oral cancer docx. class presentation. nursing college in India.

1. Presentation;medical surgical nursing.Regd no.:14N1616 pg. 1
PresentationSubject: Medical surgical Nursing
Topic: Oral cancer
Presentedto:
Mrs. Narmada A.
asst.professor
Department of medical surgical nursing
Bapuji College Of Nursing
Davangere.
Presented by:
Raju Paudel
IIIyear B.Sc.nursing
regdno:14N1616
Date:
Place:Davangere

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INTRODUCTION.
Oral cancer in short is cancer of mouth and buccal cavity. Oral cancer is the most
common form of cancer in India. 130,000 people succumb to oral cancer in India
annually. The reason for this high prevalence of oral cancer in India is primarily
tobacco consumed in the form of gutka, quid, snuff or misri. In the North East India, the
use of areca nut is also a risk factor for oral cancer.
DEFINATION
Oral cancer appears as a growth or sore in the mouth that does not go away. Oral
cancer, which includes cancers of the lips, tongue, cheeks, floor of the mouth, hard
and soft palate, sinuses, and pharynx (throat), can be life threatening if not diagnosed
and treated early.
Anatomy and physiology

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Types
Squamous cell carcinoma
More than 90 percent of cancers that occur in the oral cavity and oropharynx are
squamous cell carcinoma. Normally, the throat and mouth are lined with so-called
squamous cells, which are flat and arranged in a scale-like way. Squamous cell
carcinoma means that some squamous cells are abnormal.
Verrucous carcinoma:
About 5 percentof all oral cavity tumors are verrucous carcinoma, which is a type
of very slow-growing cancer made up of squamous cells. This type of oral cancer
rarely spreads to other parts of the body, but can invade the tissue surrounding the site
of origin.
Minor salivary gland carcinomas:
This category includes several kinds of oral cancer that can develop on the minor
salivary glands, which are found throughout the lining of the mouth and throat. These
types include adenoid cystic carcinoma, mucoepidermoid carcinoma, and
polymorphous low-grade adenocarcinoma.
Lymphomas:
Oral cancers that develop in lymph tissue, which is part of the immune system, are
known as lymphomas. The tonsils and base of the tongue both contain lymphoid
tissue. See our pages on Hodgkin lymphoma and non-Hodgkin lymphoma for cancer
information related to lymphomas in the oral cavity.
Benign oral cavity and oropharyngeal tumors: Several types of non-cancerous tumors
and tumor-like conditions can arise in the oral cavity and oropharynx. Sometimes,
these conditions may develop into cancer. For this reason, benign tumors, which
usually don’t recur, are often surgically removed. The types of benign lesions include:
 Eosinophilic granuloma
 Fibroma
 Granular cell tumor
 Karatoacanthoma
 Leiomyoma
 Osteochondroma
 Lipoma
 Schwannoma
 Neurofibroma
 Papilloma
 Condyloma acuminatum
 Verruciform xanthoma
 Pyogenic granuloma

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 Odontogenic tumors (lesions that begin in tooth-forming tissues)
Risk factors
 Tobacco smoking:there are more than 100 chemicals in tobacco out of
which 6o and more are carcinogenic.These carcinogens alter the mitosis
and gives cancer.
 Nonsmoking tobacco.Tobacco chewing causes cancer too.
 Alcohol: absorptionof alcohol starts from mouth itself and chemicalcause’s
cancer.
 Prolonged sunlight exposure:UV lights causes mutation in cells and
causes cancer.
 Gendermale> female
 Age 45 years<
 Fair skin>dark skin. Melanin is supposed to have preventive factor for
cancer.
 Poor oral hygiene.
 Poor diet
 Weakened immunity. Immunity compromised patient are more prone to
cancer.
 Marijuana use. As tobacco , marijuana too has carcinogenic affect.

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Causes
 Idiopathic
 Tobacco smoking
 Nonsmoking tobacco
 Alcohol consumption
 Radiation
 Multiple injury in oral cavity
 Mutation
 Metastatic
 Human papilloma virus
 Candida
 Lichen plannus

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Pathophysiology of oral cancer
Cancer is mainly due to the mutations in the DNA. When the etiologic
factors are dominant 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 and translocation. Blood related disorderare seen at this stage.
Due to this the normal cell physiology is affected.Forexample the suppressor
gene becomes less effective, simultaneously there is altered cell cycle and cells
are formed and they are uncontrolled. Due to decreasedsuppressorgene they
become uncontrolled. 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
numbness inthe area. The degree of size and shape of the tumor causes
change in voice and the falling of teeth.

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Clinical features
Some of the most commonoral cancer symptoms and signs include:
 Persistentmouth sore: A sore in the mouth that does not heal is the most
commonsymptom of oral cancer
 Pain: Persistentmouth pain is another commonoral cancer sign
 A lump or thickening in the cheek
 A white or red patch on the gums, tongue, tonsil, or lining of the mouth
 A sore throat or feeling that something is caught in the throat that does not go
away
 Difficulty swallowing or chewing
 Difficulty moving the jaw or tongue
 Numbness of the tongue or elsewhere in the mouth
 Jaw swelling that makes dentures hurt or fit poorly
 Loosening of the teeth
 Pain in the teeth or jaw
 Voice changes
 A lump in the neck
 Weightloss
 Persistentbad breath
Diagnostic Evaluation
 History collection:
History for previous attacks of cancer, tumors , family history is taken.
Occupational history and habits like smoking and alcoholism are collected.
Family history is collected.
 Physical examination
Oral examination is done and the presence of ulcers, change in taste as
well as the dental health is seen.
Coating of tongue and changes in buccal mucosaare seen.
 x-ray
Xrays shows the changes in gums as well as the salivary glands.
 MRI
 CT scan
 PET:
A PET scan creates pictures of organs and tissues in the body. First, a technician gives you an
injection of a small amount of a radioactive substance. Your organs and tissues pick up this
substance. Areas that use more energy pick up more. Cancer cells pick up a lot, because they
tend to use more energy than healthy cells. Then a scan shows where the radioactive
substance is in your body.

