Podcast
Questions and Answers
A patient undergoing chemotherapy develops mucositis. Which intervention is MOST appropriate to alleviate this side effect?
A patient undergoing chemotherapy develops mucositis. Which intervention is MOST appropriate to alleviate this side effect?
- Prescribing antibiotics to prevent secondary infection.
- Administering aspirin to reduce inflammation.
- Applying topical corticosteroids to reduce pain.
- Using ice cubes to soothe the oral mucosa. (correct)
A patient is scheduled to undergo radiotherapy for oral cancer. Why is it crucial to address dental issues before the start of radiotherapy?
A patient is scheduled to undergo radiotherapy for oral cancer. Why is it crucial to address dental issues before the start of radiotherapy?
- To allow time for the patient to adjust to wearing a mouthguard.
- To prevent any interference with the radiation beam's accuracy.
- To ensure that the patient's teeth are aesthetically pleasing for post-treatment appearance.
- To mitigate the risk of osteoradionecrosis and other oral complications. (correct)
A patient undergoing chemotherapy experiences a significant drop in blood cell counts. What is the MOST likely reason for this adverse effect?
A patient undergoing chemotherapy experiences a significant drop in blood cell counts. What is the MOST likely reason for this adverse effect?
- Direct damage to the bone marrow, where blood cells are produced. (correct)
- Increased peripheral destruction of blood cells.
- Selective targeting of mature blood cells by chemotherapy drugs.
- An allergic reaction to the chemotherapy medication.
A dentist is treating a patient who underwent radiotherapy for head and neck cancer five years ago. What is the MOST important long-term consideration for this patient's dental management?
A dentist is treating a patient who underwent radiotherapy for head and neck cancer five years ago. What is the MOST important long-term consideration for this patient's dental management?
A patient presents with a 3 cm oral tumour, no palpable cervical lymph nodes, and no evidence of distant metastases. According to the TNM staging system, what stage is this cancer MOST likely classified as?
A patient presents with a 3 cm oral tumour, no palpable cervical lymph nodes, and no evidence of distant metastases. According to the TNM staging system, what stage is this cancer MOST likely classified as?
A patient is about to start chemotherapy that includes Methotrexate. Which analgesic should be AVOIDED due to potential drug interaction?
A patient is about to start chemotherapy that includes Methotrexate. Which analgesic should be AVOIDED due to potential drug interaction?
Which of the following factors is LEAST likely to directly increase the risk of developing oral cancer?
Which of the following factors is LEAST likely to directly increase the risk of developing oral cancer?
Which of the following statements BEST describes the role of 'neo-adjuvant' chemotherapy in cancer treatment?
Which of the following statements BEST describes the role of 'neo-adjuvant' chemotherapy in cancer treatment?
What is the PRIMARY mechanism by which radiotherapy exerts its therapeutic effect on cancerous tumors?
What is the PRIMARY mechanism by which radiotherapy exerts its therapeutic effect on cancerous tumors?
Which specialist is NOT typically involved in the initial diagnosis and assessment of oral cancer within a multi-disciplinary team (MDT)?
Which specialist is NOT typically involved in the initial diagnosis and assessment of oral cancer within a multi-disciplinary team (MDT)?
In the context of cancer treatment, what is the purpose of neoadjuvant therapy?
In the context of cancer treatment, what is the purpose of neoadjuvant therapy?
A patient is scheduled to receive Total Body Irradiation (TBI) as part of their treatment. In which of the following clinical scenarios is TBI MOST commonly used?
A patient is scheduled to receive Total Body Irradiation (TBI) as part of their treatment. In which of the following clinical scenarios is TBI MOST commonly used?
A patient undergoing chemotherapy experiences significant hair loss and mouth sores. Which phase of the cell cycle is LEAST relevant to these side effects?
A patient undergoing chemotherapy experiences significant hair loss and mouth sores. Which phase of the cell cycle is LEAST relevant to these side effects?
A patient presents with a persistent, non-healing ulcer on their tongue. An incisional biopsy is performed. Which of the following is the MOST important reason for performing a biopsy?
