Oral Cancer

Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are several types of oral cancers, but around 90% are squamous cell carcinomas originating in the tissues that line the mouth and lips.
Oral or mouth cancer most commonly involves the tongue.

1. Prepare by: Arpana Bhusal BNS

2. Cancer is a disease of the cells in the body. The body is made up from millions of tiny cells. There are several types of oral cancers, but around 90% are squamous cell carcinomas originating in the tissues that line the mouth and lips. Oral or mouth cancer most commonly involves the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth). Most oral cancers look very similar under the microscope and are called squamous cell carcinoma. I NTR O DUCT IO N

3. ST RUC T UR E O F M O U T H

4. “ Cancer is defined as the uncontrollable growth of cells that invade and cause damage to surrounding tissue of oral cavity. Oral cancer appears as a growth or sore in the mouth that does not go away. Oral cancer, which includes cancers of the lips, tongue , cheeks, floor of the mouth , hard and soft palate, sinuses , and pharynx if not diagnosed and treated early.” DEFINITION

5. “ Oral Cancer is a group of cancers in the mouth include tongue, oral mucosa, and gum. Oral cancer can develop in any part of the oral cavity or oropharynx. Most oral cancers begin in the tongue and in the floor of the mouth. Almost all oral cancers begin in the flat cells (Squamous cells) that cover the surfaces of the mouth, tongue, and lips. These cancers are Called squamous cell ca r c i n om a s .”

6. Tobacco and alcohol use. Most cases of oral cancer are linked to cigarette smoking, heavy alcohol use, or the use of both tobacco and alcohol together. Using tobacco plus alcohol poses a much greater risk than using either substance alone. HPV. Infection with the sexually transmitted human papillomavirus (specifically the HPV 16 type) has been linked to a subset of oral cancers. Age . Risk increases with age. Oral cancer most often occurs in people over the age of 40. RISK FACTORS AND ETIOLOGICAL FACTORS OF ORAL CANCER

7. Sun exposure . Cancer of the lip can be caused by sun exposure. Diet . A diet low in fruits and vegetables may play a role in oral cancer development. Some studies suggest that not eating enough fruits and vegetables and increase intake Junk food, soft drink may increase the chance of oral cancer, Alcohol: People who drink alcohol are more likely to develop oral cancer than people who don't drink. A personal history of head and neck cancer: People who have head and neck cancer are at increased risk of developing another primary head and neck cancer. Smoking increases this risk ORAL SEX SPECIALLY IN LESBIAN AND GAY

8. Stage 1- The cancer measures <2 cm (about 1 inch) and has not spread to area of lymph nodes Stage 2- The cancer measures >2 cm but <4 cm (<2 inches) and has not spread to area of lymph nodes Stage 3- Any of the following may be true ; The cancer measures >4cm; the cancer any size, but has spread to only one lymph node on same side of neck as the cancer; the lymph node containing cancer measures <=3 cm STAGES OF ORAL CANCER

9. Stage 4- Any of the following may be true: The cancer has spread to tissue around the lip and oral cavity; area lymph nodes may or may not contain cancer; the cancer is any size and has spread to >1 lymph nodes on same side of neck as the cancer, to lymph nodes on one or both side of neck, or to any lymph node measuring >6cm; cancer has spread to other parts of the body

10. Common symptoms of oral cancer include : Patches inside mouth or on lips that are white, a mixture of red and white, or red White patches (leukoplakia) are the most common. White patches sometimes become malignant. Mixed red and white patches (erythroleukoplakia) are more likely than white patches to become malignant. Red patches (erythroplakia) are brightly colored, smooth areas that often become malignant. SI G N S AN D SY M P T OM S OFORALCANCER

11. A sore on lip or in mouth that won't heal Bleeding in mouth Loose teeth Difficulty or pain in chewing, swallowing, speaking Difficulty wearing dentures A lump in neck and enlarged cervical lymph nodes Numbness in the tongue or other areas of the mouth 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 voice OTHER SIGN AND SYMPTOMS

12. HISTORY OF THE PATIENT PHYSICAL EXAMINATION OFTHE MOUTH EXTRAORAL EXA MI N A T IO N INTRAORAL EXA MI N A T IO N CONT………. DIAGNOSIS OF ORAL CANCER

