oral cancer description and care

1. ECHO India
ECHO India Cancer Prevention, Detection and Awareness Capacity
Building Webinar series for Nurses
Moving Knowledge, Not People
TOPIC – “ Treatment incorporating research, nursing management of
patients with Oral Cancer, health education and followup care for –
Hormonal Therapy/Targeted Therapy, Immunotherapy and Palliation ”

2. INTRODUCTION

3. HORMONAL THERAPY
• HORMONES: It is a substances made by
glands in our bodies. They are carried
around our body in our blood stream and
act as messengers between one part of our
body and another.
• Hormones are responsible for many
functions in our body, including the growth
and activity of certain cells and organs. The
endocrine system is the network of glands
that make hormones.

4. HORMONAL THERAPY
• Hormone therapy is a cancer
treatment that slows or stops the
growth of cancer that uses
hormones to grow and it is also
called hormonal therapy,
hormone treatment, or endocrine
therapy. It is used to treat cancer
and ease the cancer symptoms.

5. Mechanism of Action

6. Types of Hormonal Therapy
Neo Adjuvent
Therapy
• Make a tumor
smaller before
surgery or
radiation
therapy
Adjuvent Therpay
• Lower the risk
that cancer will
come back after
the main
treatment
To reudce
metastasis
• Destroy
cancer cells that
have returned
or spread to
other parts of
your body

7. Routes of Administration
• Pills form
Oral
• Intramuscular (arm, thigh, or hip, or right under
the skin in the fatty part of your arm, leg, or
belly).
Injection
• Not advised in Oral Cancers, however can be
used in ovarian and testicle cancers.
Surgery

8. TARGETED THERAPY
• Targeted therapy is a type of cancer treatment that targets
proteins that control how cancer cells grow, divide, and
spread. It is the foundation of precision medicine.

9. Mechanism of Action

10. Overview

11. Goals
Cure and kill the
cancer cells
Deliver cell-killing
substances to
cancer cells
Stop signals that
help form blood
vessels
Relieve symptoms
caused by cancer
Slow the cancer
growth

12. Disadvantages

13. Side Effects
Others symptoms are:
Fatigue
Mouth sores
Nail changes
loss of hair color
Skin problems, which might
include rash or dry skin

14. Duration of Treatment
Type of cancer and how
advanced it is.
Type of targeted therapy
It can be given in cycles
Treatment can be given every
day, every week, or every
month
How your body reacts to
treatment

15. Nurses Role During Therapy
• Family, carers or others are adequately informed about the treatment and administration
process.
• Patient education and consent processes have been completed and documented according to
local institute requirements.
• The planned treatment is verified with the patient and understood by them.
• All medication is stored appropriately prior to administration.
• Independent verification of the medication order (including chemotherapy, targeted therapy
and supportive medication) according to the protocol, the patient’s treatment plan, patient
laboratory parameters and other individual parameters.
• The therapy and associated treatments are administered to the patient in a safe and timely
manner.
• Any immediate and longer term effects are appropriately managed.
• All professional and legal responsibilities with respect to administration of medications are
met.

16. IMMUNOTHERAPY
• Immunotherapy is a type of cancer treatment that
helps your immune system fight cancer. The immune
system helps your body fight infections and other
diseases. It is made up of white blood cells
and organs and tissues of the lymph system.
• Immunotherapy is a type of biological therapy.
Biological therapy is a type of treatment that uses
substances made from living organisms to treat
cancer.

17. IMMUNOTHERAPY
1. Aid in recognition of cancer as foreign by the immune system
2. Stimulate immune responsiveness
3. Relieve inhibition of the immune system that allows tolerance of tumor growth
Differs from:
• Chemotherapy: targets rapidly dividing cells
• Targeted Therapies: interfere with key molecular events in tumor cells that drive
tumour growth and invasion

18. Types

19. Mechanism of Action

21. Types

22. Immune Checkpoint Inhibitor
Immune checkpoints are a normal part of
the immune system. Their role is to
prevent an immune response from being
so strong that it destroys healthy cells in
the body.
Examples of immune checkpoint inhibitors
include:
• Atezolizumab (Tecentriq)
• Avelumab (Bavencio)
• Dostarlizumab (Jemperli)
• Durvalumab (Imfinzi)
• Ipilimumab (Yervoy)
• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)

23. T – Cell Transfer Therapy

24. Monoclonal Antibodies
Monoclonal antibodies are immune
system proteins that are created in the
lab. Antibodies are produced naturally by
your body and help the immune system
recognize germs that cause disease, such
as bacteria and viruses, and mark them
for destruction.

25. Vaccines

26. Modes of Administration

27. PALLIATION

28. Meaning
• It is an approach that improves the quality of life
of patients and their families facing the problem
associated with life-threatening illness, through
the prevention and relief of suffering by means
of early identification and impeccable
assessment and treatment of pain and other
problems, physical, psychosocial and spiritual
(WHO 2018).

