Oral Cancer introduction for nurses.pptx

Introduction to oral cancer

1. ECHO India ECHO India Oral Cancer Prevention, detection, and awareness Capacity building ECHO for Nursing Professionals. Moving Knowledge, Not People TOPIC- “ Introduction to Oral Cancer “

2. CANCER Cancer : An abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasize .   Oral cancer is one of the most common cancers in India. – India Times, 2023   More young people are becoming victims of head & neck cancer: Experts. – Tribune India, 2022   A surge in oral cancer cases due to tobacco consumption, say doctors. – Indian Express, 2022   India sees 1 million deaths due to oral cancer every year. – Hindustan Times, 2019   Not just tobacco, alcohol too top driver of oral cancer: new research. – Tribune India, 2022   These news reports from the last three years say one thing: India’s battle with oral cancer is a serious one.  

3. Incidence & Prevalence Oral Cancer Globally, oral cancer is the sixth most common type of cancer with India contributing to almost one-third of the total burden and the second country having the highest number of oral cancer cases. In India, around 77,000 new cases and 52,000 deaths are reported annually, which is approximately one-fourth of global incidences. India as about 70% of the cases are reported in the advanced Stages India has the highest Age Standardized Rate (ASR) for incidence of 9.6 for both genders combined and 14.3 for men alone. Even among females, it is among the top five most common cancers in India

4. Incidence & Prevalence Oral Cancer Oral cancer is an important health issue in India as it is affecting a large population in Various Zone Wise In the Central, East, West, and North Parts of India Buccal Mucosal Cancer is More Common affecting males. South and the Area of North–East -Tongue cancer is more common

5. Classification

6. Diagnosis, screening, and early detection of Oral cancer mucosa right behind the last molars on the bottom row of teeth. The oropharynx includes the soft palate which is the soft part of the roof of the mouth right behind the hard palate, the tonsils, the walls of the throat, and the posterior or back one-third of the tongue

7. Sites of Oral Cancer Accordingly Journal of cancer research & Therapeutics categorized the different site as per the development of the cancer

8. Types of Oral Cancer 1. Tumors originate from surface epithelium a)Squamous cell carcinoma ( Most common type 90-95 cases ) b)Melanoma 2. Tumor originated from glandular tissue ( Salivary Gland, Metastatic Cancer from breast, prostate, Lung ) a) Adenocarcinoma b) Adenocystic carcinoma c) Mucoepidermoid carcinoma 3. Tumor originated from mesenchymal tissue a) Sarcoma ( osteosarcoma, chondrosarcoma, fibrosarcoma, Ewing sarcoma ) b) Lymphoma

9. Pathogenesis of Oral Cancer

10. TNM Staging of Oral Cancer The TNM staging system is commonly used to classify the extent of cancer spread in various types of malignancies, including oral cancer.

11. Causes & Risk Factors & Prevention Oral cancer is multi factorial Disease condition which likely to include in the etiology of Oral Cancer

12. Causes & Risk Factors & Prevention Carcinogenesis usually Involves the combination of the intrinsic and Extrinsic Factors & Complimentary effects

13. Causes & Risk Factors & Prevention

14. *Genetic predispositioon , *food preservatives, *occupational exposure to wood, dust, coal, H2SO4, nickel, chromium, radium *Endocrine problems - early menarche, overweight

15. Causes & Risk Factors & Prevention 1. Tobacco It is the Primary but Most Important factor for developing the oral cancer Almost 70% Oral Cancers are referred to the use of Smoked and smokeless tobacco. This Rate May increase due to following

16. Causes & Risk Factors & Prevention a. Smoking Tobacco: The cigar, Pipe Smokers are at higher risk for having oral cancer. Cigar user (who inhale deeply ) having 6 times more prone to have oral cancer. Pipe smokers lower lip are more contacted with Pipe stem so they have risk to develop lower lip Cancer b. Smokeless Tobacco (Snuff): The smokeless tobacco (Snuff) is a fine ground or powered tobacco. It is placed between the gum and cheeks or upper lips for prolong period

17. Causes & Risk Factors & Prevention 2. Alcohol It is the second Most Commonest Important factor for developing the oral cancer Almost 70% Oral Cancers are referred to the use of Smoked and smokeless tobacco. This Rate May increase due to following

18. The high frequency intake of the alcohol is consider to be a more significant risk factor and is notable in cancer of oral cavity. However when combined with smoking is has a accelerated effect. At least 75% of oral cavity cancer are developed from the alcohol and tobacco use.