A patient presents with a persistent, non-healing ulcer on their tongue. An incisional biopsy is performed. Which of the following is the MOST important reason for performing a biopsy?
Which imaging modality would be the MOST appropriate FIRST-LINE investigation to assess potential bony involvement of an oral squamous cell carcinoma?
Which imaging modality would be the MOST appropriate FIRST-LINE investigation to assess potential bony involvement of an oral squamous cell carcinoma?
A patient diagnosed with oral cancer is experiencing significant weight loss, muscle wasting, and fatigue, indicative of cachexia. Which of the following interventions would be MOST appropriate to manage these symptoms?
A patient diagnosed with oral cancer is experiencing significant weight loss, muscle wasting, and fatigue, indicative of cachexia. Which of the following interventions would be MOST appropriate to manage these symptoms?
Flashcards
Multi-Disciplinary Team (MDT)
Multi-Disciplinary Team (MDT)
A team of specialists involved in oncology treatment, including surgeons, oncologists, radiologists, speech therapists, and GPs.
Cancer
Cancer
The uncontrolled growth and spread of abnormal cells, becoming invasive upon penetrating the basement membrane.
Adjuvant Chemotherapy
Adjuvant Chemotherapy
Given after surgery/radiotherapy to eliminate any remaining cancer cells.
Neo-Adjuvant Chemotherapy
Neo-Adjuvant Chemotherapy
Signup and view all the flashcards
Induction Chemotherapy
Induction Chemotherapy
Signup and view all the flashcards
Chemotherapy
Chemotherapy
Signup and view all the flashcards
Phase-Dependent Chemotherapy
Phase-Dependent Chemotherapy
Signup and view all the flashcards
Non-Phase Dependent Chemotherapy
Non-Phase Dependent Chemotherapy
Signup and view all the flashcards
Administration Routes
Administration Routes
Signup and view all the flashcards
Acute Chemotherapy Toxicity
Acute Chemotherapy Toxicity
Signup and view all the flashcards
Long-Term Chemotherapy Effects
Long-Term Chemotherapy Effects
Signup and view all the flashcards
Dental Care Before Chemotherapy
Dental Care Before Chemotherapy
Signup and view all the flashcards
Radiotherapy Mechanism
Radiotherapy Mechanism
Signup and view all the flashcards
Radiotherapy Side Effects
Radiotherapy Side Effects
Signup and view all the flashcards
Oral Radiotherapy Complications
Oral Radiotherapy Complications
Signup and view all the flashcards
Dental Management for Radiotherapy
Dental Management for Radiotherapy
Signup and view all the flashcards
Study Notes
- Oncology treatment relies on a multi-disciplinary team (MDT) of specialists
- The MDT includes surgeons (OMFS, ENT, Plastics), oncologists (radiotherapy, chemotherapy), radiologists, speech therapists, restorative dentists, MacMillan nurses, dieticians, and general practitioners (GPs)
Understanding Cancer
- Cancer arises from the uncontrolled growth and spread of abnormal cells
- Cancer becomes invasive upon penetrating the basement membrane
Common Treatment Modalities
- Surgery
- Radiotherapy
- Chemotherapy
- Hormone therapy
- Immunotherapy
Oral Cancer Evaluation
- Diagnosis and assessment involve:
- Biopsy and measurement
- Examination under anaesthesia (EUA)
- Endoscopy of the upper aerodigestive tract
- Assessment of cervical lymph node involvement
Imaging Techniques
- X-rays (OPG, CXR)
- CT scan
- MRI
- Staging determines the extent and prognosis of the disease
TNM Oral Cancer Classification
- Tumour (T) Classification
- T1: Tumour ≤2 cm
- T2: Tumour 2-4 cm
- T3: Tumour >4 cm
- T4: Tumour invading deep structures, regardless of size
- Lymph Nodes (N) Classification
- N0: No regional lymph node metastasis
