Cancer of the oral cavity are associated with the use of tobacco and alcohol as they seems to have a synergistic carcinogenic effect. More common after the age of 35 years, with 65 years behind the average age of diagnosis. Oral cavity cancer is two times more common in men than in women. The common sites of oral malignant lesions are lower lip (mostly), lateral border and undersurface of tongue, labial commissure and buccal mucosa. According to NATIONAL CANCER INSTITUTE, ‘Oral cancer is defined as the cancer that forms in tissues of the oral cavity (the mouth) or the oropharynx (the part of the throat at the back of the mouth).’ According to FDI World Dental Federation, ‘Oral cancer is a type of head and neck cancer and is any cancerous tissue growth located in the oral cavity.’ Oral cancer is defined as the abnormal uncontrolled growth of cells in the oral cavity, characterized by lesions, thickened mass and dysphagia. There are two types of oral cancer:- Oral cavity cancer (cancer that starts in mouth) Oropharyngeal cancer (cancer that starts in throat behind the mouth) Head and Neck Squamous Cell Carcinoma (HNSCC) is a term used for the cancers of oral cavity, pharynx and larynx, accounts 90% malignant tumors. The exact cause is unknown Long term use of tobacco History of frequent alcohol consumption Prolong sunlight exposure may lead to lip cancer Irritation from the pipe stem resting on the lip in Pipe smokers HPV contributes 25% of oral cancer cases Multiple oral sex partners Low serum Vitamin A, C and E levels Smoked meat ingestion Poor oral hygiene Recurrent herpetic lesion may lead to lip cancer Immunosuppression Syphilis Chronic irritation (jagged tooth, ill fitting prosthesis, chemical or mechanical irritants) TNM CLASSIFICATION OF ORAL CANCER T- Primary tumor TX Primary tumor cannot be assessed T0 No evidence of primary tumor Tis Carcinoma in situ T1 Tumor 2 cm or less in greatest dimension T2 Tumor more than 2 cm but not more than 4 cm in greatest dimension T3 Tumor more than 4 cm in greatest dimension T4a Tumor invades through cortical bone, into deep/ extrinsic muscle of tongue, maxillary sinus, or skin of face T4b Tumor invades masticator space, pterygoid plates, or skull base, or encases internal carotid artery N- Regional Lymph nodes NX Regional lymph node cannot be assessed N0 No regional lymph node metastasis N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension N2 Metastasis in lymph node, more than 3 cm but not more than 6 cm in greatest dimension N3 Metastasis in a lymph node more than 6 cm in greatest dimension M- Distant Metastasis M0 No distant metastasis M1 Distant metastasis Lip Cancer Indurated Painless ulcer Tongue Cancer Ulcer or area of thickening Soreness or pain Increased salivation Slurred speech Dysphagia Toothache Earache(later sign) Oral Cavity Cancer Leukoplakia Also known as Smoker's patch, white patch

1. CANCER OF
THE ORAL
CAVITY
BY;
ANUSHRI SRIVASTAVA
INDIRA GANDHI SCHOOL AND COLLEGE OF NURSING

2. INTRODUCTION
Cancer of the oral cavity are associated with the use
of tobacco and alcohol as they seems to have a
synergistic carcinogenic effect.
More common after the age of 35 years, with 65
years behind the average age of diagnosis.
Oral cavity cancer is two times more common in men
than in women.
The common sites of oral malignant lesions are lower
lip (mostly), lateral border and undersurface of
tongue, labial commissure and buccal mucosa.

3. DEFINITION
• According to NATIONAL CANCER INSTITUTE,
‘Oral cancer is defined as the cancer that forms in tissues of the oral cavity (the mouth) or
the oropharynx (the part of the throat at the back of the mouth).’
• According to FDI World Dental Federation,
‘Oral cancer is a type of head and neck cancer and is any cancerous tissue growth located
in the oral cavity.’
• Oral cancer is defined as the abnormal uncontrolled growth of cells in the oral cavity,
characterized by lesions, thickened mass and dysphagia.

4. TYPES OF ORAL CANCER
There are two types of oral cancer:-
• Oral cavity cancer
(cancer that starts in mouth)
• Oropharyngeal cancer
(cancer that starts in throat behind the mouth)
Head and Neck Squamous Cell Carcinoma (HNSCC) is a term used for the cancers of
oral cavity, pharynx and larynx, accounts 90% malignant tumors.

