OM VERMA ASSOCIATE PROFESSOR GRACIOUS COLLEGE OF NURSING ABHANPUR RAIPUR C.G

2. GRACIOUS COLLEGE OF
NURSING
ABHANPUR RAIPUR C.G.
ORAL CANCER
ORAL CANCER
PRESENTED BY
OM VERMA
ASSISTANT PROFESSOR

3. INTRODUCTION
Cancer refers to any one of a large
number of diseases characterized
by the development of abnormal
by the development of abnormal
cells that divide uncontrollably and
have the ability to infiltrate
( penetrate ) and destroy normal
body tissue.

6. Definition
A disease in which abnormal
cells divide uncontrollably and
destroy tissue in oral cavity it is
destroy tissue in oral cavity it is
called oral Cancer
According to lippen cott

7. A term for diseases in which
abnormal cells divide without
control and can invade nearby
tissues. Cancer cells can also spread
to parts of the neck oral cavity through
to parts of the neck oral cavity through
the blood and lymph systems.
According to Levis

8. "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
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 carcinomas.“
According to luckmans

11. Increase used junk food and soft
drink

17. TNM staging system

18. PRIMARY TUMOR (T)
TX - Primary tumor cannot be evaluated
T0 - No evidence of primary tumor
Tis - Carcinoma in situ ; abnormal cells are
present but have not spread to near tissue
present but have not spread to near tissue
although not cancer, Carcinoma in situ may
become cancer and is sometimes called pre-
invasive cancer)
T1, T2, T3, T4 - Size and/or extent of the primary

19. PRIMARY TUMOR (T)
Indicated by the letter T and the suffix
1,2, 3 or 4 represent more advancing
disease
T1- Tumor 2 cm or less
₂
T1- Tumor 2 cm or less
T₂- Tumor more than 2 but less than 4 cm
T3- Tumor more than 4 cm
T4- Tumor more than 4 cm with deep invasion of
underlying tissues

20. REGIONAL LYMPH NODES (N)
Is used to describe progressive lymph nodes involvement
NX - Regional lymph nodes cannot be
evaluated
N0 - No regional lymph node involvement
N0 - No regional lymph node involvement
N1, N2, N3 - involvement of regional lymph
nodes (number of lymph nodes and/or extent of
spread)

21. REGIONAL LYMPH NODES (N)
N1 - Metastasis is a single ipsilateral node > 3 cm
N2 - single ipsilateral node < 3 cm but > 6 cm or
multiple clinically positive ipsilateral less than 6 > cm
N3 - Clinically positive ipsilateral more the 6 cm
bilateral or contra lateral..

22. DISTANT METASTASIS (M)
MX - Distant metastasis cannot be
evaluated
M0 - No distant metastasis
M1 - Distant metastasis is present

23. E.g - Consequently, a person's cancer
could be listed as T1N2M0, meaning
it is a small tumor (T1), but has
spread to some regional lymph nodes
(N2), and has no distant metastasis
(M0).

24. PATHOPHYSIOLOGY

25. PROTO-ONCOGENES
Encode proteins that
function to stimulate
cell division, inhibit
cell differentiation,
and halt cell death. All
of these processes are
important for normal
of these processes are
important for normal
human development
and for the
maintenance of tissues
and organs.

26. ORAL CANCER
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY

27. Due to etiological factors such as smoking
,tobacco,
,Cancer is mainly due to the mutations in the DNA.
When the etiologic factors are dominant ( effective ) to the cells
of an individual the physical and chemical changes in DNA
occurs.
Changes in immunity are seen at this stage itself. This affects
the cell.
Due to the changes in DNA, the cells do not undergo normal
transcription ( duplicate ) and translocation.
Blood related disorder are seen at this stage.

28. Due to this the normal cell physiology is
affected. For example the suppressor gene
becomes less effective, simultaneously there is
altered cell cycle and cells are formed and they
are uncontrolled.
Due to decreased suppressor gene they
become uncontrolled.