19. Causes & Risk Factors & Prevention 3. Betel quid chewing Betel quid chewing, integral to South and Southeast Asian cultures like India, embodies hospitality and tradition, prevalent in weddings and festivals. Ingredients like betel leaf, areca nut, and lime hold symbolic significance. Despite health risks, including cancer, government efforts to regulate and raise awareness face challenges in reconciling tradition with public health

20. Causes & Risk Factors & Prevention 5. Nutritional Deficiencies Nutritional deficiencies, like lack of fruits and vegetables, increase the risk of oral cancer. Inadequate intake of essential nutrients weakens the body's defense mechanisms against cancerous cell growth. A balanced diet rich in vitamins and minerals is crucial for maintaining oral health and reducing the risk of oral cancer.

21. Causes & Risk Factors & Prevention 6. Oral Infection Oral infections, particularly those caused by certain strains of human papilloma virus (HPV) and chronic infections like Candida, are significant risk factors for oral cancer. Persistent inflammation and damage to oral tissues increase the likelihood of malignant transformation, highlighting the importance of oral hygiene and prompt treatment of infections in preventing oral cancer.

22. Causes & Risk Factors & Prevention 7. Radiation Exposure Chronic Exposure to sun light consisting of the ultra violet radiations is a positive risk factor and thus higher incidence in individuals working under the sunlight. If ionizing radiation passes through a cell in the body, it can lead to mutations (changes) in the cell's DNA, the part of the cell that contains its genes (blueprints). This could contribute to cancer, or to the death of the cell

23. Causes & Risk Factors & Prevention 7. Radiation Exposure Sources of ionizing radiation Natural background radiation - comes from cosmic rays from our solar system and radioactive elements normally present in the soil. Medical radiation- comes in the form of diagnostic x-rays and other tests, as well as from radiation therapy. Non-medical, man-made radiation - it can come from workplace and other sources like nuclear weapons testing

24. Causes & Risk Factors & Prevention 7. Chronic Irritation Sources of Chronic Irritation Mechanical Irritation – it is mainly due to ill fitting dentures, Repetitive Ulceration Mucositis, Gingivitis Glossitis. Chemical Irritation- These includes wood dust, textile, leather workers, etc the chemicals cause irritation to the mucosal lining and the larynx and oral cavity.

25. Signs & Symptoms The signs and symptoms of oral cancer can vary depending on factors such as the location and stage of the cancer. Sign & symptoms includes 1. Leukoplakia : it is also called Thick, white patches. The commonest site the lateral boarder of Tongue, floor of mouth, It has irregular boarder

26. Signs & Symptoms 2. Erythroplakia : It is Red velvety Patches in the mouth specially found at buccal mucosal site as well as the tongue. 3. Hyperkeratosis: the Patches later become keratinized with hard and leathery apperence 4. Oral candidiasis - Candida albicans  is the most commonly implicated organism in this oral cancer condition.

27. Signs & Symptoms 5. Oral ulceration: non-healing of ulcer is a significant manifestation. especially if they persist for more than two weeks. 6. Pain and Discomfort: Oral cancer can cause persistent pain or discomfort in the mouth, tongue, or throat. This can range from mild discomfort to severe pain due to presence of Visible or palpable lesion .

