detail description of the oral cavity

1. CANCER OF THE ORAL CAVITY
Ms. Saheli C
LECTURER
IACN

2. INTRODUCTION
• Cancer of the oral cavity can occur in any part of the mouth i.e.
(lips, lateral tongue, floor of the mouth most commonly) or
throat and is highly curable if discovered early.
• Malignancies of the oral cavity are usually squamous cell
cancers and is around 90% of the total cases.

4. DEFINITION
Oral cancer defined as a uncontrollable growth of the cells or
sore in the mouth that does not heal; causes damage to the
surrounding tissues of the lips, tongue, cheecks, floor of the
mouth, hard and soft palate, sinuses and pharynx and can be
life threatening if not diagnosed and treated early.

5. RISK FACTORS AND ETIOLOGY
• Cigarette, cigar and pipe smoking.
• Use of smokeless tobacco.
• Excessive use of alcohol.
• Oral cancers are often associated with the combined use
of alcohol and tobacco.
• Other factors include gender (male), age (older than 50
years)
• African American descent.

6. • A personal history with head and neck cancer
• Diet: A diet low in fruits and vegetable may play a role
in oral cancer development.
• Sun exposure: Cancer of the lip can be caused by sun
exposure.

7. STAGES OF ORAL CANCER
 STAGE 1: The cancer measures < 2 cm (about 1 inch) and has
not spread to area of the lymph nodes.
 STAGE 2: The cancer measures > 2 cm but < 4 cm (< 2 inches)
and has not spread to area of lymph nodes.
 STAGE 3: The cancer measures > 4 cm, the cancer of any size,
but has spread to only one lymph node on same side of the
neck, the lymph node containing cancer measures <= 3 cm.

8.  STAGE 4 : The cancer has spread to tissue around the lip and
oral cavity, cancer spread to > 1 lymph nodes on same side of
the neck and measures > 6 cm; and cancer has spread to
other parts of the body.

9. CLINICAL MANIFESTATIONS
• Few or no symptoms, most commonly a painless sore or
mass that will not heal.
• Typical lesion is a painful indurated ulcer with raised
edges.
• As the cancer progresses, patient may complain of
tenderness
• Difficulty in chewing, swallowing or speaking,
• Coughing of blood tinged sputum,
• Enlarged cervical lymph nodes

11. • Patches inside mouth or on lips that are a mixture of red
and white patches.
• Bleeding in the mouth.
• Loose teeth.
• Difficulty wearing dentures, swelling of the jaw that
causes dentures to fit poorly or become uncomfortable.
• Pain in one ear without hearing loss.
• Hoarseness, chronic sore throat or change in the voice.

12. DIAGNOSTIC EVALUATION
• History collection.
• Oral examination and physical examination: Visual inspection and
palpation of all mucosal surfaces, bimanual palpation of the floor of
the mouth and clinical assessment of the neck for lymph node
involvement.
• Assessment of cervical lymph nodes
• Biopsy- Confirmatory test.
• Fine needle aspiration cytology.
• Routine pan endoscopy.
• 3D imaging with CT scan and MRI.

13. • Blood test: Laboratory values may be notable for an
elevated alkaline phosphatase and possibly an
elevation of the WBC count.
• Dental X ray.

14. MANAGEMENT
• Management varies with the nature of the lesion, preference of
the physician and patient choice.
• Resectional surgery, radiation therapy, chemotherapy or a
combination may be effective.
• Lip cancer: Small lesions are excised liberally
• Larger lesions may be treated by radiation therapy.

15. • Tongue cancer: Treated aggressively, recurrence rate is high.
( total resection or hemiglossectomy) are performed.
• Radical neck dissection for metastases of oral cancer to
lymphatic channel in the neck region with reconstructive
surgery.

16. SURGICAL MANAGEMENT
• Maxillectomy ( removal of the part of the maxilla).
• Mandibulectomy ( removal of the mandible or lower jaw or part
of it).
• Glossectomy ( Tongue removal, can be total, hemi or partial ).
• Radical neck dissection
• Combination : Glossectomy and laryngectomy done together.

18. RADIATION THERAPY
• Affects cells only the treated area. It may be used before the
surgery to kill the cancer cells and shrink the tumour.
• It is used for small cell carcinoma.
• Two types; External radiation and internal radiation.
• External radiation: The radiation comes from the machine.
Patients goes to the hospital once or twice a day, generally 5
days a week for several weeks.
• Internal radiation: Radioactive implant is inserted directly in
tissue with the use of needles and thin plastic tubes for several
days. Patient has to stay in the hospital.

19. CHEMOTHERAPY
• Medical oncologist administers chemotherapy if cancer has
spread to the lymph node or other organ.
• The medicine circulates in the blood and disrupts the growth
of the cancer cell.
• Chemotherapy when combined with surgery it is helpful.

20. PRE OPERATIVE NURSING MANAGEMENT
 Assess the patients nutritional status pre operatively , a dietary
consultation may be necessary.
 Implement enteral (through the GI tract) or parenteral (IV)
feedings as needed to maintain adequate nutrition.
 If a radial graft is to be performed, then perform Allen test on
the donor arm; must to ensure that the ulnar artery is patent
and can provide blood flow to the hand after removal of the
radial artery.

21.  Assess the patients ability to communicate in writing as verbal
communication may be impaired by radical surgery for oral
cancer (provide a pen and paper after surgery to patients who
can use them to communicate).
 Obtain a communication board with commonly used words or
pictures (give after surgery to patients who can not write so
that they may point to needed items).
 Consult a speech therapist.

22. POST OPERATIVE NURSING MANAGEMENT
• Assess for patent airway.
• Perform suctioning if the patient is unable to manage oral secretions,
if grafting was part of the surgery, suctioning must be performed with
care to prevent damage to the graft.
• Assess the graft for viability, assess color (white may indicate arterial
occlusion, and blue mottling may indicate venous congestion),
although it can be difficult to assess the graft by looking into the
mouth.
• A Doppler ultrasound device may be used to locate the radial pulse at
the graft site and to assess graft perfusion.

23. DIET PLAN
• Advice patient to avoid cold drinks, banana, cold milk, curd
preparation, ice cream, refrigerated food items and also tell
about to take salt restricted diet because of hypertension.
• Protein is essential for healthy immune system.
• CHO and fats assist the body by supplying the calories required
for a healthy living.

24. COMPLICATIONS
• Dry mouth.
• Cavities.
• Oral communication with the sinuses.
• Difficulties in speaking, drinking and eating.
• Malocclusion : misalignment between the teeth of the
two dental arches.
• Facial deformities.
• Isolation from the societies.

25. RESTORING FUNCTION
• Prostheses fabricated by a maxillofacial prosthodontist to
restore form and function.
• Facial prostheses.
• Palatal augmentation.
• Resection prostheses.
• Implants.
• Dental implants