https://wtspee.

com/967716954868
 ‫وزارة التعليم‬
‫المملكة العربية السعودية‬
‫كلية فقيه للعلوم الطبية‬

‫‪https://wtspee.com/967716954868‬‬

‫‪Carcinoma of Tongue‬‬

‫‪Prepared by:‬‬

‫‪TO :‬‬
‫‪Dr.‬‬
OUTLINES
 Introduction
 Definition of tongue Cancer.
 Pathophysiology of tongue cancer.
 Type of tongue cancer.
 Risk factors of tongue cancer
 Sign and symptoms of tongue cancer.
 Diagnostic Procedures
 Management
 Case study
 Conclusion
https://wtspee.com/967716954868
 Introduction
• Tongue cancer is the most common malignancy diagnosed in the
oral cavity and accounts for between 25 and 40 oral squamous cell
carcinomas.
• The tongue appears to be predisposed to malignant invasion due to
its highly muscular structure and rich lymphatic network
• In advanced cases, surgical resection followed by radiotherapy (RT)
with or without chemotherapy is performed and appears to be
beneficial.
• In early cases (T1-2), surgery is usually the preferred form of
treatment.
• However, the treatment of cervical lymph nodes (LN) and the role
of postoperative adjuvant treatment remain uncertain.
 Pathophysiology

• Squamous cell carcinoma accounts for 95 of all malignant

tumors of the oral cavity.
• Other oral malignancies include salivary gland malignancies,
mucosal melanomas, lymphomas, and sarcomas.
• At the earliest detectable stage, squamous cell carcinoma
appears as hard, pearly plaques or irregular, rough, or warty
areas of thickened mucosa.
• Tongue cancer is treatable if detected early, but can be life-
threatening if not diagnosed and treated early.
• Over time, it can spread to other parts of the mouth, to other
areas of the head and neck, or to other parts of the body.
 Signs and Symptoms

• Sore in mouth that does not heal

• Persistent tongue and/or jaw pain
• Lump or thickening inside the mouth
• White or red patch on gums, tongue, tonsil, or lining of mouth
• Sore throat or feeling that something is stuck/lodged in the
throat
• Difficulty swallowing or chewing
• Difficulty moving jaw or tongue
• Hoarseness or numbness of mouth or tongue
• Loss of appetite
• Weight loss, dysphagia and odynophagia
• Ear or jaw pain
 Causes

• The cause of tongue cancer is unknown.

• The cause could be inadequate oral hygiene and thick
white spots on the mucous membranes of the oral
cavity (leukoplakia).
• The disorder is statistically related to alcoholism,
liver cirrhosis, excessive smoking and syphilis.
• Irritation caused by uneven teeth, protruding fillings,
and ill-fitting dentures can also contribute to the
development of tongue cancer.
• As with other types of cancer, the possibility of a
genetic predisposition to cancer may also be a factor.
 Risk Factors

• Tobacco consumption
• Alcohol consumption
• Betel and gutka chewing
• Human papillomavirus (HPV) infection
• Male sex
• Age
• Some genetic forms of anemia
• A condition called graft-versus-host disease, which
occurs in some patients who undergo stem cell
transplants.
Diagnostic Procedures
 Diagnostic Procedures

1. CECT of the head and neck from the base of the

skull to the upper chest: to detect bony infiltration
(cortical bone pillar) in the jaw, pterygoid plates
and occult metastases in the cervical lymph nodes.
2. MRI of the tongue to detect infiltration in the
extrinsic and intrinsic muscles of the tongue and
nerves. and glasses

https://wtspee.com/967716954868
 Diagnostic Procedures

• Endoscopy, this test uses a thin tube with a light and a

camera. The tube is inserted into the nose and passed
down the throat. Look for signs of tongue cancer in the
mouth and throat. It can also be used to see if the cancer
has spread by looking at other parts of the throat, such as
the voice box.
• Biopsy, this test consists of taking a sample of cells from
the tongue. There are different types of biopsy procedures.
A sample can be taken by cutting off part or all of the
suspicious tissue.
Management
 Surgery
• Glossectomy: Surgery to remove part or all of the tongue.
• The surgeon removes the cancerous tumor and some healthy
cells around it, called margins.
• Removing the border ensures that all cancer cells are removed.
• How much of the tongue the surgeon removes depends on the
size of the cancer. The operation may involve removing part or
all of the tongue.
 Surgery
• Reconstructive surgery.
• Reconstructive surgery may be necessary when parts of
the face, jaw, or neck are removed during surgery.
• Healthy bones or tissue can be taken from other parts of
the body and used to fill the spaces left by the cancer.
• This tissue can replace part of the lip, tongue, palate or
jaw, face, throat, or skin.
• If reconstruction is used to replace parts of the tongue, it
is usually done at the same time as surgery to remove
the cancer.
 Targeted and immunotherapy cancer drugs

