This document discusses head and neck squamous cell carcinoma (HNSCC), including risk factors such as age and gender, types such as oral cavity cancer and oropharyngeal cancer, clinical manifestations like leukoplakia and erythroplakia, diagnostic studies including biopsy and imaging, and management with surgery, chemotherapy, and radiation therapy. Nursing care focuses on pain management, nutrition, and helping patients cope with changes from treatment.

2. Introduction
Head & neck squamous cell
carcinoma (HNSCC) is a term used
for cancers of the oral cavity,
pharynx, & larynx
It is more common after age 35,
with 65 yrs being the average age of
diagnosis
It is 2 times more common in men

3. Introduction
Oral cavity cancer which starts the
mouth, & oropharyngeal cancer,
which develops in the part of the
throat just behind the mouth.
Most of the oral malignant lesions
occur on the lower lip

4. Types & characteristics
Lip
Constant over exposure to sun,
ruddy & fair complexion, recurrent
herpetic lesions,
syphilis,immunosuppression,
irritation from pipe stem
Indurated, painless ulcer
Surgical excision, radiation

5. Types & characteristics
Tongue
Tobacco, alcohol, chronic irritation,
syphilis
Ulcer/area of thickening,
soreness/pain, increased salivation,
slurred speech, dysphagia, tooth
ache, ear ache
Surgery
(hemiglossectomy/glossectomy),

6. Types & characteristics
Oral cavity
Poor oral hygiene, tobacco usage, c/c
alcohol intake, c/c irritation
Leukoplakia, erythroplakia,
ulcerations, sore spot, rough area, pain,
dysphagia, difficulty in chewing &
speaking
Surgery (mandibulectomy, radical
neck dissection, resection of buccal

7. Clinical manifestations
Leukoplakia (smoker’s patch, a white
patch on the mouth mucosa /tongue)
Erythroplakia (red velvety patch
which is not associated with any
trauma or inflammation)
Ulcerations
A sore that bleeds easily & does not
heal
A rough area (felt with tongue)

8. Dr Suwas Darvekar

9. Clinical manifestations
The patch becomes keratinized (hard
& leathery) & is described as
hyperkeratosis
Sore throat
Voice changes
Pain
Dysphagia
Difficulty in moving the jaw

10. Dr Suwas Darvekar
This patient of SMF has so much of limitation in opening of mouth that
it is difficult to put even 2 fingers in the mouth

11. Diagnostic studies
Toluidine blue test
Biopsy
CT
MRI
PET

12. Dr Suwas Darvekar
Cancer of Tongue

13. Management
Surgical therapy
Radical procedures involving extensive
rsections.
Mandibulectomy, hemiglossectomy,
glossectomy, resection of the buccal
mucosa & floor of the mouth, & radical
neck dissection (sternocleido mastiod
muscle, internal jugular vein, mandible,
a part of thyroid & parathyroid gland,
& spinal accessory nerve)

14. Management
Surgical therapy
A tracheostomy is commonly
performed along with radical neck
dissection
A gastrostomy tube may be inserted in
case of swallowing difficulty

15. Management
Chemotherapy& radiation therapy are
used together when there are positive
margins, bone erosion, or positive lymph
nodes
Chemotherapy - 5-FU, cisplatin,
carboplatin, paclitaxel, docetaxel,
cetuximab
Brachytherapy

16. Nursing management
Assessment
History collection
Integ : indurated painless ulcer on lip,
painless neck mass
GI : area of thickening or roughness,
ulcers, leukoplekia, limited movement
of the tongue, drooling, slurred speech

17. Nursing diagnosis
Chronic pain related to surgery, tumor
Imbalanced nutrition less than body
requirement related to oral pain,
difficulty chewing/swallowing, surgical
resection
Ineffective coping related to body
image change

19. COLON CANCER
Risk factors
1. Increasing age
2. Family history
3. Previous colon CA or polyps
4. History of IBD
5. High fat, High protein, LOW fiber
6. Breast Ca and Genital Ca

20. COLON CANCER
Sigmoid colon is the most common site
Predominantly adenocarcinoma
If early 90% survival
34 % diagnosed early
66% late diagnosis

21. COLON CANCER
PATHOPHYSIOLOGY
Benign neoplasm DNA alteration malignant
transformation malignant neoplasm  cancer
growth and invasion  metastasis (liver)

22. COLON CANCER
ASSESSMENT FINDINGS
1. Change in bowel habits- Most common
2. Blood in the stool
3. Anemia
4. Anorexia and weight loss
5. Fatigue
6. Rectal lesions- tenesmus, alternating D and C

23. Colon cancer
Diagnostic findings
1. Fecal occult blood
2. Sigmoidoscopy and colonoscopy
3. BIOPSY
4. CEA- carcino-embryonic antigen

24. Colon cancer
Complications of colorectal CA
1. Obstruction
2. Hemorrhage
3. Peritonitis
4. Sepsis

25. Colon cancer
MEDICAL MANAGEMENT
1. Chemotherapy- 5-FU
2. Radiation therapy

26. Colon cancer
SURGICAL MANAGEMENT
Surgery is the primary treatment
Based on location and tumor size
Resection, anastomosis, and colostomy (temporary or
permanent)

27. Colon cancer
NURSING INTERVENTION
Pre-Operative care
1. Provide HIGH protein, HIGH calorie and LOW
residue diet
2.Provide information about post-op care and stoma
care
3. Administer antibiotics 1 day prior