28. Signs & Symptoms Ulceration with fresh bleeding from the lesion Odynophagia (difficulty while swallowing): Painful swallowing, or odynophagia , can accompany dysphagia in cases of advanced oral cancer. Cervical lymphadenopathy : In oral cancer, cervical lymphadenopathy commonly occurs as a consequence of the disease's progression & reflects Metastasis

29. Signs & Symptoms Halitosis: Persistent bad breath that is not alleviated by oral hygiene measures can be a symptom of oral cancer. Xerostomia : It occurs due to the tumor growth obstructing the parotid duct Difficulty in articulation of the jaw & Changes in voice, pronunciation and speech : the growth of the lesion affecting jaw functioning & throat or vocal cords can lead to changes in voice quality or persistent hoarseness. Weight loss and malnutrition: Advanced oral cancer can lead to unintentional weight loss due to difficulty eating or swallowing. Anemia due to reduced oral intake Infections secondary to anemia, chemotherapy due to myelo -suppression

30. Five-Year Survival Rates Several factors influence the five-year survival rates of oral cancer patients, including Tumor characteristics (such as stage, grade, and histological subtype), Treatment modalities (including surgery, radiation therapy, chemotherapy, and targeted therapies), Patient demographics (such as age, sex, socioeconomic status, and co-morbidities), Healthcare-related factors (such as access to specialized care, treatment adherence, and supportive services). Understanding the interplay of these factors is essential for risk stratification, treatment planning, and prognostic assessment in oral cancer patients. The 5-year survival of oral cancer patients is around 50% after treatment with surgery and radiotherapy, much lower than most of the developed countries .

31. Impact of Oral cancer Oral cancer can have a profound impact on various aspects of an individual's life, including physical health, emotional well-being, social relationships, and overall quality of life. 1. Physical Health Effects: Oral cancer can cause symptoms such as pain, difficulty swallowing ( dysphagia ), changes in speech, persistent mouth sores, and bleeding. Depending on the location and stage of the cancer, individuals may experience functional impairments related to eating, drinking, speaking, breathing & Facial Disfigurment . 2. Emotional and Psychological Impact: A diagnosis of oral cancer can evoke a range of emotional responses, including fear, anxiety ,sadness, anger, and uncertainty about the future.

32. Impact of Oral cancer 3. Social and Occupational Effects: Oral cancer can disrupt social relationships, employment, and daily activities, leading to social withdrawal, isolation, and reduced participation in social events or work-related responsibilities. 4. Financial Burden: T he financial impact of oral cancer can be substantial, encompassing costs related to medical treatment, medications hospitalization rehabilitation, transportation, and supportive care services. Additionally, individuals may face challenges related to loss of income, employment

33. Impact of Oral cancer 5. Quality of Life : Oral cancer can significantly affect overall quality of life, encompassing physical, emotional, social, and functional well-being. Factors such as pain, treatment side effects, psychosocial distress, and changes in lifestyle may contribute to diminished quality of life.

34. References Brunner & Suddarth’s , Textbook of Medical-Surgical Nursing, 12thEdition, LWWpublication . Joyce M. Black, Medical-surgical nursing clinical management for positive outcome, 8thEdition, SaundersPublication Linda willamus , understanding Medical-surgical nursing, 3rd edition, lww publication. Lewis,heitkemper , medical-surgical nursing, assessment and management of clinical problems, 6thedition, Mosby publication Ken Russell Coelho; Challenges of the Oral Cancer Burden in India; Journal of Cancer Epidemiology Volume 2012, Page-17 Siegel RL, Miller KD, Wagle NS, Jemal; A. Cancer statistics, 2023. CA Cancer J Clin . 2023;73(1):17‐48. doi:10.3322/caac.21763 Siegel RL, Giaquinto AN, Jemal A ; Cancer statistics, 2024. CA Cancer J Clin . 2024;74(1):12‐49. doi:10. 3322/ caac . 21820 Ajay PR, Ashwinirani SR, Nayak A, Suragimath G, Kamala KA, Sande A, et al. Oral cancer prevalence in Western population of Maharashtra, India, for a period of 5 years. J Oral Res Rev 2018;10:11-4. Workman, medical-surgical nursing, critical thinking for collaborativecare,edition,Elsevier publication. Linten , Introduction to medical-surgical nursing, 5thedition, Elsevier publication. Thavarool SB at.all ; Improved survival among oral cancer patients: findings from a retrospective study at a tertiary care cancer centre in rural Kerala, India; World Journal of Surgical Oncology; V(17):2019

35. Thank You!