase-dependent

Kills cells at a lower dose.

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Phase-dependent examples

Methotrexate and Vinca alkaloids.

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Non-phase dependent examples

5 – fluorouracil and Alkylating agents.

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Chemotherapy - Broad Groups

Alkylating agents, Antimetabolites, Antitumour antibiotics, Biological therapies.

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Routes of Administration

Oral, I.M., I.V., Intrathecal.

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Local Toxicity

Tissue destruction that occurs when a substance is injected outside of the blood vessel.

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Bone Marrow Toxicity

A dose-limiting factor concerning the toxicity that affects the bone marrow. Patients need regular FBC and differential.

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GI Toxicity

Nausea and vomiting due to stimulation of the CT zone, gut, and cerebral cortex.

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Methotrexate - Mucositis

Ulceration and inflammation of the mucous membranes caused by methotrexate.

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Alopecia

Hair loss that can be reduced by scalp cooling, starting 18-21 days after the first injection; doesn't occur with all agents.

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Chemotherapy - Carcinogenesis

The potential for cancer development, especially acute leukemia from long-term alkylating agents.

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Gonadal Damage

Damage to reproductive organs, potentially leading to sterility.

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Oral Complications

Infections, ulceration, mucositis, lip cracking, gingival bleeding, xerostomia, dehydration, and abnormal dental development.

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Pre-Chemo Dental Fitness

Addressing any dental issues to ensure the patient is in optimal oral health before starting chemotherapy.

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Bleeding/Infection Risks

Increased bleeding risk and susceptibility to infection of dental treatments.

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Methotrexate Ulcer Treatment

Ulceration may respond to topical folinic acid; avoid aspirin due to increased methotrexate toxicity.

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Methotrexate and Suxamethonium

There might be increased toxicity of suxamethonium with methotrexate.

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Managing Stomatitis

Sucking ice cubes or drinking cold water can help prevent – stomatitis – particularly with 5-FU

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Established Mucositis

Optimize oral hygiene, consider benzydamine hydrochloride.

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Candidosis Treatment

Fluconazole

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Herpetic Infection Treatment

Aciclovir

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Treating Systemic Infections

Aggressive treatment is needed to prevent infections from becoming systemic.

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Post-Chemo Risks

Increased susceptibility to infection and bleeding tendencies is a side effect.

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Platelets >50x10^9/litre

50x10^9/litre - Some patients may have desmopressin/platelets to cover surgery.

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Platelets <50x10^9/litre

Surgical procedures cause bleeding if platelets are not supplemented.

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Granulocytes <2x10^9/litre

<2x10^9/litre – prophylactic antibiotics needed.

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Types of Radiotherapy

Curative, palliative, neoadjuvant, adjuvant, and total body irradiation methods exist.

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Neoadjuvant Radiotherapy

Given before surgery to shrink the tumour

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Adjuvant Radiotherapy

Given after surgery to destroy any residual tumour cells.

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Radiotherapy Target

DNA is the main target which can lead to cell death and tumour necrosis.

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Carcinogenesis and Chemotherapy

Long term alkylating agents can lead to acute leukaemia

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Chemotherapy and Sterility

Damage to reproductive organs leading to reduced/loss fertility

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Oral complications of chemotherapy

Infections, ulceration, mucositis, lip cracking, gingival bleeding, xerostomia, dehydration, and abnormal dental development

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Dental Check-up

Get dentally fit if possible to minimize complications during chemotherapy

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Treating Ulceration

Ulceration often responds to topical folinic acid. Aspirin should be avoided due to increased methotrexate toxicity.

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Preventing Stomatitis

Sucking ice cubes or drinking cold water can help prevent stomatitis, especially with 5-FU treatments.

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Established Mucositis Management

Optimize oral hygiene, consider benzydamine hydrochloride

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Candidosis

Treat with Fluconazole

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Herpetic infection

Treat with Aciclovir

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Systemic Infections

Aggressive treatment is needed to prevent infections from becoming systemic.

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Radiotherapy Fractions

Given in fractions over 4-6 weeks to allow normal tissue recovery.

