BAN QUIZ 4

G2 and M checkpoints, growth/replication controlled by signalling, tumor suppressors, programmed cell death

how does the body prevent cancer

rituximab

monoclonal antibody targeting CD20 protein on B cells, leading to their destruction.

elevated WBCs on CBC with differential

what lab test would make you suspicious of leukemia

lymph node biopsy

how is definitive diagnosis of lymphoma determined

pembrolizumab

a immune checkpoint inhibitor that inhibits the PD-1 pathway, enhancing T-cell responses against cancer

Non-hodgkin lymphoma

hematologic condition associated with invasion of Waldeyer’s ring

oral hygiene, chlorohexidine, chemotherapy (kills blast cells)

treatment of leukemic gingivitis

acute leukemias

rapid onset and progress, REQUIRE treatment within hours and days

aphthous major, diffuse ecchymosis

initial presentation of AML

stage III lymphoma

spread of cancer to lymph nodes below diaphragm

swollen, painless, fixed or rubbery mobile nodes

characteristics of lymphadenopathy

dysphagia, paresthesia (numbness), pain

symptoms of oropharyngeal lymphoma

MALT lymphoma

sjogrens disease increase risk of what

non-hodgkin lymphoma

second most common ORAL cancer

larger than 1 cm

size of lymph nodes persisting for more than 4 weeks that should be biopsy

myeloid sarcoma

a solid tumor of myeloid cells, often associated with acute myeloid leukemia (AML). Can cause EXPANSION OF MANDIBLE

rapid progression, bilateral viral infection, decreased inflammation (neutropenia)

in what ways can infection present abnormally in leukemia

tumor encroaching on nerve

what is numb chin syndrome an indication of

blast crisis

a life-threatening phase of chronic myeloid leukemia (CML) where immature blood cells proliferate uncontrollably, resembling acute leukemia.

oral ulcerations (stomatitis), dry mouth, opportunistic infections

adverse effects of immunotherapies

budesonide

corticosteroid can be CONTINOUSLY used to treat Immunotherapy-induced stomatitis/mucositis

stomatitis/mucositis

most prevalent adverse effect of mTOR inhibitors (immunotherapy)

Bevacizumab

immunotherapy that can cause mucocutaneous bleeding

swelling, progressive infection, pain, trauma, suspicious lesion

examples of when treatments would be medically necessary

late onset dryness

what raises suspicion for salivary GVHD

mucoceles

non dangerous clear fluid filled bumps that can develop at sites of minor salivary glands, may realte to GVHD or decreased salivary function

pilocarpine (salagen)

sialogogue used to manage dry mouth as a result of radiation-induced hyposalivation

elective treatment

Any treatment that does not need to be completed for a medical reason

acute iritis, narrow angle glaucoma, uncontrolled asthma

Siagologues should not be used when pts have which conditions

head and neck radiation with chemotherapy

what causes most severe MUCOSITIS with longest duration

removal of potential irritants

general management for Mucositis caused by cytotoxic chemotherapy and/or head & neck radiation

viscous lidocaine, benzocaine, magic mouthwash

topical anesthetic that may be used for pain associated with mucositis

recurrent HSV

In immunocompromised hosts, lesions may be widespread (not isolated to bone-bound tissue) and are EXTREMELY painful

microdontia (small teeth/roots) or hypodontia/oligodontia (missing teeth)

potential effect of chemotherapy and radiation in pediatric pts

severe aplastic anemia, severe combined immunodeficiency, sickle cell disease

non-malignancies that require HCT

at least 28 days before transplant

when should pre HCT dental health stabilization occur

prevent acute infection

goal of dental treatment prior to HCT

pre treatment antibacterial rinse (chlorohexidine), limit aerosols during procedure

dental treatment protocol when treating pt with neutropenia

Acute Myeloid Leukemia (AML)

Leukemic gingivitis is most likely to be seen in which type of leukemia?

without immunosuppression pts develop GVHD

why is immunosupression important after transplant

mild-moderate

GVHD level associated with highest survival rates

Multiple Myeloma (MM)

“Punched out” radiolucencies are a characteristic feature of which hematologic malignancy?

chronic GVHD

presents with similar symptoms to many autoimmune diseases (dry eyes, sclerosis, xerostomia)

recognize neoantigens on tumor cells

how do T cells prevent cancer

create antibodies against damaged cells

how do B cells prevent cancer

when they touch similar cells

when do cells normally stop growing

stimulate growth, resist inhibition, avoid apoptosis, angiogenesis, metastasis, mutation

properties of cancer cells

cytotoxic chemotherapy

kills ALL rapidly dividing cells

targeted chemotherapy

interferes with specific proteins involved in cancer growth and spread

hormone chemotherapy

slows or stops the growth of sex-hormone related cancers

adjuvant therapy

chemotherapy given AFTER surgery or radiation to kill remaining cancer cells

neoadjuvant therapy

chemotherapy given to shrink a tumor BEFORE surgery

blood, GI,hair, skin, epithelial

CELLS other than cancer cells that are AFFECTED by CYTOTOXIC CHEMOTHERAPY

gives patient time to recover (from adverse effects)

why would cytotoxic chemotherapy is administered in cycle

toxicities and time needed for body to recover

important considerations for length of treatment

imatinib (Gleevec)

