Методичні розробки 3 модуль
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Анатомическая схема классификации стадий рака губы
Анатомическая схема классификации стадий рака языка
Б. Задачи для самоконтроля:
1.Какие гистологические формы рака губы встречаются чаще всего? (Ответ: плоскоклеточный)
2.Какие стадии рака языка считают запущенным?
(Ответ: III и IV стадия)
3. Укажите оптимальный метод лечения рака губы Т1 NОМО. (Ответ: близкофокусная рентгенотерапия)
В. Материалы для тестового контроля. Тестовые задания с одним правильным ответом
(α=ІІ):
1.Заболеваемость раком слизистой оболочки полости рта: A. Снижается.
B. Стабильная. C. Повышается.
Правильный ответ: С)
2.Наиболее частой морфологической формой злокачественных опухолей слизистой оболочки полости рта является:
A. Плоскоклеточный рак. B. Саркома.
C. Мукоэпидермоидная опухоль. D. Цилиндрома.
E. Недифференцированный рак. (Правильный ответ: А)
3.Наиболее частой локализацией рака слизистой оболочки полости рта является:
A.Язык.
B.Дно полости рта.
C.Слизистая щеки.
D.Слизистая мягкого неба.
E.Слизистая альвеолярного отростка челюсти. (Правильный ответ: В)
Г. Учебные задачи 3-го уровня (нетипичные задачи):
1.У больного Ш., 55 лет, в центре нижней губы наблюдается язва 2 см в диаметре, с валикоподобными краями, наблюдается инфильтрация тканей, которые окружают язву.
Поставьте предварительный диагноз? В какие лимфатические узлы возможные метастазы? Определите метод лечения больного.
(Ответ: рак нижней губы. Возможны метастазы в подчелюстные лимфатические узлы. Лечение комбинировано)
2.Больная В., 60 лет, обратилась с жалобами на боль во время глотания, которые возникла около 3 недель тому назад и постепенно усиливается. Во время осмотра на боковой поверхности языка слева определяется язва с переходом на слизистую оболочку дна полости рта, до 2 см в диаметре, болезненная при пальпации, с кровоточащим дном, наблюдается ограничение подвижности языка. Окружающие ткани ткани инфильтрированы.
Поставьте предварительный диагноз и укажите, какие методы исследования нужно провести для уточнения диагноза.
(Ответ: рак боковой поверхности языка слева. Необходимо провести биопсию (гистологический метод) и цитологическое исследование язвы)
3.Врач-стоматолог поликлиники обнаружила у больного поражение нижней губы, подозрительное на рак.
Ккакой клинической группе относится больной? Какая дальнейшая тактика врачастоматолога?
(Ответ: клиническая группа 1-А. Необходимо провести биопсию или цитологическое обследование, направить больного в онкологический диспансер)
7. ЛИТЕРАТУРА: Основная литература:
1.Онкологія. За ред. Б.Т. Білтнського, Ю.М. Шпарика. – Київ: «Здоров‘я», 2004. – 527 с.
2.Онкологія /За ред. В.П.Баштана, А.Л. Одабашьяна, П.В. Шелешка. – Тернопіль; Укрмедкнига, 2003. – 316 с.
3.Черенков В.Г. Клиническая онкология: Руководство для студентов и врачей. М.: ВУНМЦ МЗ РФ, 1999. – 384 с.
Дополнительная литература:
1.Онкологія. За ред. І.Б. Щепотіна. – Київ: «Книга плюс», 2006. – 496 с.
2.Пачес А.И. Опухоли головы и шеи. М.: Медицина, 1983. – 416 с.
3.Соловьѐв М.М. Онкологические аспекты в стоматологии. М.: Медицина, 1983. – 160 с.
4.Гистологическая классификация опухолей слюнных желѐз. Всемирная организация здравоохранения. Женева, 1976.
5.Справочник по онкологии. Под ред. С.А. Гриневича, Д.В. Мясоедова. – Київ. «Здоров‘я», 2009. -576 с.
6.Вибрані лекції з клінічної онкології. За ред. проф. Г.В. Бондаря і проф. С.В. Антіпової. Луганськ, 2009. – 560 с.
