Transcript Chapter 52 The Patient with Cancer

Chapter 55
The Patient With Cancer
DH210 Clinical Sciences
Lisa Mayo, RDH, BSDH
“Successful people are always looking for ways to help
others, unsuccessful people ask what’s in it for me?”
~Brian Tracy
Objectives
1. Cancer Basics
2. Cancer Tx
3. Dental Hygiene Care
Objective #1: Cancer Basics
Cancer
• Tx modalities: radiation therapy, chemotherapy, surgery,
hematopoietic cell transplantation
• AFFECT THE ORAL CAVITY TREMENDOUSLY!
• Definition: Group of neoplastic diseases in which there is
transformation of normal cells into malignant ones
• Cancer cells will spread to distant sites (metastasis)
• Characteristics of benign and malignant neoplasms: Table 55-1
• Classification of cancer based on origin of the tissue involved
Review Sheet CH55 #2-3
Oral Cancer Survival
Factors of survival
• Location and size of tumor
• Type
• Presence of metastasis
• Tumor sensitivity to tx
• Physical status/age of patient
Risk Factors
Review Sheet CH55 #4
•
•
•
•
•
•
Tobacco use
Alcohol use
Sunlight exposure
Environmental/occupational
Low SES
Viruses
• Epstein-Barr
• Hep C
• HPV
NBQ
The MOST common location of oral cancer is the
a.
b.
c.
d.
Floor of the mouth
Lateral border of the tongue
Lip
Pharynx
NBQ
The MOST common location of oral cancer is the
a.
b.
c.
d.
Floor of the mouth
Lateral border of the tongue
Lip
Pharynx
NBQ
Clients over age 60 who smoke are the fastest
growing segment of the oral cancer population.
Human papilloma virus 16 (HPV 16) is
responsible for the increased risk for oral cancer
especially in the tonsillar area.
a.
b.
c.
d.
The first statement is TRUE; the second is FALSE
The first statement is FALSE; the second is TRUE
Both statements are TRUE
Both statements are FALSE
NBQ
Clients over age 60 who smoke are the fastest
growing segment of the oral cancer population.
Human papilloma virus 16 (HPV 16) is
responsible for the increased risk for oral cancer
especially in the tonsillar area.
a.
b.
c.
d.
The first statement is TRUE; the second is FALSE
The first statement is FALSE; the second is TRUE
Both statements are TRUE
Both statements are FALSE
Objective #2: Cancer
Treatments
• Surgery
• Chemotherapy
• Radiation therapy
• Hematopoietic cell transplantation
• Hormone therapy
• Vaccine therapy
• Biotherapy
• Combo
Cancer Treatment
• Based on location/Size of tumor
• Treatment objectives
• Cure
• Control
• Palliative
Surgery
• Most common form of treatment for solid tumors
• Debulk large tumors then chemo/radiation
• Provide pain relief or prolong life when no chance of
cure is possible
Chemotherapy
• Involves the use of drugs that affect the rapidly dividing
cancer cell at different points in the cell cycle
• Wilkins p.839, Box 55-3 (NEED TO KNOW types of
agents used!)
• Objectives
• Destroy cancer cells & keep it from metastasizing
• Prevent cancer from recurring
• Improve quality of life
Chemotherapy
• Indications
• Eliminate a localized tumor too large for surgical removal
• Prior to surgery: makes tumor easier to remove
• Treat cancer that has metastasized to other parts of the body
• Prevent cancer recurrence
• Extend life when no chance of a cure is possible
• Systemic side effects (MANY!) SEE WILKINS p.840
• Affects rapidly dividing parts of the body the most (hair, oral
mucosa, GI, bone marrow)
• Alopecia (hair loss)
• Myelosuppression: bone marrow suppression
• Immunosuppression
Review Sheet CH55 #13
Oral Complications of Chemotherapy
• Oral mucositis/stomatitis (next slide)
• Xerostomia
• Infections: bacterial, viral, fungal
• Bleeding
• Neurotoxicity: mimic toothache, usually bilateral
Review Sheet CH55 #8, 14
WHO: Oral Mucositis Scale
Review Sheet CH55 #8-9, 16
Wilkins Table 55-2
Review
All of the following are systemic side effects of
chemotherapy except:
A) alopecia
B) skin reaction
C) nausea
D) anemia
Review
All of the following are systemic side effects of
chemotherapy except:
A) alopecia
B) skin reaction
C) nausea
D) anemia
Radiation Therapy
• Ionizing radiation to tx cancer
• Impacts the cancer cell's ability to replicate and
survive
• Not all tumors are radiosensitive
• Indications
• Tx small localized tumor that is radiosensitive
• Shrink a large tumor prior to surgery
• Assist chemotherapy effect when used
concurrently
Radiation Therapy
Types
1. External beam: radiation that is applied outside
the body. (next slide illustrates exposure areas
for external radiation)
2. Internal: the source (such as implants or seeds)