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 DNA studies
 Endoscopy
 Biopsy .
 Oral screening
Management
Goal: to control the growth of tumor , control metastasis and prevent the
complications.
Medicalmanagement:
 Chemo therapy.
o It can be done either
 Locally
 Or systemic.
Chemotherapy is often used along with radiation therapy.
Most commonlyused chemo therapy drugs are
 Cisplatin
 Carboplatin
 5-fluorouracil (5-FU)

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 Paclitaxel (Taxol®)
 Docetaxel (Taxotere®)
 Radiation therapy
A high frequencywaves are used to kill the target cells and contro or core the
cancer.
 Immunotherapy.
Cancer immunotherapy refers to a diverse set of therapeutic strategies designed to induce the patient's
own immune system to fight the tumor.
 Genetic engineering
 Monoclonal antibodies
 Hormones.
Surgical management
 Maxillectomy (can be done with or without orbital exenteration)
Maxillectomy is the removal of all or part of the maxilla bone. It is indicated for tumors of the
hard palate, nose, maxillary sinus or other tumors that have grown to involve the maxilla.
 Mandibulectomy (removal of the mandible or lower jaw or part of it)
Mandibulectomy is a procedure that is used to eradicate disease that involves
the lower jaw or mandible. This procedure can be used in various settings,
including infectious etiologies (eg, osteomyelitis) or a benign or malignant
neoplastic process (eg, invasive squamous cell carcinoma) that involves the
jaw. In cases of severe oral and maxillofacial trauma, if a section of the
mandible is not salvageable, mandibulectomy may be an appropriate
treatment.

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 Glossectomy(tongue removal, can be total, hemi or partial)
A glossectomy is the removal of all or part of the tongue.
 Radical neck dissection
The neck dissection is a surgical procedure for control of neck lymph node metastasis. This can be
done for clinically or radiologically evident lymph nodes or as part of curative surgery where risk of occult
nodal metastasis is deemed sufficiently high. The aim of the procedure is to remove lymph nodes from the
neck into which cancer cells may have migrated. Metastasis of tumours into the lymph nodes of the neck is
one of the strongest prognostic indicators for head and neck cancer.
 Mohs surgery or CCPDMA
Mohs surgery is a precise surgical technique used to treat skin cancer. During Mohs surgery,
thin layers of cancer-containing skin are progressively removed and examined until only cancer-
free tissue remains.
CCPDMA is the acronym for "complete circumferential peripheral and deep margin assessment"
 Combinational, e.g. glossectomyand laryngectomy done together
 Feeding tube to sustain nutrition. Sustained formula are given by tube feeding
 Reconstructive surgery
Reconstructive surgery is, in its broadest sense, the use of surgery to restore the form and function of the
body; maxillo-facial surgeons, plastic surgeons and otolaryngologists do reconstructive surgery on faces
after trauma and to reconstruct the head and neck after cancer
Nursing management
 Early diagnosis of disease
 Check for signs and symptoms
 Preoperative care
patientidentificationband  informedconsentdocumentation
 surgical site identification  medical historyandphysical exam
 all preoperative testing(e.g.laboratorytesting,ECG)  radiological exams
 preoperative vital signs  medications
 allergiesandsensitivities  NPO status
 surgical site marked  voiding
 eye glasses/contactlens  dentures/dental work
 hearingaids  jewelry

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 make-upremoval
 Intraoperative care
 Postoperative care
Airwayobstruction • Hypoxia
• Haemorrhage:internal orexternal • Hypotensionand/orhypertension
• Postoperative pain • Shivering,hypothermia
• Vomiting,aspiration • Fallingonthe floor • Residual narcosis
 Rehabilitation
 Psychologicalcare
Health education
 Stop smoking. Smoking is the major cause of mouth cancer and switching to low-
tar cigarettes makes no difference.
 Do not drink large amounts of alcohol as this poses almostas big a risk as
smoking.
 People who both smoke and drink heavily are up to 38 times more likely to
develop the condition.
 Avoid excessive exposure to sunlight to help prevent lip cancer.
 Avoid Electromagnetic field.
 Avoid radiation in occupational area.
 Personal hygine
 Light exercise
 Avoid obesity
 Eat plenty of fruit and vegetables like carrot, pumpkin, leafy vegetable, ascorbic
foods
 Avoid cosmeticscontaining formaldehyde and other carcinogens .
 Go and see a dentist if a mouth ulcer or a white or red patch in your mouth does
not clear after three weeks.
 Visit your dentist at least once a year.
 Cancer can be cured if detected at early stage.
Prognosis
 Postoperative disfigurementof the face,head and neck
 Complications of radiation therapy, including dry mouth and difficulty swallowing
 Other metastasis (spread) of the cancer
 Significant weight loss
 Death

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Nursing Diagnosis
 Ieffective airway clearance related to tumor in nasogastric tract.
 Imbalanced Nutrition: Less Than Body Requirements related to Hypermetabolic
state associated with cancer

 Impaired oral mucous membrane related to drying effectof prolonged use of
steroids
 Chronic Pain related to growth / metastatic tumor
 Anxiety related to change in health status