29. At this time Lump and bump are seen.
Due to pressure there occurs pressure atrophy and
pain is seen at this time.
These uncontrolled cells form lumps and ulcers in
oral cavity. These may cause difficulty in swallowing.
Neovascularization and enervation causes the
Neovascularization and enervation causes the
numbness in the area. The degree of size and shape
of the tumor causes change in voice and the falling of
teeth
Than lead the oral cancer

30. Clinical
Clinical
manifestation

32. Some general signs and symptoms
associated with, but not specific to,
cancer, include:
Fatigue
Weight changes, including unintended loss or
gain

33. Skin changes, such as yellowing, darkening or
redness of the skin, sores that won't heal, or
changes to existing moles
Changes in bowel or bladder habits
Persistent cough or trouble breathing
Difficulty swallowing
Difficulty swallowing
Hoarseness
Persistent indigestion or discomfort after eating
Persistent, unexplained muscle or joint pain
Persistent, unexplained fevers or night sweats
Unexplained bleeding or bruising

34. Leukoplakia - Is a condition that involves white
patches or spots on the inside of the mouth. It can
be caused by chewing tobacco,
Erythroplakia - Is an abnormal red area or group
of red spots that forms on the mucous membrane
lining the mouth any smoking, and alcohol
lining the mouth any smoking, and alcohol
Erythroleukoplakia - An abnormal patch of red
and white tissue that forms on mucous
membranes in the mouth and may become
cancer. Tobacco (smoking and chewing) and
alcohol may increase the risk of
erythroleukoplakia. use.

39. DIAGNOSTIC TEST

40. HISTORY TAKING
PHYSICAL EXAM.
Physician may feel areas of body for
Physician may feel areas of body for
lumps that may indicate cancer. During a
physical exam, physician may look for
abnormalities, such as changes in skin
color or enlargement of an organ, that may
indicate the presence of cancer.

45. Laboratory tests.
Laboratory tests, such as urine and blood
tests, may help physician identify
abnormalities that can be caused by cancer.
abnormalities that can be caused by cancer.
For instance, in people with leukemia, a
common blood test called complete blood
count may reveal an unusual number or
type of white blood cells.

46. Radio graphical examination
.
Imaging tests allow physician to examine bones
and internal organs in a noninvasive way. Imaging
tests used in diagnosing cancer may include a
computerized tomography (CT) scan, bone scan,
magnetic resonance imaging (MRI), positron
emission tomography (PET) scan, ultrasound and X-
ray, among others. uses a combination of X-
rays and computer technology to produce
images of the inside of the body. It shows detailed
images of any part of the body, including the bones,
muscles, fat, organs and blood vessels. CT scans
are more detailed than standard X-rays.

47. BIOPSY
During a biopsy, physician collects a sample of
cells for testing in the laboratory. There are several
ways of collecting a sample. Which biopsy
procedure is right for you depends on type of
cancer and its location. a long, thin needle 14
gauge or larger is inserted through the skin
gauge or larger is inserted through the skin
and into the suspicious area.
In the laboratory, physician look at cell samples
under the microscope. Normal cells look uniform,
with similar sizes and orderly organization. Cancer
cells look less orderly,

48. INDIRECT LARYNGOSCOPY AND
PHARYNGOSCOPY:
healthcare provider uses a small mirror on a
long thin handle to look at your throat, the base
of your tongue and part of your larynx (voice
box).
box).

49. MANAGEMENT

50. CANCER TREATMENTS HAVE
DIFFERENT OBJECTIVES,
SUCH AS:-
1.Cure. The goal of treatment
is to achieve a cure for
is to achieve a cure for
cancer, allowing you to live a
normal life span.

51. 2. PRIMARY TREATMENT.
The goal of a primary treatment is to completely
remove the cancer from body or kill the cancer
cells. Any cancer treatment can be used as a
primary treatment, but the most common primary
primary treatment, but the most common primary
cancer treatment for the most common cancers is
surgery. If your cancer is particularly sensitive to
radiation therapy or chemotherapy, you may
receive one of those therapies as your primary
treatment.

52. PALLIATIVE TREATMENT.
Palliative treatments may help relieve side
effects of treatment or signs and symptoms
caused by cancer itself. Surgery, radiation,
chemotherapy and hormone therapy can all
chemotherapy and hormone therapy can all
be used to relieve symptoms and control the
spread of cancer when a cure Does not
possible. Medications may relieve
symptoms such as pain and shortness of
breath.