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High Radiosensitivity (Malignant)

Lymphoma, Leukaemia, Seminoma.

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External Beam Irradiation

Multi-field technique used, applying three or four fields.

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Local Toxicity Definition

Destruction of tissue if a substance is injected outside the vessel.

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FBC Monitoring During Chemotherapy

Regular Full Blood Count (FBC) and differential counts are needed.

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Chemotherapy Induced GI Toxicity

Nausea, vomiting, and gut irritation due to chemotherapy.

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Methotrexate - Induced Mucositis

Ulceration of the lining of the mouth, often caused by methotrexate.

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Chemotherapy Induced Alopecia

Hair loss due to chemotherapy, can be mitigated with scalp cooling.

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Chemotherapy - Long Term

Cancers or other complications caused by chemotherapy after treatment.

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Chemotherapy - Gonadal Damage

Adverse effects on reproductive organs caused by anticancer drugs.

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Chemotherapy infection

Always aggressively treat infections, do not let them get systemic.

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Granulocytes

Blood count where granulocytes >2x10^9/litre – normal management.

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What is Radiotherapy

To kill malignant cells by damaging their DNA, used for tumor shrinkage.

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Palliative Radiotherapy

A treatment aimed to improve the patient's quality of life by easing symptoms.

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Radiosensitivity - Normal Tissue

Highly sensitive normal tissue can be damages when undergoing Radiotherapy.

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External Radical Beam

Radical external beams use 3/4 fields.

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Brachytherapy

Using radioactive materials placed inside the body, close to the cancer cells, to deliver radiation.

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Radiotherapy Induced Fatigue

A common side effect of radiotherapy; feelings of weariness, reduced energy, and a strong desire to rest.

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Mucositis

Inflammation and ulceration of the mucous membranes lining the digestive tract, often a side effect of radiotherapy.

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Xerostomia

Dry mouth caused by reduced or absent saliva flow, often due to radiation damage to the salivary glands.

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Radiation Caries

Tooth decay caused or accelerated by radiation therapy, often affecting the incisal edges and necks of teeth.

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Osteoradionecrosis

A severe complication of radiotherapy to the jaws, resulting in bone death due to reduced blood supply.

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Trismus

A painful condition caused by the involuntary contraction of jaw muscles, limiting the opening of the mouth. Often caused by radiotherapy.

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Loss of Taste

Changes in the way things taste as a result of damage in the sensors, often caused by radiotherapy.

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Skin pigmentation

A change in skin color, especially darkening, occurring at the site of radiation beam entry during radiotherapy.

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Hair loss

The loss of hair at the site where the radiation beam enters during radiotherapy treatments.

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Radiation Induced Malignancy

Cancers that develop as a consequence of prior radiation exposure; may appear several years after radiotherapy.

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Pre-treatment dental care

Remove poor prognosis teeth before any treatment can commence.

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Manage early complications

Helping to manage dry mouth, mucositis and candidiasis

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Promote optimum oral hygiene

Enhance saliva production to protect the oral cavity.

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Fluoride supplementation

Increased fluoride limits teeth degradation.

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What is Brachytherapy

A type of radiotherapy where radioactive sources are placed inside the body.

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Mucositis (Radiotherapy)

Inflammation and ulceration of the digestive tract's mucous membranes.

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Xerostomia (Radiotherapy)

Dry mouth due to reduced saliva flow from radiation damage.

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Trismus (Radiotherapy)

Involuntary jaw muscle contraction, limiting mouth opening post-radiotherapy.

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Loss of Taste (Radiotherapy)

Change in taste due to sensor damage from head/neck radiotherapy.

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Hair Loss (Radiotherapy)

Hair loss that occurs at the site where the radiation beam enters.

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Basic types of Chemotherapy

Basic types of chemotherapy, radiotherapy.

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General Radiotherapy Side Effects

Tiredness, nausea, loss of appetite, skin soreness, pigmentation, and hair loss at the beam site.

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Mucositis (Oral)

Inflammation and ulceration of the oral mucosa.