7.Стандарти діагностики і лікування онкологічних хворих. Затверджено наказом Міністерства охорони здоров‘я України «Про затвердження протоколів надання медичної допомоги за спеціальністю «Онкологія» від 17.09.2007 № 554. – 199 с.
8.Руководство по химиотерапии опухолевых заболеваний. Под ред. Н.И. Переводчиковой.
–Москва: Практическая медицина, 2005. – 704 с.
Ministry of health Ukraine
Higher state educational establishment of Ukraine
«Ukrainian medical stomatological academy»
It is «ratified» at meeting of chairof surgical stomatology and maxillofacial surgery with plastic and reconstructive surgery of the head and neck
The Head of the chair
doctor of medicine Aveticov D. S.
METHODICAL INSTRUCTION
FOR INDEPENDENT WORK OF STUDENTS DURING PREPARATION FOR PRACTICAL
(SEMINAR) LESSON
Names of the discipline |
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Surgical stomatology |
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Module № |
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3 |
Thematic module № |
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3 |
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Theme of lesson |
Organization of |
oncostomatological aid for patients and their |
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prophylactic |
system. Sequence and principles (methods) of |
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diagnosis of the oncostomatological patient. Medical documents |
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for surgeon – stomatologist‖. |
Course |
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IV |
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Faculty |
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Stomatological |
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Poltava – 2012
1. SUBJECT URGENCY.
Public awareness of head and neck cancer is low.
A randomised controlled trial found that patients attending primary care who had read an information leaflet about head and neck cancer had increased awareness of risk compared to patients who had not seen the leaflet. A questionnaire of awareness of signs and symptoms and risks of oral cancer showed that all those who received the leaflet (smokers, non-smokers and past smokers) reported greater knowledge (p< 0.001) with smokers 16 times more likely to perceive that they were at greater risk.
The most appropriate primary care setting in which to advise patients seeking help for suspected head and neck cancer has not been identified. Patients have different perceptions of the ability of dentists and doctors to diagnose and treat oral lesions. The signs and symptoms and the location of the lesions all influence a patient‘s choice of health professional for first consultation.
All healthcare practitioners, including dental and medical practitioners, should be aware of the presenting features of head and neck cancer, and the local referral pathways for suspected cancers.
There is no evidence for an effective screening programme for head and neck cancers. In particular, toluidine blue dye does not appear to be a cost-effective method of screening for oral cancers in a primary care (dental) setting.
Dental practitioners should include a full examination of the oral mucosa as part of routine dental check up.
Oral cavity tumours may arise from the anterior two-thirds of tongue (the oral tongue), floor of mouth, buccal mucosa, retromolar trigone, hard palate, or gingiva. Choice of therapeutic option for patients with early cancer of the oral cavity should be determined by the tumour‘s site and extent, the patient‘s general condition and preference and availability of local expertise.
It is important to consider the treatment related morbidity, and likely cosmetic and functional outcome of treatment, as well as tumour control, when making decisions about treatment.
In patients with head and neck cancer, 76% of recurrences occur within the first two years posttreatment, and 11% occur in the third year. In one study, 61% of patients with recurrence reported symptoms but 39% had no symptoms.
2.SPECIFIC GOALS:
2.1.To analyze the data of statistics of tumours and tumours-like diseases of maxillofacial area.
2.2.To explain features aetiology and pathogenesis of tumours and tumours-like diseases of
maxillofacial area.
2.3. To offer methods of diagnostics of tumours and tumours-like diseases of maxillofacial
area.
2.4.To classify tumours and tumours-like diseases of maxillofacial area.
2.5.To make the plan of examination of the patient with a tumour or tumours-like disease of
maxillofacial area.
