CDHO Advisory | Gastrointestinal Tract Tumours COLLEGE OF DENTAL HYGIENISTS OF ONTARIO ADVISORY ADVISORY TITLE Use of the dental hygiene interventions of scaling of teeth and root planing including curetting surrounding tissue, orthodontic and restorative practices, and other invasive interventions for persons1 with gastrointestinal tract tumours. ADVISORY STATUS Cite as College of Dental Hygienists of Ontario, CDHO Advisory Gastrointestinal Tract Tumours, 2020-01-20 INTERVENTIONS AND PRACTICES CONSIDERED Scaling of teeth and root planing including curetting surrounding tissue, orthodontic and restorative practices, and other invasive interventions (“the Procedures”). SCOPE DISEASE/CONDITION(S)/PROCEDURE(S) Gastrointestinal tract tumours INTENDED USERS Advanced practice nurses Nurses Dental assistants Patients/clients Dental hygienists Pharmacists Dentists Physicians Denturists Public health departments Dieticians Regulatory bodies Health professional students ADVISORY OBJECTIVE(S) To guide dental hygienists at the point of care relative to the use of the Procedures for persons who have gastrointestinal tract tumours, chiefly as follows. 1. Understanding the medical condition. 2. Sourcing medications information. 3. Taking the medical and medications history. 4. Identifying and contacting the most appropriate healthcare provider(s) for medical advice. 1 Persons includes young persons and children Page | 1 CDHO Advisory | Gastrointestinal Tract Tumours 5. Understanding and taking appropriate precautions prior to and during the Procedures proposed. 6. Deciding when and when not to proceed with the Procedures proposed. 7. Dealing with adverse events arising during the Procedures. 8. Keeping records. 9. Advising the patient/client. TARGET POPULATION Child (2 to 12 years) Adolescent (13 to 18 years) Adult (19 to 44 years) Middle Age (45 to 64 years) Aged (65 to 79 years) Aged 80 and over Male Female Parents, guardians, and family caregivers of children, young persons and adults with gastrointestinal tract tumours. MAJOR OUTCOMES CONSIDERED For persons who have gastrointestinal tract tumours: to maximize health benefits and minimize adverse effects by promoting the performance of the Procedures at the right time with the appropriate precautions, and by discouraging the performance of the Procedures at the wrong time or in the absence of appropriate precautions. RECOMMENDATIONS UNDERSTANDING THE MEDICAL CONDITION Types of gastrointestinal tract tumours covered in the Advisory 1. Anal cancer 2. Colorectal cancer 3. Esophageal tumours 4. Inherited colorectal cancer syndromes 5. Pancreatic cancer 6. Pancreatic endocrine tumours 7. Polyps of the colon and rectum 8. Small-bowel tumours 9. Stomach cancer 10. Tumours of the mouth and adjacent tissues a. Jaw tumours b. Oral squamous cell carcinoma c. Salivary gland tumours Page | 2 CDHO Advisory | Gastrointestinal Tract Tumours Terminology used in this Advisory 1. Achalasia, a disorder of the esophagus which a. impairs its ability to move food to the stomach b. originates in damage to the nerves of the esophagus 2. Adenocarcinoma, a malignant tumour in epithelial tissue, specifically in a gland. 3. Adenoma, a benign tumour that a. develops from epithelial tissue b. in the colon is often referred to as an adenomatous polyp, which occur in a range of sizes c. is not cancerous, though some adenomas have the potential to become cancerous. 4. Ameloblastoma (adamantinoma), a benign tumour, which usually is a. in the posterior regions of the mandible b. composed of epithelial cells that resemble enamel-producing cells but do not form enamel. 5. Anatomy of the gastrointestinal tract and its terminology are illustrated in the diagram: a. Digestive system 6. Benign and malignant a. benign refers to a tumour that i. is not cancerous ii. does not spread within the body iii. usually grows slowly iv. which is often but not always harmless because of pressure on adjacent 1. blood vessels 2. nerves 3. organs b. malignant refers to cancerous cells that i. spread throughout the body, by metastasis, invading or destroying tissues ii. grow rapidly in an uncontrolled way iii. may 1. be resistant to treatment 2. return even after all have been removed or destroyed. 7. Carcinoma, a malignant tumour that starts in epithelial tissue. 8. Cystadenocarcinoma of the pancreas, a rare type of pancreatic cancer that develops from a cystadenoma, a benign tumour. 9. Ductal adenocarcinoma, Adenocarcinoma that arises in the duct of the pancreas. 10. Dysphagia, difficulty swallowing. 11. Epithelial tissue, a tissue which a. is a layer of cells that i. covers the body ii. lines all the body’s cavities except blood vessels and lymphatics b. is of two principal types from both of which colorectal cancer develops i. lining epithelial tissue ii. glandular epithelial tissue. 