of the radiation is placed within the body
• Less radiation is delivered to surrounding
tissues than external
Common Fields of Radiation for Head & Neck Tumors
Parotid Field
Oropharynx Field
Antrum Field
Floor of
Mouth
Radiation Systemic Side Effects
• Skin reactions: looks like a bad sunburn
• Fatigue
• Gastric upset
• Nausea, vomiting
• Constipation, diarrhea
Review Sheet CH55 #7-8, 14, 16
Radiation Oral Complications
• Oral mucositis or
stomatitis
• Xerostomia
• Radiation caries
• Ageusia (Loss taste)
• Infection
• Bacterial
• Viral
• Fungal
• Trismus (pain/weakness of
mastication muscles)
• Osteoradionecrosis
NBQ
Radiation therapy such as brachytherapy or linear
accelerator therapy can have serious side effects,
the MOST serious of which is:
a. Xerostomia
b. Carious lesions
c. Trismus
d. Dysgeusia
e. Osteoradionecrosis
NBQ
Radiation therapy such as brachytherapy or linear
accelerator therapy can have serious side effects,
the MOST serious of which is:
a. Xerostomia
b. Carious lesions
c. Trismus
d. Dysgeusia
e. Osteoradionecrosis
Hematopoietic Cell Transplantation
Types of transplants
Autologous
“self”
Allogenic
“matched donor”
Syngeneic
“identical twin”
Review Sheet CH55 #17
Stages of Transplantation
1. Patient selection: non-responsive to chemo/rad
2. Histocompatibility matching
3. Pancytopenic period
• All cellular elements of blood depressed
• Protective isolation for patient required (susceptible to
infection)
• New marrow begins day 10-20
4. Recovery
• Immune recovery: 3-12 months
• Long-term recovery: 1-3 years
Review Sheet CH55 #17
Oral Complications
Review Sheet CH55 #7, 16
Oral complications
• Xerostomia
• Severe oral mucositis (10-14 days post-op)
• Viral & fungal infections (Candidiasis)
Systemic Complications
1. Infection: bacterial, viral, fungal
2. Organ complications
3. Acute graft-versus-host disease
• Donor's T-lymphocytes see host cell antigens as
foreign & react against the host tissue
• Symptoms (1st 100 days post-op)
• Painful red skin rash starting on the palms of hands
and soles of feet and progressing to the upper trunk
4. Chronic graft-versus-host disease
• Affects all body organs
• Appears up to 2 years post-transplant
Review Sheet CH55 #18
Objective #3: Dental Care
Dental Hygiene/Dental Care Plan
• Optimal oral health PRIOR to STARTING any type of
cancer therapy
• Personal factors: cancer brings fear and anxiety to the
patient, and many times is viewed by the patient as
cancer = death
• Encourage pt to bring a friend/family member to appt
• Positive reinforcement
• Written instructions
• Show patient you care about them and the success of
their cancer tx
Review Sheet CH55 #5, 19
Pretx Therapy
Review Sheet CH55 #6
Prior to therapy: Box 55-4
Reduced risks for development of
oral complications
During Cancer Tx
•
•
•
•
•
•
•
Box 55-5
Excellent home care
Fl gel trays
Xerostomia control
Caries control (next slide)
Perio control
Mouthrinse: every 2-3hrs baking
soda/water, no alcohol
• Monitor for trismus: pain/weakness
of mastication muscles
Review Sheet CH55 #9-12
Radiation Caries
Chemotherapy
During chemotherapy treatment
• Consult oncologist before any dental
procedures
• Premed: patients with catheters
• Postpone clinical services:
1) Platelet count is less than 50,000/mm3
2) Neutrophil count less than 1,000/mm3
Special Care for Children
• At risk for same complications as adults
• Extract loose primary teeth
• Teeth expected to exfoliate during therapy
• Remove orthodontic bands/brackets
• Monitor craniofacial/dental structures
• Perform routine daily personal oral care
• Avoid cariogenic foods/beverages
NBQ
A patient undergoing chemotherapy presents
with signs and symptoms of mucositis. Which of
the following interventions would best relieve
symptoms?
a.
b.
c.
d.
Glycerin and water spray
Sodium fluoride rinses
Lidocaine topical spray
Sodium bicarbonate rinses
NBQ
A patient undergoing chemotherapy presents
with signs and symptoms of mucositis. Which of
the following interventions would best relieve
symptoms?
a.
b.
c.
d.
Glycerin and water spray
Sodium fluoride rinses
Lidocaine topical spray
Sodium bicarbonate rinses
NBQ
Which of the following is a common oral side
effect of radiation to the head and neck area?
a.
b.
c.
d.
Occlusal caries
Fissuring of the tongue
Cervical caries
Periodontal abscesses
NBQ
Which of the following is a common oral side
effect of radiation to the head and neck area?
a.
b.
c.
d.
Occlusal caries
Fissuring of the tongue
Cervical caries
Periodontal abscesses