2.6. To make the plan of treatment of the patient with a tumour or tumours-like disease of maxillofacial area.
3. BASIC LEVEL OF PREPARATION.
Names of the previous disciplines |
The received skills |
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1. |
Ethics. |
To come into psychological contact with oncological patients. |
2. |
The organization of public health |
To use knowledge by principles of the organization of the |
services. |
oncological help and prophylactic medical examination. To issue |
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the necessary documentation. |
3. |
Pathomorphology. |
To describe character of pathological changes of anatomic |
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structures at development of tumours. To show skills on a |
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capture of a material for cytologic and morphological research. |
4. |
Pathological physiology. |
To determine aetiology and pathogenesis tumours. |
5. |
Propaedeutics of internal illnesses. |
To write the scheme of the general examination of the patient. |
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To examine oncological patient. |
6. |
General oncology. |
To describe principles of diagnostics and treatment oncological |
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illness. To appoint the scheme of examination of the patient. |
4.THE TASK FOR INDEPENDENT WORK DURING PREPARATION FOR THE LESSON
4.1. The list of the basic parameters, characteristics which the student should acquire by preparation for the lesson:
The term |
Definition |
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1. |
A tumour |
The abnormal weight of tissues with superfluous growth which does not |
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correlate with growth of a normal tissyes and lasts after cancellation of |
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factors which have caused it. |
2. |
Clinical examination |
System of medical actions which is carried out by medical establishments |
for the prevention and |
with the purpose of duly diagnostics, treatments and preventive maintenance |
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treatment of disease. |
of diseases. |
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3. |
Oncological vigilance |
The medical tactics directed on early revealing of oncological diseases. The |
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main rule of this tactics: « Irrespective of an occasion on which the patient |
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has addressed to the doctor, the doctor should exclude at him the diagnosis of |
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oncological disease». |
4.2.Theoretical questions for the lesson:
1.Structure of the organization of the oncological stomatologic help.
2.Principles of clinical examination for the prevention and treatment of disease of patients with
tumours of a head and a neck.
3.The organization of the oncological stomatologic help.
4.The medical documentation of the surgeon - stomatologist.
5.Classification of tumours of maxillofacial localization.
6.A method of examination of the patient with oncological diseases.
4.3.Practical works (tasks) which are carried out on lesson:
1.To make examination of the patient with a tumour of maxillofacial area.
2.To make the scheme of examination of the patient with a tumour or a tumour – like disease of maxillofacial localization.
5. ORGANIZATION OF THE MAINTENANCE OF THE TRAINING MATERIAL. Oncology is the branch of medicine dealing with tumors (cancer). A medical professional who
practices oncology is an oncologist. The term originates from the Greek "Ογκολογία" derived from onkos (όγκος), meaning bulk, mass, or tumor, and the suffix -logy (-λογία), meaning "study of" or "to talk about".
The oncology – science which studies the origin, development, prevalence of tumours, opportunities of their diagnostics, treatment and preventive measures. Our focus will be on its branch - the oncological stomatology. It studies oncological problems or localization of tumours in maxillofacial area in stomatology. There is a set of tumour definitions in the medical literature. What is understood under this definition?
Tumour is the pathological overgrowth of tissues, which arises spontaneously and is characterized by structural polymorphism and functional independence, these properties being inherited during cell division.
Epidemiology Head and neck cancers are traditionally associated with older men who smoke and consume alcohol. A percentage of patients will not have the traditional risk factors, but the absence of these risk factors does not preclude the diagnosis. Evidence suggests that the incidence in the younger population of both sexes is rising. This coincides with an increase in the incidence of oral cancer. No evidence to explain these changes was identified.
Risk factors
Healthcare professionals should be aware of the possible risk factors for head and neck cancer and that patients with a combination of risk factors may be at greater risk.
A detailed case history should be taken for patients with suspected head and neck cancer.
Smoking is a risk factor. Leaving a cigarette on the lip is predictive of lip cancer risk irrespective of cumulative tobacco consumption.
Chewing tobacco is a risk factor for cancer of the oral cavity.
Alcohol consumption strongly increases the risk of developing cancers of the oral cavity, pharynx and larynx. There is a strong relationship between the quantity of alcohol consumption and the level of risk. No threshold was identified below which there was no increased risk.