- N1: Mobile, ≤3 cm, ipsilateral node
- N2: Mobile, 3-6 cm, ipsilateral node
- N3: Fixed, >6 cm, contralateral or bilateral nodes
- Metastases (M) Classification
- M0: No distant metastasis
- M1: Distant metastases present
Oral Cancer Staging
- Stage I: T1 N0 M0
- Stage II: T2 N0 M0
- Stage III: T3 N0 M0 OR T1/T2/T3 N1 M0
- Stage IV: T4 OR Any T N2/N3 M0 OR Any T Any N M1
Cancer Risk Factors
- Age
- Smoking
- High alcohol intake
- Hormones
- Genetic predisposition
- Environmental exposure
- Poor diet (low antioxidants, fibre)
- Viral infections (Hepatitis B/C, HPV)
General Cancer Symptoms
- Unexplained weight loss (cachexia)
- Anorexia
- Anaemia (chronic blood loss)
- Sensory/motor dysfunction (e.g., cranial nerve involvement)
- Pain (usually late-stage)
- Impaired immune response
Chemotherapy Terminology
- Adjuvant: Given after surgery/radiotherapy to eliminate residual disease
- Neo-Adjuvant: Given before surgery to shrink tumours
- Induction: Primary treatment for widespread disease
How Chemotherapy Works
- Chemotherapy targets and kills tumour cells, while sparing normal tissues
- It acts at different stages of the cell cycle
- G0 (resting)
- G1 (protein/RNA synthesis)
- S (DNA synthesis)
- G2 (RNA synthesis)
- M (mitosis)
Chemotherapy Types
- Phase-Dependent: Effective only in specific cell cycle phases (e.g., Methotrexate, Vinca Alkaloids)
- Non-Phase Dependent: Works throughout the cycle (e.g., 5-Fluorouracil, Alkylating Agents)
Administration Routes
- Oral, Intramuscular (I.M.), Intravenous (I.V.), Intrathecal
- Long-term catheters (Hickman Lines, Portacath)
- Pump mechanisms in specific arteries
Chemotherapy Complications
- Acute Toxicity
- Local: Tissue destruction if injected outside the vessel
- Bone Marrow: Low blood counts requiring regular monitoring
- Gastrointestinal (GI): Nausea, vomiting, mucositis (especially with Methotrexate)
- Hair Loss (Alopecia): Can be reduced with scalp cooling
- Long-Term Effects
- Carcinogenesis: Long-term use may cause leukemia
- Gonadal Damage: May result in infertility
Dental Considerations for Chemotherapy Patients
- Before: Ensure dental fitness to reduce complications
- During:
- Treat infections aggressively
- Avoid aspirin (increases Methotrexate toxicity)
- Use ice cubes to reduce stomatitis
- After: Increased risk of infections and bleeding
Radiotherapy Uses
- Curative
- Palliative
- Neoadjuvant (before surgery to shrink tumour)
- Adjuvant (after surgery to eliminate residual cells)
- Total Body Irradiation (for bone marrow transplants)
Radiotherapy Efficacy
- 49% cured by surgery
- 40% cured by radiotherapy
- 11% cured by chemotherapy
Radiotherapy Mechanism
- Damages DNA, leading to cell death and tumour shrinkage
- Most damage occurs during mitosis
- Given in fractions over 4-6 weeks to allow normal tissue recovery
Radiotherapy Side Effects
- General: Fatigue, nausea, appetite loss, skin erythema, pigmentation, hair loss
- Oral Complications: Mucositis, ulceration, candidiasis, xerostomia, dental caries, periodontal disease
- Osteoradionecrosis: Poor blood supply leading to jawbone damage (high risk post-extraction)
Dental Management for Radiotherapy Patients
- Remove high-risk teeth before starting therapy
- Manage dry mouth, mucositis, and infections
- Optimize oral hygiene with fluoride supplements
- Monitor for cancer recurrence
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This lesson covers oncology treatment by a multi-disciplinary team. It explains how cancer arises, various treatments, and oral cancer evaluation involving diagnosis, biopsy, and imaging techniques like X-rays and CT scans. It further covers TNM classification.