12. Erythroplakia and leukoplakia a. may be regarded as pre-cancerous conditions b. erythroplakia is a slightly raised red area in the mouth that bleeds easily Page | 3 CDHO Advisory | Gastrointestinal Tract Tumours c. leukoplakia causes white patches in the mouth. 13. Gardner syndrome, which a. is characterized by multiple osteomas b. requires early identification, which is clinically critical, because i. of the multiple gastrointestinal polyps which invariably become malignant ii. more than half the patients with Gardner syndrome have dental anomalies, which may first be detected during oral health investigations for multiple 1. impacted teeth 2. un-erupted teeth. 14. Helicobacter pylori, a bacterium which a. is commonly found in the stomach b. is present in approximately one-half of the world’s population c. in most people it infects, produces i. no symptoms ii. no problems attributable to it d. is capable of causing digestive problems, such as i. ulcers ii. much less commonly, stomach cancer. 15. Metastasis a. the process by which tumour cells i. move from the primary location of a cancer ii. sever connections with the original cell group iii. establish remote colonies b. a tumour that develops away from the site of origin. 16. Odontoma, a type of tooth tumour that a. interferes with eruption of teeth b. is usually asymptomatic c. occurs usually before the age of 20 years d. occupies the space of a missing tooth or represents a developmental defect of a supernumerary tooth e. contains enamel, dentin, or cementum f. includes fibrous odontoma, an odontoma containing fibrous elements, and cementoma g. may be suggested by a clinically absent tooth, separated teeth or an expanded jaw h. is generally noted on radiographic examination 17. Oral exostoses, tori, that a. are bony swellings in the mouth b. are not rare c. vary in shape and size d. occur i. in the midline of the palate ii. on the lingual side of the lower jaw iii. on the buccal side of upper and lower jaws e. are regarded as developmental abnormalities that may i. present in adult life ii. grow slowly throughout life. 18. Oral human papillomavirus comprises a group of viruses Page | 4 CDHO Advisory | Gastrointestinal Tract Tumours a. with more than 100 types; of these at least 40 can be passed through sexual contact b. that often produce asymptomatic infections which resolve without treatment. 19. Osteoma, a benign bony outgrowth that a. occurs mostly on skull and facial bones b. may occur in Gardner syndrome. 20. Osteosarcoma a. is the most common cancerous bone tumour in youth b. is diagnosed at the average age of 15 c. may rarely occur in adults d. appears equally frequently in boys and girls until late adolescence, when boys are more commonly affected. 21. Proton pump inhibitors, medications that a. are used to treat some gastrointestinal disorders b. reduce the amount of acid in the stomach. 22. Squamous cells, the flat, skin-like cells that cover the inside of the mouth, nose, larynx and throat. 23. Squamous cell carcinoma, squamous cell cancer a. is carcinoma of squamous cells b. accounts for 90 percent of mouth and oropharyngeal cancers. Overview of gastrointestinal tract tumours Resources consulted . Colorectal Cancer Fact Sheet: College of Dental Hygienists of Ontario . Oral Cancer Fact Sheet: College of Dental Hygienists of Ontario . Human Papillomavirus Fact Sheet: College of Dental Hygienists of Ontario . American Cancer Society: Colorectal Cancer Facts & Figures 2017–2019 . American Cancer Society: Key Statistics About Stomach Cancer . Anal Cancer: American Society of Colon & Rectal Surgeons . Canadian Cancer Statistics, 2019: Canadian Cancer Society . Cancer of the Mouth and Throat: eMedicineHealth . Colorectal Cancer: Merck Manuals . Colorectal Cancer Screening: Cancer Care Ontario . Concepts in the Prevention of Adenocarcinoma of the Distal Esophagus and Proximal Stomach: American Cancer Society . Dermatologic Manifestations of Gardner Syndrome: Medscape . Esophageal Cancer: Merck Manuals . Gastrointestinal Stromal Tumors: Merck Manuals . Ontario Cancer Facts – Incidence of esophageal adenocarcinoma continues to rise: Cancer Care Ontario . Inherited Colorectal Cancer Syndromes: Clinics in Colon and Rectal Surgery . Jaw Tumors: Merck Manuals . NSAIDs (including aspirin) – Role in prevention of colorectal cancer: UpToDate . Oral Cancer and Precancerous Lesions: Oral Cancer Foundation . Oral Squamous Cell Carcinoma: Merck Manuals . Pancreatic Cancer: Merck Manuals Page | 5 CDHO Advisory | Gastrointestinal Tract Tumours . Pancreatic Endocrine Tumors: Merck Manuals . Polyps of the Colon and Rectum: Merck Manuals . Salivary Gland Tumors: Merck Manuals . Small-Bowel Tumors: Merck Manuals