Poor diet is a risk factor for head and neck cancer. Conversely, people with a good Mediterranean diet have less than half the risk of developing oral/pharyngeal cancer and half the risk of developing laryngeal cancer (results adjusted for smoking and body mass index; BMI).The key protective elements of the Mediterranean diet include: citrus fruit; vegetables, specifically tomatoes (fresh and processed); olive oil and fish oils.
There is evidence to suggest that the presence of gastro-oesophageal reflux disease (GORD) is a risk factor for laryngeal and pharyngeal cancer.
There is evidence to suggest a genetic susceptibility to head and neck cancer. At present there are no valid genetic screening tools.
Human papillomavirus (HPV) 16 sero-positivity is associated with an increased risk of oral/ pharyngeal cancer.
Diagnosis and staging of head and neck malignancy will normally include clinical examination by an experienced clinician, fibre optic endoscopy, fine needle aspiration (FNA)/core biopsy of any neck masses, followed by further examination under anaesthetic with additional biopsies if needed. Head and neck tumours are staged by the UICC: TNM Classification of Malignant
Tumours, which describes the anatomical extent of disease based on an assessment of the extent of the primary tumour, the absence or presence and extent of regional lymph node metastasis and the absence or presence of distant metastasis. Patients with confirmed malignancy will also undergo radiological staging by computerised tomography (CT) or magnetic resonance imaging (MRI).
Endoscopy. Routine oesophagoscopy and bronchoscopy in the absence of specific symptoms appear to have minimum benefit with respect to detection of synchronous primary tumours.
Direct pharyngolaryngoscopy and chest X-ray are recommended for patients with squamous cell carcinoma of the head and neck, while oesophagoscopy and bronchoscopy might be reserved for patients with associated symptoms.
Symptom-directed selective endoscopy appears to be an effective alternative to panendoscopy for the identification of synchronous primary tumours.58 When combined with a chest X-ray, symptomdirected endoscopy will detect most second primaries of the upper aerodigestive tract.
CT is more sensitive than endoscopy or manual examination at defining the T stage of the primary tumour (size of tumour, relationship to critical deep structures). Due to improved detection of superficial tumours and lack of artefact from dental amalgam, MRI is more accurate than CT in staging oropharyngeal and oral tumours.
CT and MRI are of similar accuracy in detecting neck node metastases, and are superior to physical examination. CT is marginally more accurate in detecting infrahyoid node metastasis. The given definition does not describe the whole clinical and morphological picture of the tumour
process. To solve this problem of the definition we can highlight 3 interconnected directions:
1.Biological - experimental оncology. It studies reasons, patterns and mechanisms of growth of
tumours.
2.Individual - clinical oncology. Studies reasons of occurrence, pathogenesis, clinical displays of tumour development, develops methods of diagnostics, treatment and preventive measures of concrete displays of tumours of various localizations.
3.Social - study of prevalence and character of tumours (epidemiology), reasons of their occurrence and development, sexual as well as age structure of patients, etc.
Social and medical value of the problem of malignant new growths of maxillofacial area is caused by high occurrence of the disease and the subsequent death rate of the patients. It is the result of the untimely diagnostics and insufficient literacy about clinic of disease and medical tactics.
Nowadays the given service is presented by scientific research institutes, oncological clinics, oncological branches and the consulting rooms.
The oncological service of the country is headed by the Ministry of Health.
Problems of malignant formations cannot be solved by the efforts of the individual countries. International cooperation is of great importance. The basic international organization is the International Anticarcinogenic Union. It organizes congresses that summarize scientific achievements in the field of oncology every four years. United Nations has the Oncological Department in the World Health Organization (WHO). The department has the scholarship fund for training of the highly skilled oncologists.
Oncological clinic is the basic link in the struggle against cancer.
Oncology is concerned with:
The diagnosis of any cancer in a person
Therapy (e.g., surgery, chemotherapy, radiotherapy and other modalities)
Follow-up of cancer patients after successful treatment
Palliative care of patients with terminal malignancies
Ethical questions surrounding cancer care
Screening efforts:
o of populations, or
o of the relatives of patients (in types of cancer that are thought to have a hereditary basis, such as breast cancer).