13. BLOOD TESTS LABORATORY VALUES M A Y BE AN ELEVATED N O T A B L E F O R ALKALINE P H O S P H A T A S E , A N D POSSIBLY AN ELEVATION OF THE WBC COUNT . BIOPSY DENTAL X RAY CT SCAN MRI

14. After knowing about the stages of the disease, than doctors decided to give treatment of the patient…. MEDICAL MANAGEMENT: RADIATION THERAPY: Radiation therapy (also called radiotherapy) affects cells only the treated area. It may be used before surgery to kill cancer cells and shrink the tumor. It is used for small cell carcinoma. It also may be used after surgery to destroy cancer calls that may remain in the area. Radiation therapy uses high-energy rays to kill cancer cells. Doctors use two types of radiation therapy to treat oral cancer: EXTERNAL RADIATION: The radiation comes from a machine. Patients go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks. INTERNAL RADIATION (IMPLANT RADIATION): Radioactive implant is inserted directly in tissue with the use of needles and thin plastic tubes for several days. Patient has to stay in the hospital. CHEMOTHERAPY: Medical oncologist administers chemotherapy if cancer has spread to lymph nodes or other organs. The medicine circulates in the blood and disrupts the growth of the cancer cells. Chemotherapy medications are taken by mouth or given through a vein for several months. Chemotherapy is not curative for this type of tumor, but when combined with surgery it is helpful in controlling the tumor. Chemotherapy is the prescribed for: TREATMENT FOR ORAL CANCER

15. After surgery to decrease the risk of the cancer returning To slow the growth of a tumor and control symptoms when the cancer cannot be curedSURGICAL MANAGEMENT: Surgery to remove the tumor in the mouth or throat is a common treatment for oral cancer. Sometimes the surgeon also removes lymph nodes in the neck. Other tissues in the mouth and neck may be remove as well. Patients may have surgery alone or in combination with radiation therapy. • • • Maxillectomy (removal of the part of the maxilla) Mandibulectomy (removal of the mandible or lower jaw or part of it) Glossectomy (tongue removal, can be total, hemi or partial) Radical neck dissection Combinational e.g., glossectomy and laryngectomy done together.

16. Dry mouth Cavities Oral communication with the sinuses Difficulties speaking, drinking and eating Malocclusion(misalignment or incorrect relation between the teeth of the two dental arches) Facial deformities Isolation from society COMPLICATIONS OF ORAL CANCER

17. Pre-treatment dental examination to prevent or reduce oral complications Osteoradionecrosis Bone which can not heal Hyperbaric oxygen treatment REDUCING COMPLICATIONS

18. Prostheses fabricated by a maxillofacial prosthodontist to restore form and function Obturators Facial prostheses Palatal augmentations Resection prostheses Implants RESTORING FUNCTION

19. Dental implants RESTORING FUNCTION

20. FACIAL PROSTHESES RESTORING FUNCTION

21. 1. 2. Inflammed/altered oral mucus membrane related to a pathologic condition or infection Disturb body image- related to a physical change in appearance resulting from a disease condition or its treatment 3. 4. Fear of pain and social isolation related to disease or change in physical appearance Imbalance nutrition less then body requirement related to inability to ingest adequate nutrition secondary to oral or dental conditions 5.6 . 7. Deficit knowledge about disease process and treatment plan Risk for infection related to disease condition or treatment Impaired verbal communication related to treatment NURSING DIAGNOSIS AND IT’S INTERVENTION

22. Tell patient to avoid cold drinks, banana, cold milk, curd preparations, ice cream, refrigerated food items and also tell about take salt restricted diet because hypertension Protein is essential for a healthy immune system, without which the body takes longer to recover from illness and lowers resistance to infection Carbohydrates and fats assist the body by supplying the calories required for a healthy living. DIET PLAN

23. DRY MOUTH SORE OR BLE E DI N G GUMS T OO T H DECAY INFECTION SORE THROAT IN MOUTH DE L A YED HEA L ING AFTER DENTAL CARE HEALTH TEACHING