29. Goal
• The goal is to prevent and relieve symptoms and thereby improve
quality of life for both patient and family.

30. Palliative Care Team

31. Issues Related to Palliative Care
Care givers
needs and
practical needs
Family
Emotional
and
coping
Spiritual

32. Issues…..
Breaking bad news
Anxiety
Patient aspirations and expectations
Counselling

33. Psychological and emotional support
Supports group
Massage therapy
Aromatherapy
Issues…..

34. Physical Issues faced by patient
• Pain
• Hydration and nutrition
• Gastrointestinal symptom relief
• Anxiety
• Agitation
• Dysphagia
• Dyspnoea
• Bleeding
• Airway management
• Hypercalcaemia

35. Pain Management
• The three major pain types are all encountered – somatic, visceral and, particularly difficult,
neuropathic.
SOMATIC PAIN
• Morphine remains the first choice strong opioid.
• It is initiated by titrating immediate release morphine oral solution or tablet or patch
• If the patient can swallow, then sustained release tablets (e.g. Zomorph) can be used.
• In case of vomiting, subcutaneous (SC) infusion of morphine or dia-morphine can be used
and Dia-morphine is preferred since it is more soluble and can be used in much smaller
volumes.
• If morphine tolerance or kidney failure is there then taransdermal fentanyl patch can be
used .
• Carbamazepine is an alternative and is available both as tablet, liquid and even
suppositories.

36. Cont…
Visceral pain
• Treatment depends on the cause, titrating analgesics and using the pain ladder.
If the pain is poorly sensitive to opioids, adjuvants should be considered early.
Mucosal pain
• This can be due to treatment, infection or tumour.
• Treatment of infection such as candida or herpes is essential.
• Useful additional topical agents include sulcralfate, benzydamine, chlorhexidine,
steroids and topical local anaesthetics such as lignocaine preparations. Coating
measures including bioadherent oral gel may be preferred by the individual
patient.
• Mouthwash with turmeric infused and lemon infused water, honey application,
glycerine application may sooth the pain.

37. Cont…….
Neuropathic Pain
• This is very common both as a presenting feature of the disease and a result of
treatment, particularly radiation. The drugs used can be referred to as adjuvants.
• A tricyclic antidepressant, most usually amitriptyline is available as tablet and liquid.
• Anticonvulsants such as gabapentin and pregabalin are the most used, available only
as tablets or capsules unless through special arrangements with a pharmacy.
• Physical therapy – inclusive of TENS (Transcutaneous electrical nerve stimulation),
certain exercises and massage therapy are useful to reduce pain.
• Psychocorporal Techniques – like relaxation, sophrology, hypnosis, mindfulness based
stress reduction, cognitive-behavioural therapy are useful to reduce anxiety and
neurovegetative hypertonicity.

38. Dysphagia
• The 40% per cent of patients with head and neck cancer suffer from
dysphagia.
• This is due to: Mechanical obstruction, functional obstruction, drug
induced side effects, fistula, pain.
• Management includes:
 Diet modification
Postural techniques
Swallowing maneuver
Motor excercises
Alternative routes of feeding like NG tube
Medical treatment – anti-Parkinson’s drug

39. Airway Management
• Tracheostomy can be considered in some cases but in order
to avoid tracheostomy in some cases de-bulking techniques
can be used.
• Education should be given to patient , family and community
staff manage tracheostomy wound care along with
maintenance of a clean secure tube.
• Heat moisture exchange and voicing attachments may be used
to aid patient communication.

40. Oral Care
• Maintain frequent
attention to good oral
hygiene
• Alcohol-free
chlorhexidine
mouthwash may be
used in debilitated
patients – inhibits
plaque formation.
• Maintain good denture
care by cleaning and
rinsing thoroughly

41. Oral Care
BMJ
JOURNAL
2024

42. GI symptom management
• Maintain frequent attention to good oral hygiene
• Alcohol-free chlorhexidine mouthwash may be used in debilitated patients – inhibits
plaque formation.
• Maintain good denture care by cleaning and rinsing thoroughly
• Constipation can develops in half of patients and it is common during treatment in
many patients.
• This is due to dehydration, reduced physical activity and the use of constipating drugs,
particularly opioids and anticholinergic medication.
• Laxative agents include stimulants and softeners such as lactulose, magnesium
hydroxide and docusate.
• Laxatives should be initiated once opioid medication is prescribed.

43. Hypercalcemia management

44. PROBABLE NURSING DIAGNOSIS
• Imbalanced nutrition less than body requirement related to dysphagia.
• Chronic pain related to treatment therapy.
• Anxiety
• Ineffective coping
• Ineffective health maintenance
• Disturbance body image related to adverse effect of treatment.
• Fatigue related to adverse effect of chemotherapy.
• Risk for infection related to decrease white blood count.

45. RESEARCH ARTICLES

47. learners are able to
implement nursing
care to patients
undergoing various
therapies for Ca Oral
Cavity
• Improved
competencies of
nurses
• Evidence based
practice
• Excellence in care
• Wholistic treatment
• Patient and family
satisfaction
 Hormonal Therapy
 Target Therapy
 Immunotherapy
 Palliation

48. REFERENCES
1) Cocks H, Ah-See K, Capel M, Taylor P. Palliative and supportive care in head and neck cancer: United
Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016 May;130(S2):S198-S207. doi:
10.1017/S0022215116000633. PMID: 27841131; PMCID: PMC4873917.
2) McMenamin EM, Grant M. Pain Prevention Using Head and Neck Cancer as a Model. J Adv Pract
Oncol. 2015 Jan-Feb;6(1):44-9. PMID: 26413373; PMCID: PMC4577032.
3) Wessex Palliative Physicians. The Palliative Care Handbook: A Good Practice Guide. 9th edition;
2019.
4) https://www.cancer.gov/about-cancer/treatment/types/immunotherapy
5) https://www.cancer.gov/about-cancer/treatment/types/hormone-therapy
6) https://getpalliativecare.org/whatis/disease-types/head-neck-cancer-palliative-care/
7) https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/pain/pain-
management-without-drugs