Main tasks of the department of the head and neck:
Study of prevalence of formations on the head and/or neck; The organization of preventive actions among the population;
The organization of general educational work on the given section;
Early diagnostics of the premalignent diseases and malignant formations of the head and neck; Adequate treatment of tumours;
Prophylactic clinical examination of patients; Rehabilitation of the patients;
Introduction of new methods of diagnostics and treatment of patients with tumours of the head and neck;
The analysis of the reasons of late diagnostics and untimely treatment of patients with tumours of the head and neck;
Training of doctors - stomatologists on the basis of oncological clinics.
Early detection of the malignant tumour is a prerequisite for its successful treatment. History of the patient usually offers clues that may be suggestive of a malignant process:
the living condition and habits;
the area of living.
At its |
initial stages |
a tumour is unlikely to produce any complaints. As the suspiction of |
a malignancy |
is sometimes |
based only on a few indistinct symptoms, the meticulous questioning |
is mandatory. It is therefore necessary to inquire where there has beeen any minor change in the
patient`s |
well-being. Of great |
importance is what is referred to as the syndrome of minor |
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symptoms |
and |
signs, i.e. the state of discomfort that may be indicative of the malignancy: |
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fatigability |
without apparent |
cause and a reduction in working capability; |
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rejection or |
unwillingness to |
eat certain foods; |
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drowsiness;
apathy to what used to be of interest;
―a foreign body‖ sensation;
abdominal discomfort rather than pain(e.g. a feeling of heaviness);
lack of satisfaction after urination or defecation, ect.
Furthermore, a |
change in size, color |
or consistency of a pre-existing |
lesion (e.g. a birthmark)is |
not |
infrequently of |
a diagnostic value. |
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The earlier the diagnosis of the malignant tumour, the better the prognosis. As the patient with |
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malignancy may first report to a |
physician of whatever speciality, |
the oncological alertness |
is |
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important for each health care professional. |
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The |
oncological alertness implies: |
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Physician`s knowledge of early and|or atypical symptoms and signs of malignancy and its |
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complications. |
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2. |
Physician`s knowledge of the clinical pictures of premalignant conditions |
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treatment. |
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3. |
The timely referral of patients with supposedly |
malignant |
conditions |
to |
specialized |
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medical centres. |
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4. |
The adequacy of the patient`s examination by the physician who was the first |
to suspect |
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the malignancy irrespective of their speciality. |
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Persistent progression of symptoms is often a hallmark of |
a malignant |
condition. The |
history |
of |
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the |
disease is often short in duration; on the other hand, a |
long-standing chronic |
inflammation |
or |
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benign tumour may precede a malignant process.
The |
physical examination is invariably based on routine methods: |
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inspection; |
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palpation; |
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auscultation. |
Premalignant conditions include diffuse and focal overgrowth of the epithelium of the skin and mucous membranes, which can be recognized through inspection and endoscopy.
The examples might be as follows:
leukoplakia, or ``white spots``, i.e. vegetations of the epithelium covering mucous
membranes, the changes being undetectable on palpation;
certain benign cutaneous lesions (e.g. papillomas, polyps, birth marks);
different forms of senile dyskeratosis.
Pain is not a characteristic feature of tumour, with the exception of tumours arising from blood vessels and neural tissues, which exert pressure on the tissues. Usually, the pain is related to the
distention of the adjacent tissues, infiltration of the nerves or organ insufficiency. |
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Palpation is one of the major methods used in the physical examination |
as |
it |
provides |
the |
physician with vital information of the tumour.The palpation of the tumour |
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to |
be gentle |
and |
with appropriate pressure, the finger tips being used to feel first the intact adjacent tissue while
approaching the tumour itself. It |
is sometimes performed with both hands, as is the case with |
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feeling the lymph nodes, breast tumours. |
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The size of a tumour measures |
from milimetres to centimeters. The tumour shape is accounted |
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for its nature. Nodularity of the |
surface and adherence to the |
neighbouring tissues, coupled with |
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firm consistency, is |
characteristic |
off a malignancy, in contrast to a benign overgrowth or a cyst |
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which has smooth |
surface and is often round and mobile. It |
is noted that metastatic nodules on |
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the surface of a malignant tumour are likely to be smooth. |
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The consistency of |
a tumour appreciably depends on its type: |
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soft (normally implies a benign nature of the tumour, e.g. lipomas or polyps of mucous
membranes; |
in some |
cases, |
however, this |
can be a |
finding |
of an undifferentiated |
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tumour(e.g.sarcoma); |
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hard |
(associated |
with an |
overgrowth of |
the connective |
tissue, e.g. fibroma); |
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firm (firm consistency, together with elasticity without fluctuation, is typical of an encapsulated tumour filled with fluid);
wooden-like without demarcation (carcinoma).