A targeted therapy used primarily used to treat Philadelphia chromosome associated chronic myeloid leukemia (CML)

fewer side effects

benefit of targeted chemotherapy

small molecule drugs (nibs)

targeted chemotherapy drugs that ENTER CELL and target specific substance within cell

large molecule drugs/monoclonal antibodies (mabs)

targeted chemotherapy that target proteins or enzymes from CELL SURFACE

immunotherapy

a type of Targeted treatment that uses the body's own immune system to fight cancer,

angiogenesis inhibitors

targeted chemotherapy that inactivates vascular endothelial growth factor (VEGF)

mucositis (mucous membrane inflammation)

ADR of angiogenesis inhibitors

signal transduction inhibitors

targeted chemotherapy that interferes with intracellular signaling pathways to inhibit cancer cell growth

proteasome inhibitors/monoclonal immunoglobulins (mibs)

targeted chemotherapy that activate cell signaling to cause apoptosis

synthetic cytokines

immunotherapy that is a synthetic version of IL-2 that increases growth and activity of T and B cells

checkpoint inhibitors

immunotherapy that blocks checkpoint proteins to enhance T and B cell responses against tumors

Chimeric antigen receptor (CAR) T-cell therapy

immunotherapy that modifies T cells to find specific tumor cell

monoclonal antibodies

can be both targeted chemotherapy and immunotherapy

ceritinib, crizotinib

drugs that target ALK in non-small cell lung cancer

tobacco use

Which modifiable risk factor has the greatest impact on overall cancer incidence in the United States?

tumor supressor, mutation leads to loss of regulation

How does p53 mutation influence cancer risk?

Non-Hodgkin Lymphoma

Which type of lymphoma is more common?

bone marrow biopsy

most definitive study for the diagnosis of acute myeloid leukemia (AML)

myelodysplastic syndrome

A group of disorders caused by poorly formed or dysfunctional blood cells, often leading to ineffective hematopoiesis and an increased risk of AML

infection (neutropenia) and bleeding (thrrombocytopenia)

risks of myelodysplasia (pancytopenia related)

blood smear and bone marrow biopsy

tests for differential diagnosis of blood disorders/ cancers

hypercellular marrow

hallmark of MDS characterized by many abnormally shaped,
immature forms of blood cells and a high number of myeloid progenitors.

flow cytometry

test used to look for specific marker of disease

gentetic

test to look for specific muations realted to disease

0.8

threshold ANC under which a pt would require antibiotics

50

threshold PLT under which a pt would require platelet transfusion

24

threshold HCT under which pt would require RBC transfusion

oral hygiene, antibiotics, chlorhexidine, EXT when safe

how would you treat a periodontal abscess oin a pt with pancytopenia

platelet transfusion, prophylactic antibiotics, no NSAIDs, anti-fibrinolytic agent

what is the treatment plan for a pt with pancytopenia who requires emergent extraction

discuss with oncology, temporary stabilization if possible

approach for extraction in pts with cancer

allogenic hematopoietic stem cell transplant

a procedure that infuses healthy stem cells from a DONOR into a patient to replace damaged or diseased bone marrow, usually for LEUKEMIA

autologous hematopoietic stem cell transplant

a procedure that infuses a patient's OWN healthy stem cells back into their body after high-dose chemotherapy or radiation therapy, typically used for LYMPHOMA and MYELOMA

conditioning/myeloablation

the process of preparing a patient for a stem cell transplant by destroying diseased bone marrow and suppressing the immune system, often using chemotherapy or radiation.

infection,bleeding mucositis, xerostomia, taste dysfunction, acute GVHD

acute oral complications that may occur after ALLOGENIC HCT

Chronic GVHD, 2nd malignancies (oral squamous cell carcinoma), infections ect.

chronic complications that may occur after ALLOGENIC hematopoietic cell transplantation (HCT)

xerostomia, decay, relapse, 2nd malignancies

chronic complications that may occur with AUTOLOGOUS HCT

HLA matching

How are donors chosen for Allogeneic HCT?

decreased survival and increased graft rejection and risk of GVHD

risks with single antigen mismatch in A,B,C, or DR in HLA region

infection risk, bleeding risk, long term dental prognosis, timing of procedures

main considerations for treating oncology pts

open and broach, SDF, perio therapy (scaling)

examples of temporary stabilization in dentistry

dental stabilization, conditioning, transplant, recovery

order of events of HCT treatment

oral mucositis

complication of cancer therapies, especially HCT and head and neck radiation that causes painful inflammation and ulceration of the mucous membranes in the mouth

non-keratinized tissues

most suscptible tissue to mucositis

within 3 weeks

when does mucositis typically develop after HCT

palifermin

used to decrease severity of mucositis by thickening epithelial tissue before chemo