3BDS: Human diseases: oncology

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in which tissues do cancers originate
 All body tissues. All reproducing, replicating cells
 The tissues with the highest turnover rate are more commonly affected
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what is the of cancer which is found in glandular, squamous epithelium and lymphoid tissue and connective tissue = sarcoma
glandular- adenocarcinoma
squamous epithelium- squamous cell carcinoma
lymphoid tissue= lymphoma
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what does prognosis depend on
- Depends on primary site (some are easier to diagnose because it is more obvious)
- Depends on grade and stage of cancer (the higher the worse)
- Depends on patient fitness for treatment (very frail..or many cormobidities.. worse outcome)
- Standardised
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what are some examples of carcinogenic agents that induce mutations
chemicals, radiation, viruses, environmental factors
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give examples of two viruses that cause cancer, mention what cancer they cause
EBV: Hodgkin’s and non-hodgkin’s and stomach cancer
HPV: cervical and some caners of the back of the throat, oropharynx, vagina, penis, anus, *****, (head and neck cancers too)
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how does immune surveillance protect us from cancer
 Cancer cells present antigen that may be recognised by immune system leading to cancer cell death
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how does loss of immune surveillance makes cancers grow unchecked
 Immune system loses ability to recognise cancer cells as foreign
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what rewakens the immune surveillance
 Novel anticancer therapy ‘reawakens’ the immune system to cause cancer cell death- immunotherapy like chemotherapy
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what is grading for
• Grading tries to establish how aggressive a cancer is: how fast cells are dividing
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what is staging for
• How advanced it is in terms of metastatic spread and size
• Implications for choice and success of treatments
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what does TNM stand for
T=tumour, how big the tumour- differentiated etc
N= how many lymph nodes are affected
M= metastases
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what are some local effects of cancer (presenting features of cancer)
=lump is noticed by patient or clinician
= bleeding: bleed in urine, stool, sputum, inter-menstrual or post coital
= local pain
=local obstruction:dysphagia, constipation, urinary probs in prostate cancer
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what are the systemic effects of cancer (presenting features of cancer)
fatigue, weight loss, anaemia from blood loss, pain from metastases- bones/liver/ headache, hypercalcaemia, cachexia, nausea and vomiting
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what is cachexia
Generalised loss of fat, muscle, fatigue etc
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what is used to make a diagnosis
 Blood tests: tumour specific markers, routine bloods
 Biopsy or surgical resection specimen: histology and surface antigens
 Imaging-USS, CT, MRI, PET, Bone scan to show metastases
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what are the treatment options
- Surgery: can be curative or debulking to improve outcome of other Rx
- Chemotherapy- systemic
- Radiotherapy- can be directed at an organ
- Hormonal treatments
- Immunotherapy
- BM Transplant
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Chemotherapy side effects
- Chemotherapy affects rapidly dividing cells
Blood count falls: risk of neutropenic sepsis at nadirs of white cell count
Bleeding risk with thrombocytopenia
Anaemia contributes to fatigue
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GI Tract side effects/ other side effects from chemo
GI tract side effects:
 Mucositis
 Diarrhoea
 Constipation
 Nausea
 Vomiting
 Anorexia

other side effects:
 Hair loss
 Fatigue
 Memory and concentration problems
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Radiotherapy side effects depend on what and what are the side effects
depends on where radiotherapy is directed and which normal tissues are hit

• GI tract: diarrhoea
• Head- hair loss
• Bladder- radiation cystitis
• Salivary glands- xerostomia
• Oral mucosa- mucositis
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what are normal treatments for
- For hormone sensitive tumours
- Breast cancer (oestrogen)
- Prostate cancer (testosterone)
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give some examples of cancer immunotherapy
cytokines, monoclonal antibodies, vaccines to treat cancer, checkpoint inhibitors, CAR T- cell therapy
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how could cancer present to dentists
• Bone metastases may be present in facial bones and cause pain or get worse (prostate, renal, lung, breast, myeloma commonly metastasise to bone)
• Anaemia due to blood loss: may be present on oral examination
• Bleeding and bruising: in haematological
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what are the oral side effects of chemotherapy
 Mucositis
 Ulceration
 Lip cracking
 Candidiasis or HSV due to immune suppression
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what is mucositis
Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, usually as an adverse effect of chemotherapy and radiotherapy treatment for cancer.
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what are bisphosphonates used for
Metastatic breast cancer
Metastatic prostate cancer
Myeloma
Patients with malignant hypercalcaemia
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Dental aspects of living with cancer
 Be aware that chemotherapy causes neutropenia and low platelet counts between cycles
Infection risk
Bleeding and bruising
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what is palliative care
Palliative care is an approach that improves the quality of life of patients and their families facing the problem ***ociated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable ***
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who might benefit from a palliative care approach
• Any stage of any illness where symptoms are distressing for the patient and family
• Physical
• Psychosocial
• Spiritual
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give examples of non opioids
paracetamol, NSAIDS= aspirin, ibuprofen, diclofenac, naproxen, etoricoxib, celecoxib
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give examples of mild opioids
codeine, dihydrocodeine, tramadol
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give examples of strong opioids
morphine-1st line
oxycodone-2nd line
fentanyl
diamorphine
methadone
hydromorphone
buprenorphine
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give examples of adjacent analgesics
(tricyclic antidepressants, amitriptyline, notriptyline)
[serotonin noradrenaline reuptate inhibitors, duloxetine]
{anticonvulsants, gabapentin, pregabalin}
dexamethasone
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Card 2

Front

what is the of cancer which is found in glandular, squamous epithelium and lymphoid tissue and connective tissue = sarcoma

Back

glandular- adenocarcinoma
squamous epithelium- squamous cell carcinoma
lymphoid tissue= lymphoma

Card 3

Front

what does prognosis depend on

Back

Preview of the front of card 3

Card 4

Front

what are some examples of carcinogenic agents that induce mutations

Back

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Card 5

Front

give examples of two viruses that cause cancer, mention what cancer they cause

Back

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