The mobility of a tumour can be either spontaneous (active) or induced (passive).Of special importance is the tumour motility in relationship to the skin or muscles.
The tumour can move spontaneously:
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when it originates from |
a mobile organ (in the cavity); |
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on changing the body |
position; |
on swallowing ;
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on muscular contraction (muscle tumour). |
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The physician has to evaluate the tumour`s mobility. It is of particular significance in |
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infiltrating immobile tumours, which most commonly appear malignant by nature. |
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It is noteworthy that in numerous cases |
it is the metastases |
that are identified |
first. Similarly, all |
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the |
lymph nodes have to be thoroughly |
palpated. Metastatic |
lymph nodes differ |
from intact ones |
in that they are enlarged, round, firm and occasionally nodular and adhered to the surrounding
tissues and other |
lymph nodes. However, unlike inflamed nodes, they commonly lack tenderness. |
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Oral and pharyngeal tumours have to be examined |
by way of palpation. The digital examination |
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of these tumours yields additional information about |
their |
size, form, mobility and consistency. |
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To |
confirm the |
diagnosis of a malignant lesion or |
its |
metastases special investigations have to |
be |
performed: |
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1.Endoscopy.
2.Cytology (swabs, aspirates).
3.Histology (biopsy).
4.X-ray investigations.
5.Radioisotope mthods (scanning, scintigraphy).
6.Ultrasonography.
7.Computerised axial tomography.
8.Laboratory tests (blood cell morphology, enzyme activity etc, as indicated).
The classification was suggested as an international one by the Committee on Tumour
Nomenclature |
of the International Anticancer Union. According to this classification, there are 7 |
groups of tumours, their total number exceeds 200: |
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Epithelial tumours without specific localization (nonorganospecific). |
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Tumours of endocrine and exocrine glands as well as epithelial integument |
(organspecific). |
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Mesenchymal tumours. |
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Tumours of melanin-forming tissue. |
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Tumours of nervous system and brain membranes. |
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Tumours of blood system. |
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Teratomas. |
According to their clinico-morphological characteristics the tumours are divided into 3 groups: benign, malignant, tumours with local destructive growth.
Metastases can be: lymphogenic, hematogenic, implantation(contact).
According to the clinical classification, the 4 stages of pathological overgrowth are identified:
I stage-tumour is localized, occupies a limited area, does not infiltrate into the wall of the organ,
metastases are absent. |
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II stage-tumour is of a big size, can |
infiltrate into the organ wall but does not spread beyond the |
organ, there can be solitary metastases to the regional lymph nodes. |
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III stage-tumour is of a big size |
with degeneration, infiltration into the hollow organ wall; |
multiple metastases to the regional lymph |
nodes are |
present. |
IV stage-tumour with distant metastases |
to organs |
and lymph nodes and with infiltration of |
surrounding |
organs. |
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The TNMGP classification |
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Abbre- |
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Stands for |
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Stages |
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viation |
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considered |
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T |
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Tumour |
Size of |
the |
primary |
T1-T4 |
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tumour |
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N |
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Nodes |
Involvement |
of |
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NO-nodes are not palpable |
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lymph |
nodes |
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N1-metastases to the regional nodes |
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N2-metastases |
to the second level nodes |
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N3-metastases to distant nodes |
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M |
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Metastases |
Presence |
of |
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organ |
M0-no |
metastases |
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metastases |
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M1-metastases |
present |
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G |
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Grade |
Tumour |
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G1-low |
level |
of |
malignancy(highly |
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differentiation |
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differential tumour) |
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G2-moderate |
level |
of |
malignancy(low |
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differentiated tumour) |
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G3-high level (undifferentiated tumour) |
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P |
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Penetration |
Depth |
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of |
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the |
P1-cancer infiltrating into the mucous |
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tumourous |
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membrane |
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infiltration |
into |
the |
P2-cancer infiltrating into the submucous layer |
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walls |
of |
a |
hollow |
P3-cancer infiltrating into as deep as the serous |
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organ(histological |
layer |
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criteria) |
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P4-cancer infiltrating into |
the serous layer or |
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extending beyond the organ wall. |
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Head and neck surgeon
Surgeons who treat head and neck cancer may have different specialties. For example,
surgeon may be: an ear nose and throat (ENT) surgeon and have particular expertise in these areas a maxillofacial surgeon with oral and dental expertise a plastic surgeon with a specialist interest in reconstructive techniques.
