mehdi masoud 200910759
TRANSCRIPT
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Mehdi masoud 200910759ali mohammad 200810781
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Case:
50years old lady, seeking full denture, during
examination you noted a palpable, fixed, indurated
supraclavicular lymph node.
Her past medical history was heavy drinker andsmoker
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Supraclvicular node:
function:
The function of the supra clavicular lymph nodes and otherlymph nodes is to filter lymph fluid in the body. The right
supraclavicular lymph node is responsible for lymphatic drainage
of mediastinum, lungs, and esophagus. The left supraclavicular
lymph node is responsible for lymphatic drainage of the thorax
and abdomen.
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Causes of enlargement of supraclavicular L.N:
Bacterial infection
Fungal infection Lymphoma
Thoracic cancer
Retroperitoneal cancer
Effect of alcohol and somking:
Alcohol use clearly rasies the the risk of these cancers. Drinking andsmoking toghether raise the risk of these cancer than effect of eachone individually. This is because alcohol can act as solvent, helpingharmful chemicals in tobacco to get into the cell lining the digistivetract. Alcohol may also slow down these cells ability to repair DNA
damage caused by chemicals in tobacco
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Differntial diagnosis:
Lymphoma(hodgkin and non-hodgkin)
Metastas from lung cancer
Metastas from abdominal cancer (insetine, gastric)
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Lymphoma:Lymphoma is a type of blood cancer that occurs when B or
T lymphocytes divide faster than normal cells or live longer
than they are supposed to.
Hodgkin's lymphoma is one of the most well-known types
of lymphoma, is marked by the presence of a type of cell
called the Reed-Sternberg cell.
The non-Hodgkin lymphomas any kind of lymphomaexcept Hodgkin's lymphomas. They vary significantly in
their severity, from indolent to very aggressive.
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Investigation:
Past medical history
Physical and clinical examination
FBC:to exclude leukaemia, mononucleosis and other
causes of lymphadenopathy
ESR: an ESR of greater than 70 carries an unfavourableprognosis
CT scans of the thorax and abdomen are required for
staging Hodgkin's lymphoma.
Lymph node biopsy: to provide sufficiently large specimenfor fresh frozen and formalin-fixed samples.
Bone marrow biopsy is indicated for staging purposes
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Gallium scans
Liver function and serum protein tests
Fine needle aspiration: a diagnostic procedure used toinvestigate superficial lumps or masses
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Treatment:
Chemotherapy
Radiation
Stem cell transplant Surgery
combination
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Prognosis:new types of chemotherapy increased the survival rate than pervious.
5 years survival is seen in 98% of patients with favorable prognosis.
The adverse prognostic factors:
Age 45 years
Stage IV disease
Hemoglobin < 10.5 g/dl Lymphocyte count < 600/l or < 8%
Male
Albumin < 4.0 g/dl
White blood count 15,000/l
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Oral Complication of chemotherapy and
radiotherapy
Mucositis
Infection
taste change
dry mouth
Pain
Dehydration
Malnutrition tooth decay and gum disease
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Preventive mesaure:
Balanced diet Good oral hygiene
Prevent invasive dental procedure
Oral health examination by dentist
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