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Chapter 50

Cancer

QuestionAnswer
What is cancer not? CANCER is NOT a SINGLE DISEASE but an expanded classification housing over 100 types of diseases. More Cases Diagnosed at 55 years of age and older
Cancer is a malignant neoplasm = cancer = abnormal /unrestricted growth of cells Usually rapid growth/ not always though Destroy healthy surrounding tissue Can Metastasize/spread
Branch of science/medicine that treats cancer Oncology
Specialists who treats cancer Oncologist
Male top 3 leading sites of new cancer cases in 2018 Prostate 19% Lung and Bronchus 14% Colon & Rectum 7%
Male top 3 deaths from cancer in 2018 Lung & Bronchus 26% Prostate 9% Colon & Rectum 8%
Female top 3 leading sites of new cancer cases in 2018 Breast 30% Lung & Bronchus 13% Colon & Rectum 7%
Female top 3 deaths from cancer in 2018 Lung & Bronchus 25% Breast 14% Colon & Rectum 8%
Breast Cancer Disparities in the USA African American Women nearly 2x likely of a diagnosis African American Women more likely than White Women to die
Kidney Cancer Disparities in the USA American Indian & Alaska Natives = highest rate of diagnosis and death
Liver Cancer Disparities in the USA GREATEST RATE IN American Indians/Alaska Natives Asian and Pacific Islanders Other ethnicities
Prostate Cancer Disparities in the USA African American >than 2x as likely as White men to die from this
Cervical Cancer Disparities in the USA Women/Rural 2 x likely to die from it than Women /Urban
Multiple Myeloma Disparities in the USA African Americans 2x like as Whites of diagnosis and death from it
Early Signs/Symptoms of Cancer Changes in bowel/bladder habits Sores/no healing Unusual bleeding/discharge Thickness/lumps breast or anywhere Indigestion/Difficulty swallowing Noticeable changes mole/wart Nagging cough/hoarseness
Common Signs of Oral Cancer Swelling/lump/growth/induration = Usually Painless In/or about mouth/neck Erythroplakia Patch (velvety- deep red) Leukoplakia Patch (white or red/white) Sore/ulcer=not healed after 2 weeks Repeated bleeding of mouth/throat Difficulty swallowing
Risk factors for Oral Cancer Tobacco Hx of oral cancer lesion Excessive use of alcohol Older age Frequent Sun exposure Low consumption fruits/vegetables HPV
Oral Complications of Therapies Mucositis Neurotoxicity Infection Bleeding/Hemorrhage Xerostomia/salivary gland dysfunction Cavities Tooth growth/development altered
Mucositis No dental tx until healed Prevent by: hydration, plaque control, stop use of alcohol rinses and strong toothpaste, gentle brushing with extra-soft
Salivary Glad Dysfunction (permanent after radiation) Xerostomia No alcohol rinses/ No irritating agents <Caffeine recommended Stop tobacco use Cool-Mist Humidifier for home Consult with Oncologist for Salivary Gland Stimulant Rx Caries Prevention: Low Sucrose intake Fluoride Rx (FL2 Rx)
Oral Infection (Fungal, viral or bacterial) Consistent/frequent oral hydration Plaque Control No DHYG Tx while acute oral infection Delay DHYG Tx until NEUTROPHIL count >1000mm If a Central Venous Catheter MUST PREMED/ANTIBIOTIC PREMED
Bleeding/ due to chemotherapy induced myelosuppression Removal of plaque is important Delay DHYG tx until PLATELET COUNT >50,000 or received blood transfussion
Rampant Caries Plaque control hydration Daily Rx Fl2 application In office Fl2 application Nutritional counseling to decrease cariogenic intake 2-Week Chlorhexedine regimen if daily Rx of Fl2 not sufficient and add in office Fl2 2-3 month recare
Trismus Exercise TMJ without causing pain (2-3 x day for 20 min open and close mouth) Dental visits/altered such as short appointments or sedation to ease the TMJ
Soft-Tissue Necrosis Teeth within area where radiation is to be received, EXT within 14-21 days before radiation starts Frequent/regular dental hygiene to ensure prevention of perio and compliance with oral homecare
OHI PRODUCTS Review Table 50.3
Is there a cancer disparity based on race/ethnicity and urban/rural groups? YES
Oral cavity cancer has decreased but oropharyngeal/head and neck cancers have increased due to the human papilloma virus (HPV) in young adults Both statements are true
Don't forget....... Patients may receive single or combination of therapies such as surgery, chemotherapy, radiation therapy, hormone therapy, or bone marrow or blood stem cell transplant
Incidence of Oral Mucositis in patients undergoing cancer therapy 40%-100% Meticulous oral hygiene care can help decrease the severity
Should pre-existing dental/oral pathology be treated before cancer therapy begins? YES because these pathologies can adversely affect the patient during cancer therapy, HOWEVER, this does not mean that treating dental pathologies prior to cancer therapy will prevent oral complications. Cancer therapies affect good and bad cells.
Medication-related osteonecrosis of the jaw( MRONJ) can occur years after administration? YES, because of the half-life of the drug ALL dental/perio therapies should be completed prior to the drug is administered
Head and Neck Cancer Radiation Tx this results in permanent oral complications and need to be managed during and after radiation therapy Reason: not the radiation therapy directly but the negative effects it has for example on the salivary glands, etc.
Cancer Tx is what? It is MULTIFACETED and this means that various health and social service professionals are needed to support the patient for a positive outcome. Comprehensive care=dental hygienist working very closely with the interprofessional oncology team
American Cancer Society Says: Behavioral changes towards a healthy lifestyle can decrease the development of cancer to include use of vaccines and antibiotics
Vaccine for HPV Gardasil 9
Created by: IBrandt
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