Oncologist
These doctors specialise in the non-surgical treatments for cancer. They will decide on the correct combination of radiotherapy and/or chemotherapy and will prescribe the optimum dose.
A speech and language therapist (SLT) will advise you on swallowing and speech techniques and the provision of specialist equipment such as speaking valves.
A dietitian will advise the nutrition and feeding. Some patients require a feeding tube and the dietitian will help to assess when tube feeding is necessary. Specialist nurses or doctors will insert the feeding tube and give advice on how to use it.
Restorative dentist
A dentist who specialises in oral rehabilitation after surgery or radiotherapy to the mouth will assess teeth before, during and after treatment.
Role of the dental practitioner in cancer prevention and diagnosis
• Prevention
Actively discourage smoking and betel quid use Encourage moderation of alcohol intake Health promotion and education on oral carcinoma Provide check-ups for the edentulous and/or institutionalised elderly and other high risk non-attenders
• Early diagnosis
Be vigilant and suspicious Always examine mucosa as well as the teeth Monitor low-risk premalignant lesions Refer all high-risk lesions on discovery Perform biopsy appropriately
• After treatment
Manage simple denture problems after surgery Alleviate the effects of post-irradiation dry mouth, e.g. preventing caries
Monitor for recurrence, new premalignant lesions and second primary tumours
Monitor for cervical metastasis
Maintain morale of and provide additional support to patients and their relatives.
6. Types of individual work of students.
A.To study the following questions:
1.To know the organization of oncostomatological aid.
2.To know methods of investigations of patients.
B.Test tasks for self checking:
1.Patient А., 53 years, turn to for an advice or information to the doctor surgeon-stomatologist with complaints to presence of the ulcer on a lateral surface of the tongue which was formed by sharp edge of prothetic. The ulcer was formed more than 1 month. What should be tactics of the doctor?
(The answer: if after removal of the injuring factor, the ulcer will not disappear after 2 weeks, it is necessary to direct the patient in oncological dispensary (clinic)).
2.The doctor the surgeon-stomatologist has directed a material taken from a ulcer on a mucous membrane of hypoglossal area on cytologic research. From cytologic laboratory has received confirmation of a malignant ulcer. What should be the further actions of the doctor?
B.To observe a disease;
C.Excise the ulcer in out-patient conditions of a stomatological polyclinic with the further histological research;
D.To direct the patient to maxillofacial department;
E.To invite to consultation the doctor - oncologist;
The answer: + to direct the patient in oncological dispensary (clinic).
3. The patient has addressed to the surgeon - stomatologist with complaints to bad healing after extraction more than two weeks. The doctor has some times made scraping of socket. Three weeks later the constant pain in a jaw has appeared and the patient has directed on consultation to an oncological clinic. After histologic research of granulations the diagnosis of a malignant tumour has been put. What mistake was made by the doctor?
The answer: the granulations removed from socket necessary to direct on histological research.
C Materials for test control. Test tasks with single right answer (α=2):
1. Specify the characteristic not peculiar to a malignant tumour: A. growth with infiltration;