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General Side Effects of Radiotherapy

Tiredness, nausea, loss of appetite, skin soreness at the beam entry site, skin pigmentation, and hair loss at the beam entry site.

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What is External Radiation?

Treatment using beams from outside of the body

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Study Notes

  • A titanium capsule contains adsorbed I-125 with silver markers, measuring 0.8 mm in height, 4.5 mm in length, and 0.5 mm in width.

General Side Effects of Radiotherapy

  • Potential side effects involve tiredness, nausea, and loss of appetite.
  • Erythema (soreness of skin) may occur at the beam entry site.
  • Skin pigmentation and hair loss can take place at the beam entry site.
  • There is a risk of radiation-induced malignancy years after treatment.

Oral Complications of Radiotherapy Involving the Salivary Glands

  • Oral complications include mucositis, ulceration, candidiasis, and xerostomia.
  • Radiation caries, dental hypersensitivity, and periodontal disease may occur.
  • Loss of taste, trismus, and osteoradionecrosis are possible.
  • Craniofacial defects can arise during growth.

Osteoradionecrosis

  • Osteoradionecrosis is due to endarteritis obliterans, leading to poor blood supply.
  • Dental extractions can lead to osteoradionecrosis.
  • Teeth with a poor prognosis should be removed before treatment.
  • If extractions are needed after deep X-ray therapy (DXT) to the jaws, specialist attention, antibiotics, and potentially hyperbaric oxygen are required.
  • Osteoradionecrosis can involve the mandible.

Dental Care of the Head and Neck Radiotherapy Patient

  • Poor prognosis teeth should be removed prior to treatment.
  • Early complications like dry mouth, mucositis, and candidiasis need management.
  • Optimum oral hygiene should be promoted through fluoride supplementation.
  • Recurrence should be considered during treatment, and dentists should liaise with other clinicians.

Complications – Acute Toxicity

  • Local toxicity causes tissue destruction if a chemotherapy agent is injected outside of the vessel.
  • Bone marrow toxicity is dose-limiting; regular Full Blood Count (FBC) and differential testing is required.
  • GI toxicity can cause nausea and vomiting by stimulating the CT zone, gut, and cerebral cortex.
  • Methotrexate use can lead to mucositis.

Acute Complications - Continued

  • Alopecia can occur but can be reduced by scalp cooling; hair loss typically starts 18-21 days after the first injection, and not all agents cause it.

Long-term Toxicity

  • Carcinogenesis can occur due to long-term use of alkylating agents, leading to acute leukaemia.
  • Gonadal damage can cause sterility.

Chemotherapy – Dental Relevance

  • Oral complications include infections, ulceration, mucositis, lip cracking, gingival bleeding, xerostomia, dehydration, and abnormal dental development.

Dental Management – Before Chemotherapy

  • Aim to get dentally fit if possible.
  • Awareness is required for possible bleeding problems and a predisposition to infection.

During Chemotherapy

  • Ulceration caused by Methotrexate may respond to topical folinic acid; avoid prescribing aspirin, as it increases Methotrexate toxicity.
  • Suxamethonium may have increased toxicity in patients taking Methotrexate.
  • Patients prone to stomatitis can suck on ice cubes or drink cold water during the infusion, particularly with 5-FU.
  • Optimize oral hygiene and consider benzydamine hydrochloride for established mucositis.
  • Treat candidosis with fluconazole.
  • Treat herpetic infections with aciclovir.
  • Aggressive treatment of any infections is necessary, as they soon become systemic.

After Chemotherapy

  • There is increased susceptibility to infection and bleeding tendencies.

The Full Blood Count

  • A platelet count >50x10⁹/litre indicates routine management; some patients may require desmopressin/platelets for surgery coverage.
  • Granulocytes >2x10⁹/litre indicates normal management.

Summary

  • Basic types of chemotherapy and radiotherapy are used in dental treatment.
  • Potential complications can be local or general.
  • Dentistry plays a central role in managing head and neck cancer.
  • The impact of chemotherapy on blood count should be considered.
  • It is important to optimise dental treatment before chemotherapy/radiotherapy is started.
  • Liaison with MDT is important to treatment success.

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