-
abnormal and unrestricted growth of cells that can invade and destroy normal body tissues
neoplasm
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usually circumscribed and encapsulated, slow growing, cells resemble tissue where it arises
benign
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infiltrates locally, and has potential to spread (metastasize), cells atypical or dysplastic and may not resemble parent tissue
malignant (neoplasm or cancer)
-
how are cancers classified? (2)
- origin of tissue involved(carcinomas from epithelial tisssu, and sarcomas from connective tissue
- type of cell (epithelial or connective)`
-
a succinct, standardized description of a tumor based on origin and spread
made of 3 components (name them)
- staging
- T (tumor size)
- N (presence or absence of lymph nodes)
- M (presence or absence of distant metastases)
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second leading cause of death in US for those under 85
Cancer
-
Factors of survival for cancer
- Location and size of tumor
- Type of cancer
- presence of distant metastasis
- Tumor sensativity
- physical condition/age of the patient
-
Risk factors for cancer
- Tobacco
- alcohol
- sunlight
- environmental/occupational
- viruses
- socioeconomic (lack of medical care)
-
determining factors for treating cancer
location and size of tumor
-
-
treatment approaches
- surgery
- chemotherapy
- radioation therapy
- hematopoietic cell trasmplantation (blood)
- hormone therapy
- vaccine therapy
- biotherapy
- combination of two or more approaches
-
most common treatment for solid tumors (malignant and non malignant)
surgery
-
indication for surgery
- location and size of tumor (small and localized)
- intial therapy prior to chemotherapy or radiation therapy
- palliation
-
objectives of chemotherapy
- destroy cancer cell
- prevent recurrence,
- improve quality of life
-
Indications for chemotherapy
- eliminate a localized tumor too large for surgical removal
- treat cancer that has metastasized to other parts of the body
- prevent cancer recurrence with maintenance therapy
- use prior to surgery to make a tumor easier to remove completely
- extend life when no chance of a cure is possible (palliation)
-
Syde effects of chemotherapy
- alopecia
- mylosupression
- immunosupression
- nausea, vomiting, diarrhea
- loss of appetite
- gastrointestinal mucositis
-
Oral complications of chemotherapy
- oral mucositis/stomatitis
- xerostomia
- infections (bacterial, fungual, viral)
- bleeding
- neurotoxicity
- altered tooth development (drugs before age 10)
-
ionizing radiation impact cell's ability to replicate and survive
readiation therapy
-
indications for radiation therapy
- small localized radiosensitive tumors
- shrink tumore before surgery
- assist chemotherapy concurrently
- prevent metastaisi
- prevent recurrence
- palliation therapy
-
systemic side effects of radiation
- skin reactions (simmilar to bad sunburn)
- fatigue
- gastric upset (nausea, vomiting, constipation, diarrhea)`
-
oral complications of Radiation
- oral mucositis or stomatitis
- xerostomia
- radiation caries
- taste loss
- infeciton (bacterial, viral, fungal)
- trismus
- osteoradionecrosis
-
radiation causing the bone to be destroyed
osteoradionecrosis
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used to treat blood disorders such as leukemia. Substitutes blood stem cells or bone marrow from a healthy and compatible source
hematopoietic cell transplantation
-
types of transplants
- autologous (self)
- unrelated (any matched donor)
- allogeneic (siblings)
- haploidentical (parent)
- syngeneic (identical twin)
-
how long is immune recovery
3-12 months
-
how long is long term recovery
1-3 years
-
the donor's T lymphocytes see the host cell antigens as foreign and react against the host tissue
acute-graft-versus-host disease (acute GVHD)
-
Symptoms of Acute GVHD
- present during the first 100 days
- painful red skin rash starting on the palms of hands and soles of feet and progressing to the upper trunk
- sever, persistent diarrhea
- jaundice, elevated liver enzymes, liver tenderness
-
Infections of Acute GVHD
- Bacterial
- viral: herpes simlex, varicella zoster, cytomegalovirus
- fungal: candida albicans
-
Organ complications associated with Acute GVHD
- gastrointestinal
- hepatic
- cardiac
- pulmonary
- hematologic
- neurologic
-
oral complications w acute GVHD
- oral mucositis: sever (appears 10-14 days psot-transplant)
- xerostomia
- viral and fungal infections (herpes simplex virus and candida albicans)
-
Chronic complications of transplants
Chronic-graft-versus-host disease (chronic GVHD)
-
Which organs does Chronic HVGD affect
All
-
appears up to...years psttransplant
2
-
oral complications of chronic HVGD
- mucositis
- oral infection/periodontal infection
- xerostomia/dental caries
- poor oral hygiene
-
dental hygiene care plan
- assess
- eliminate disease
- preventive oral care instruction
-
Personal factors in Dental care plan
- encourage patient to bring friend/family to take notes
- provide written instructions
- provide positive reinforcement
- show acceptance
- practice active listening skills
-
pretreatment therapy
intensive personal oral care prior to theray to reduce risk of oral complication
-
Pre-treatment guidelines for cancer therapy patients
- conduct a pretratment oral health assessment
- schedule a DH treatment in consultation with the oncologist
- perform DH treatment prior to cancer treatment
- evalutate patient's oral health knowledge and provide oral hygiene regimen based on the cancer therapy being received
- ANTICIPATORY GUIDANCE
-
prevent tooth demineralization and dental caries
- recommend daily application fo flouride gel at home (perscription strength)
- demonstrate application of a 1.1% neutral pH sodium fluride gel or .4% stannous unflavored gel
-
what kind of sodum flouride should be used on porcelain crowns or glass or resin ionomer restorations
nautral pH
-
how long do you leave the tray on?
5 min..dont eat for 30 min after
-
During radiation how often should these be done..biofilm removal? trays? exercising for trismus?
- 2X daily
- 1x daily
- 3x daily open and close 20 times
-
After radiation therapy how often should you recall the patient?
every 4-8 weeks for the first 6 months
-
DH job during chemotherapy
- consult oncologist
- postpone clinical services
- antibiotic premedication
-
DH job after chemotherapy
- place patient on a DH maintenance schedule when all side-effects are resolved
- get patient's release
-
DH job after hematopoietic cell transplantation
- monitor patient's oral health (may have oral infections)
- consult iwth oncologist prior to clinical procedures
- delay elective procedures
- follow patient for longterm oral complications
-
Special care for children
- extract loose primary teeth
- remove orthodontic bands/brackets
- monitor craniofacial/dental structures
- perform routine daily personal oral care
- avoid cariogenic foods/drinks
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