28. Colon cancer
NURSING INTERVENTION
Pre-Operative care
4. Enema or colonic irrigation the evening and the
morning of surgery
5. NGT is inserted to prevent distention
6. Monitor UO, F and E, Abdomen PE

29. Colon cancer
NURSING INTERVENTION
Post-Operative care
1. Monitor for complications
Leakage from the site, prolapse of stoma, skin
irritation and pulmo complication
2. Assess the abdomen for return of peristalsis

30. Colon cancer
NURSING INTERVENTION
Post-Operative care
3. Assess wound dressing for bleeding
4. Assist patient in ambulation after 24H
5.provide nutritional teaching
Limit foods that cause gas-formation and
odor
Cabbage, beans, eggs, fish, peanuts
Low-fiber diet in the early stage of
recovery

31. Colon cancer
NURSING INTERVENTION
Post-Operative care
6. Instruct to splint the incision and
administer pain meds before exercise
7. The stoma is PINKISH to cherry red,
Slightly edematous with minimal pinkish
drainage
8. Manage post-operative complication

33. Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Colostomy begins to function 3-6 days after surgery
The drainage maybe soft/mushy or semi-solid
depending on the site

34. Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
BEST time to do skin care is after shower
Apply tape to the sides of the pouch before shower
Assume a sitting or standing position in changing the
pouch

35. Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Instruct to GENTLY push the skin down and the
pouch pulling UP
Wash the peri-stomal area with soap and water
Cover the stoma while washing the peri-stomal area

36. Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Lightly pat dry the area and NEVER rub
Lightly dust the peri-stomal area with nystatin
powder

37. Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Measure the stomal opening
The pouch opening is about 0.3 cm larger than the
stomal opening
Apply adhesive surface over the stoma and press for
30 seconds

38. Colon cancer
NURSING INTERVENTION: COLOSTOMY CARE
Empty the pouch or change the pouch when
1/3 to ¼ full

39. Breast Cancer
RISK FACTORS
1. Genetics- BRCA1 And BRCA 2
2. Increasing age ( > 50yo)
3. Family History of breast cancer
4. Early menarche and late menopause
5. Nulliparity
6. Late age at pregnancy

40. Breast Cancer
RISK FACTORS
7. Obesity
8. Hormonal replacement
9. Alcohol
10. Exposure to radiation

41. Breast Cancer
PROTECTIVE FACTORS
1. Exercise
2. Breast feeding
3. Pregnancy before 30 yo

43. Breast Cancer
ASSESSMENT FINDINGS
1. MASS- the most common location is the upper outer
quadrant
2. Mass is NON-tender. Fixed, hard with irregular
borders
3. Skin dimpling
4. Nipple retraction
5. Peau d’ orange

44. Breast Cancer
LABORATORY FINDINGS
1. Biopsy procedures
2. Mammography

45. Breast Cancer
Breast cancer Staging
TNM staging
I - < 2cm
II - 2 to 5 cm, (+) LN
III - > 5 cm, (+) LN
IV- metastasis

46. Breast Cancer
MEDICAL MANAGEMENT
1. Chemotherapy
2. Tamoxifen therapy
3. Radiation therapy

47. Breast Cancer
SURGICAL MANAGEMENT
1. Radical mastectomy
2. Modified radical mastectomy
3. Lumpectomy
4. Quadrantectomy

48. Breast Cancer
NURSING INTERVENTION : PRE-OP
1. Explain breast cancer and treatment
options
2. Reduce fear and anxiety and improve
coping abilities
3. Promote decision making abilities
4. Provide routine pre-op care:
Consent, NPO, Meds, Teaching about
breathing exercise

49. Breast Cancer
NURSING INTERVENTION : Post-OP
1. Position patient:
Supine
Affected extremity elevated to reduce edema

50. Breast Cancer
NURSING INTERVENTION : Post-OP
2. Relieve pain and discomfort
Moderate elevation of extremity
IM/IV injection of pain meds
Warm shower on 2nd
day post-op

51. Breast Cancer
NURSING INTERVENTION : Post-OP
3. Maintain skin integrity
Immediate post-op: snug dressing with drainage
Maintain patency of drain (JP)
Monitor for hematoma w/in 12H and apply bandage
and ice, refer to surgeon

52. Breast Cancer
NURSING INTERVENTION : Post-OP
3. Maintain skin integrity
Drainage is removed when the discharge is less
than 30 ml in 24 H
Lotions, Creams are applied ONLY when the
incision is healed in 4-6 weeks

53. Breast Cancer
NURSING INTERVENTION : Post-OP
Promote activity
Support operative site when moving
Hand, shoulder exercise done on 2nd
day
Post-op mastectomy exercise 20 mins TID
NO BP or IV procedure on operative site

54. Breast Cancer
NURSING INTERVENTION : Post-OP
Promote activity
Heavy lifting is avoided
Elevate the arm at the level of the heart
On a pillow for 45 minutes TID to relieve
transient edema

55. Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Lymphedema
10-20% of patients
Elevate arms, elbow above shoulder and
hand above elbow
Hand exercise while elevated
Refer to surgeon and physical therapist

56. Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Hematoma
Notify the surgeon
Apply bandage wrap (Ace wrap) and ICE pack

57. Breast Cancer
NURSING INTERVENTION : Post-OP
MANAGE COMPLICATIONS
Infection
Monitor temperature, redness, swelling and foul-
odor
IV antibiotics
No procedure on affected extremity

58. Breast Cancer
NURSING INTERVENTION : Post-OP
TEACH FOLLOW-UP care
Regular check-up
Monthly BSE on the other breast
Annual mammography