53. PHARMACOLOGICAL
MANAGEMENT
Chemotherapy. Chemotherapy uses drugs to
kill cancer cells.
1. Alkylating agents
1. Alkylating agents
- Cyclophosphamide
- Busulfan
- Altretamine
- Melphalan
- Oxaliplatin

54. Nitrosoureas
- Streptozocin
- Cladribine
Antimetabolites
- Cladribine
- Clofarabine
- Pentostatin
Anti-tumor antibiotics
Anthracyclines
Antimetabolites

55. Topoisomerase inhibitors
Etoposide
Mitoxantrone
Mitotic inhibitors
Vinorelbine
Vinorelbine
Vincristine
Corticosteroids
Prednisone
Methylprednisolone
Dexamethasone

56. Hormone therapy
Drugs in this category work on different actions
of hormones that make some cancers grow.
These drugs are used to slow the growth of
certain breast, prostate, and endometrial
(uterine) cancers, which normally grow in
(uterine) cancers, which normally grow in
response to natural sex hormones in the body.
They work by making the cancer cells unable to
use the hormone they need to grow, or by
preventing the body from making the hormone.

57. Immunotherapy
Immunotherapy is a type of treatment that uses
drugs to boost or alter a person's immune
system. These drugs are used with certain types
of cancer to help a patient's immune system
recognize and attack cancer cells.

58. RADIATION THERAPY
Brachytherapy cobalt-60 is a type of
internal radiation therapy that is often used to
treat cancers of the head and neck,
breast, cervix, prostate, and eye.
breast, cervix, prostate, and eye.
Brachytherapy is a type of internal radiation
therapy Brachytherapy is a procedure that
involves placing radioactive material
inside body. And kill the cancer cells.

59. Three-dimensional conformal
radiation therapy
Three-dimensional conformal radiation
therapy (3D CRT) is a common radiation
therapy used to treat cancers in many
parts of the body. 3D CRT utilizes
parts of the body. 3D CRT utilizes
radiation beams that are shaped to enter
the patient from multiple angles in such a
way that it spares as much healthy tissues
as possible.

60. Proton therapy
Proton therapy, also known as proton
beam therapy, is a form of radiation
treatment used to destroy tumor
treatment used to destroy tumor
cells. Instead of using x-rays like
regular radiation treatment, it uses
protons to sends beams of high
energy that can target tumors

61. SURGICAL
MANAGEMENT
MANAGEMENT

62. Glossectomy: This is the partial or total
removal of your tongue.
Mandibulectomy: This is surgery for oral
cancer in your jawbone.
Maxillectomy: This surgery removes part or
all of the hard palate, which is the bony roof
of your mouth.
Neck dissection: This surgery is done to
remove lymph nodes from your neck.

63. DEBULKING SURGERY
Debulking surgery removes a portion, though
not all, of a cancerous tumor. It is used in
certain situations when removing an entire
certain situations when removing an entire
tumor may cause damage to an organ or the
body. Other types of cancer treatment, such as
chemotherapy and radiation, may be used after
debulking surgery is performed.

64. CRYOSURGERY
This surgery technique uses extremely cold
temperatures to kill cancer cells. Cryosurgery is
used most often with skin cancer and cervical
cancer. Oral cancer Depending on whether the
cancer. Oral cancer Depending on whether the
tumor is inside or outside the body, liquid
nitrogen is placed on the skin or in an
instrument called a cryoprobe (which is inserted
into the body so that it touches the tumor).
Cryosurgery is being evaluated as a surgical
treatment for several types of cancers.

65. LASER SURGERY
This technique uses beams of light energy
instead of instruments to remove very small
cancers (without damaging surrounding
tissue), to shrink or destroy tumors, or to
tissue), to shrink or destroy tumors, or to
activate drugs to kill cancer cells. Laser
surgery is a very precise procedure that can
be used to treat areas of the body that are
difficult to reach including the skin, cervix,
rectum, and larynx.

66. ELECTROSURGERY
Skin cancer and oral cancer are
sometimes treated with electro
sometimes treated with electro
surgery. This technique uses
electrical current to kill cancer cells.

67. Cancer and its treatment can cause
several complications, including:
Pain. Pain can be caused by cancer or by
cancer treatment, though not all cancer is
painful. ...
Fatigue. ...
Fatigue. ...
Difficulty breathing. ...
Nausea. ...
Diarrhea or constipation. ...
Weight loss. ...
Chemical changes in your body. ...
Brain and nervous system problems.