5. ETIOLOGY
• The exact cause is unknown
• Long term use of tobacco
• History of frequent alcohol consumption
• Prolong sunlight exposure may lead to lip cancer
• Irritation from the pipe stem resting on the lip in Pipe
smokers
• HPV contributes 25% of oral cancer cases
• Multiple oral sex partners
• Low serum Vitamin A, C and E levels
• Smoked meat ingestion
• Poor oral hygiene
• Recurrent herpetic lesion may lead to lip cancer
• Immunosuppression
• Syphilis
• Chronic irritation (jagged tooth, ill fitting prosthesis,
chemical or mechanical irritants)

6. TNM CLASSIFICATION OF ORAL CANCER
• T- Primary tumor
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor 2 cm or less in greatest dimension
T2 Tumor more than 2 cm but not more than 4 cm in greatest dimension
T3 Tumor more than 4 cm in greatest dimension
T4a Tumor invades through cortical bone, into deep/ extrinsic muscle of tongue,
maxillary sinus, or skin of face
T4b Tumor invades masticator space, pterygoid plates, or skull base, or encases
internal carotid artery

7. TNM CLASSIFICATION OF ORAL CANCER
• N- Regional Lymph nodes
NX Regional lymph node cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
N2 Metastasis in lymph node, more than 3 cm but not more than 6 cm in greatest dimension
N3 Metastasis in a lymph node more than 6 cm in greatest dimension
• M- Distant Metastasis
M0 No distant metastasis
M1 Distant metastasis

8. CLINICAL MANIFESTATION
Lip Cancer
• Indurated
• Painless ulcer
Tongue Cancer
• Ulcer or area of thickening
• Soreness or pain
• Increased salivation
• Slurred speech
• Dysphagia
• Toothache
• Earache(later sign)
This Photo by Unknown Author is licensed under CC BY

9. Continued…
Oral Cavity Cancer
• Leukoplakia
Also known as Smoker's patch, white patch on
the mouth mucosa or tongue, often considered as a
precancerous lesion and less than 15% chance to
transform into malignant cells. The patch becomes
keratinized (hard and leathery) and it sometimes
described as hyperkeratosis.
Leukoplakia results from chronic irritation, especially
from smoking.

10. Continued…
• Erythroplakia
Also known as Erythroplasia, is a red velvety
pouch on the mouth or tongue, also a precancerous lesion.
More than 50% of cases of Erythroplakia may progress to
squamous cell carcinoma.

11. Continued…
.
• Ulceration
• Rough area pain
• Enlarged cervical lymph node
• Sore spot
• Dysphagia
• A lump or thickening in the cheek
• Asymptomatic neck mass
Nonspecific signs
• Chronic sore throat
• Sore mouth
• Voice changes
Late signs
• A sore throat or a feeling that something is stuck
• Difficulty chewing and speaking

12. DIAGNOSTIC
EVALUATION
History Collection
Physical Examination
Biopsy
Oral Exfoliative cytology
Toluidine Blue Test
Computed Tomography scan
Magnetic Resonance Imaging
Positron Emission Test

13. Medical Management
• Chemotherapy
5 FU, Methotrexate, Cisplatin, Carboplatin, Bleomycin, Cetuximab
• Radiation therapy
• Brachytherapy with implantation of radioactive seeds to the early stage of cancer
• Nutritional therapy
• Palliative treatment

14. SURGICAL MANAGEMENT
Most effective on early stages and the type of surgery depend on location and extent of tumor.
• Partial Mandibulectomy
• Hemiglossectomy
• Glossectomy
• Resection of buccal mucosa and floor of mouth
• Reconstructive surgery
• Radial Neck Dissection
It includes wide excision of the primary lesion with the removal of lymph nodes, the deep
cervical lymph nodes, and their lymphatic channels and other structures may also be removed or
transected depending on the extent of primary lesion.

15. Complication
Mucositis Xerostomia Swelling
Stomatitis Dysphagia

16. Nursing
Management
• Assess the patient condition
• Provide comfortable position
• Monitor vital signs
• Monitor intake and output chart
• Administer medication as prescribed by physician
• Administer analgesic as prescribed by physician
• Placement of Percutaneous Endoscopic Gastrostomy
considered before radiation treatment or surgery
• Parenteral Fluids are given for first 24 to 48 hours. After this
time enteral nutrition via NG, Gastrostomy or Nasointestinal
tube is provided.
• Frequent suctioning of oral cavity at time when swallowing
becomes difficult
• Observe for feeding tolerance and adjust the amount, time and
formula if nausea, vomiting, diarrhea or distension occurs
• Give small amount of water when the patient can swallow
• Observe for choking
• Suctioning is also necessary to prevent aspiration

17. NURSING
DIAGNOSIS
• Imbalanced nutrition less than body requirement
related to difficulty in swallowing as evidence by
weight loss
• Chronic pain related to tumor as evidence by
patient facial expression
• Ineffective health maintenance related to lack of
knowledge of disease process as evidence by poor
oral hygiene.

18. bibliography
• Bucher, Heitkemper, Dirksen. A Textbook of Medical Surgical Nursing:
Assessment and Management of Clinical Problems. Edition IX. 3251
Riverport Lane, St Loius, Missouri 63043.ELSEVIER publisher; Page
number 929-31
• https://screening.iarc.fr/atlasoralclassiftnm.php
• https://www.cancer.gov/search/results?swKeyword=Oral+cancer
• https://www.fdiworlddental.org/oral-
cancer#:~:text=It%20includes%20malignancy%20of%20the,highly%20
lethal%2C%20incapacitating%20and%20disfiguring

19. .
thanking you!