Cancer of the oral cavity

detail description of the oral cavity

1. CANCER OF THE ORAL CAVITY
Ms. SaheliC
LECTURER
IACN

2. INTRODUCTION
•Canceroftheoralcavitycanoccurinanypartofthemouthi.e.
(lips,lateraltongue,floorofthemouthmostcommonly)or
throatandishighlycurableifdiscoveredearly.
•Malignanciesoftheoralcavityareusuallysquamouscell
cancersandisaround90%ofthetotalcases.

4. DEFINITION
Oralcancerdefinedasauncontrollablegrowthofthecellsor
soreinthemouththatdoesnotheal;causesdamagetothe
surroundingtissuesofthelips,tongue,cheecks,floorofthe
mouth,hardandsoftpalate,sinusesandpharynxandcanbe
lifethreateningifnotdiagnosedandtreatedearly.

5. RISK FACTORS AND ETIOLOGY
•Cigarette, cigar and pipe smoking.
•Use of smokeless tobacco.
•Excessive use of alcohol.
•Oral cancers are often associated with the combined use
of alcohol and tobacco.
•Other factors include gender (male), age (older than 50
years)
•African American descent.

6. •Apersonalhistorywithheadandneckcancer
•Diet:Adietlowinfruitsandvegetablemayplayarole
inoralcancerdevelopment.
•Sunexposure:Cancerofthelipcanbecausedbysun
exposure.

7. STAGES OF ORAL CANCER
STAGE1:Thecancermeasures<2cm(about1inch)andhas
notspreadtoareaofthelymphnodes.
STAGE2:Thecancermeasures>2cmbut<4cm(<2inches)
andhasnotspreadtoareaoflymphnodes.
STAGE3:Thecancermeasures>4cm,thecancerofanysize,
buthasspreadtoonlyonelymphnodeonsamesideofthe
neck,thelymphnodecontainingcancermeasures<=3cm.

8. STAGE4:Thecancerhasspreadtotissuearoundthelipand
oralcavity,cancerspreadto>1lymphnodesonsamesideof
theneckandmeasures>6cm;andcancerhasspreadto
otherpartsofthebody.

9. CLINICAL MANIFESTATIONS
•Few or no symptoms, most commonly a painless sore or
mass that will not heal.
•Typical lesion is a painful induratedulcer with raised
edges.
•As the cancer progresses, patient may complain of
tenderness
•Difficulty in chewing, swallowing or speaking,
•Coughing of blood tinged sputum,
•Enlarged cervical lymph nodes

11. •Patches inside mouth or on lips that are a mixture of red
and white patches.
•Bleeding in the mouth.
•Loose teeth.
•Difficulty wearing dentures, swelling of the jaw that
causes dentures to fit poorly or become uncomfortable.
•Pain in one ear without hearing loss.
•Hoarseness, chronic sore throat or change in the voice.

12. DIAGNOSTIC EVALUATION
•History collection.
•Oral examination and physical examination: Visual inspection and
palpation of all mucosal surfaces, bimanual palpation of the floor of
the mouth and clinical assessment of the neck for lymph node
involvement.
•Assessment of cervical lymph nodes
•Biopsy-Confirmatory test.
•Fine needle aspiration cytology.
•Routine pan endoscopy.
•3D imaging with CT scan and MRI.

13. •Bloodtest:Laboratoryvaluesmaybenotableforan
elevatedalkalinephosphataseandpossiblyan
elevationoftheWBCcount.
•DentalXray.

14. MANAGEMENT
•Management varies with the nature of the lesion, preference of
the physician and patient choice.
•Resectionalsurgery, radiation therapy, chemotherapy or a
combination may be effective.
•Lip cancer: Small lesions are excised liberally
•Larger lesions may be treated by radiation therapy.

15. •Tongue cancer: Treated aggressively, recurrence rate is high.
( total resection or hemiglossectomy) are performed.
•Radical neck dissection for metastases of oral cancer to
lymphatic channel in the neck region with reconstructive
surgery.

16. SURGICAL MANAGEMENT
•Maxillectomy(removalofthepartofthemaxilla).
•Mandibulectomy(removalofthemandibleorlowerjaworpart
ofit).
•Glossectomy(Tongueremoval,canbetotal,hemiorpartial).
•Radicalneckdissection
•Combination:Glossectomyandlaryngectomydonetogether.

18. RADIATION THERAPY
•Affectscellsonlythetreatedarea.Itmaybeusedbeforethe
surgerytokillthecancercellsandshrinkthetumour.
•Itisusedforsmallcellcarcinoma.
•Twotypes;Externalradiationandinternalradiation.
•Externalradiation:Theradiationcomesfromthemachine.
Patientsgoestothehospitalonceortwiceaday,generally5
daysaweekforseveralweeks.
•Internalradiation:Radioactiveimplantisinserteddirectlyin
tissuewiththeuseofneedlesandthinplastictubesforseveral
days.Patienthastostayinthehospital.

19. CHEMOTHERAPY
•Medical oncologist administers chemotherapy if cancer has
spread to the lymph node or other organ.
•The medicine circulates in the blood and disrupts the growth
of the cancer cell.
•Chemotherapy when combined with surgery it is helpful.

20. PRE OPERATIVE NURSING MANAGEMENT
Assess the patients nutritional status pre operatively , a dietary
consultation may be necessary.
Implement enteral(through the GI tract) or parenteral(IV)
feedings as needed to maintain adequate nutrition.
If a radial graft is to be performed, then perform Allen test on
the donor arm; must to ensure that the ulnarartery is patent
and can provide blood flow to the hand after removal of the
radial artery.

21. Assessthepatientsabilitytocommunicateinwritingasverbal
communicationmaybeimpairedbyradicalsurgeryfororal
cancer(provideapenandpaperaftersurgerytopatientswho
canusethemtocommunicate).
Obtainacommunicationboardwithcommonlyusedwordsor
pictures(giveaftersurgerytopatientswhocannotwriteso
thattheymaypointtoneededitems).
Consultaspeechtherapist.

22. POST OPERATIVE NURSING MANAGEMENT
•Assessforpatentairway.
•Performsuctioningifthepatientisunabletomanageoralsecretions,
ifgraftingwaspartofthesurgery,suctioningmustbeperformedwith
caretopreventdamagetothegraft.
•Assessthegraftforviability,assesscolor(whitemayindicatearterial
occlusion,andbluemottlingmayindicatevenouscongestion),
althoughitcanbedifficulttoassessthegraftbylookingintothe
mouth.
•ADopplerultrasounddevicemaybeusedtolocatetheradialpulseat
thegraftsiteandtoassessgraftperfusion.

23. DIET PLAN
•Advice patient to avoid cold drinks, banana, cold milk, curd
preparation, ice cream, refrigerated food items and also tell
about to take salt restricted diet because of hypertension.
•Protein is essential for healthy immune system.
•CHO and fats assist the body by supplying the calories required
for a healthy living.

24. COMPLICATIONS
•Drymouth.
•Cavities.
•Oralcommunicationwiththesinuses.
•Difficultiesinspeaking,drinkingandeating.
•Malocclusion:misalignmentbetweentheteethofthe
twodentalarches.
•Facialdeformities.
•Isolationfromthesocieties.

25. RESTORING FUNCTION
•Prostheses fabricated by a maxillofacial prosthodontistto
restore form and function.
•Facial prostheses.
•Palatal augmentation.
•Resection prostheses.
•Implants.
•Dental implants