• Targeted therapy. Targeted therapy uses drugs that attack

specific chemicals in cancer cells. By blocking these
chemicals, targeted treatments can cause cancer cells to die.
Targeted therapy is used to treat tongue cancer that returns or
spreads.
• Immunotherapy. Immunotherapy is a drug treatment that
helps body's immune system destroy cancer cells.
• Immunotherapy helps immune system cells find and destroy
cancer cells. Immunotherapy may be used when the cancer is
advanced and other treatments have not helped.
 Radiation therapy &Chemotherapy

• Radiation therapy is sometimes the main treatment for

tongue cancer. It can also be used after surgery to kill
remaining cancer cells. Sometimes radiation therapy and
chemotherapy are used at the same time to treat other parts of
the body, such as the lymph nodes, if the cancer has spread.
• Chemotherapy. Chemotherapy uses powerful drugs to kill
cancer cells. Chemotherapy may be used before surgery to
control cell growth. It can also be used after surgery to kill
remaining cells. Chemotherapy is sometimes given at the
same time as radiation therapy because
Case Study
 ASSESSMENT
SUBJECTIVE DATA
Patient Name: Saleh Ali Atiah Alghanmi
Gender/Sex: Male/adult. Occupation: engineer
Marital Status: Married Age: 61y, Male
Admission Date:24-Dec-2023
Medical Diagnosis: Ca tongue-post left subtotal glossectomy with bilateral neck dissection,
left radial free flap and anastomosis, tracheostomy, and left thigh skin graft
Chief complaint: The patient came to the hospital suffering from numbness in the lips and
a change in voice
History of present illness : A 61 yr old, no past medical history, nonsmoker, he came to the
hospital suffering from numbness in the lips and a change in voice, diagnosed as Ca tongue-
well differentiated keratinizing squamous call carcinoma 21/12-admitted to ccu, post left
subtotal glossectomy with bilateral neck dissection, left radial free flap and anastomosis,
tracheostomy. and left thigh skin graft.
Past medical history: no past medical history, nonsmoker
 ASSESSMENT
OBJECTIVE DATA

Vital signs Vital signs:

Temperature: 37.7 c
Pressure: 103/58 mmHg
Pulse Rate: 75 b/m
Respiratory Rate: 21 c/m
02 Saturation: 94%
Pain Scale: 4 (Pain scale range 0= No pain - 10: sever
Pain)

Gastrointestinal Pt feeding before come to hospital was very Poor: Never eats a complete meal
System / Nutrition rakes fluids poorly NPO, and/or maintained on clear liquids,
Inspection: Inspection of Abdominal is normal shape , contour rounded. Note
gastrostomy tube . No bloating present.
Feeding: pt had Enteric Feeding Tube, gastrostomy site cheeked, 10 ml of residual
volume, due medication give start feeding 75 ml/h Diabetic resource
Auscultation: Bowel sounds are normoactive in four Quarters ,
 OBJECTIVE DATA
Neurological System • Level of Consciousness: Awake & Alert, Oriented, Obeys commands
• GCS Adult: Moderately Normal (11), E: 4,V:1, M: 6.
• Airway Protection: Cough: Negative, Gag .
• Sensory Perception: No impairment: Responds to verbal commands, has no
sensory deficit which would limitability to feel (4)
• Pupils Exam: Size: equal, Light Reflex: reactive
• Airway Protection: Cough: Negative, Gag Reflex: Negative
Head appearance is normocephalic scalp is intact without c/o deformities .
Eye Inspection- the visual impairment both sides eyes. No infection, sty -No swelling,
Face
redness-Normal sclera and pupil
The ear Ears are clean, and approxi mately of the same size and shape. There is no
pain or tenderness on the palpation, no ringing in the ears, no discharges noted
Mouth: Lips are dry . Tongue appearance with tumor signs
gums, and mucus membranes are pale, and teeth Lost 3 caries no breath odor

Nose is Both nares are patent bilaterally no congestion or discharge , mucous

membranes is moist
Neck: bilateral neck dissection,

https://wtspee.com/967716954868
 OBJECTIVE DATA
Respiratory System Inspection: Pt had Tracheostomy RR: is within 21 breath per minute, tachypnea
Sedation Vacation: Yes
Tracheostomy mask
Chest Exam BEAE,
Secretions: No.
Cardiovascular • pulse cheeked in neck site and lower tongue all present
System • Capillary beds refill is within 3 sec, Peripheral vascular: No palpitations or
edema no tingling sensation in extremities
• Rhythm: normal sinus
• Heart Sounds: s1s2 present
• MAP: 65mm Hg
• ECG: sinus
• Echo: LVEF 55% , grade I diastolic

Ur System Pt has folly catheter

lnput/Output over 12 hours: 1200/600ml, Balance 600ml, yellow color
 Investigation

Laboratory Test Normal Values Patient value Remark

CARBOXYHEMO 0.0-3 (%) 15.5 High

GLOBIN
DESOXYHEMOG 0.0-2.9 (%) 78.4 mmhg Normal
LOBIN
CREATININE 0.67-1.17 (mg/dl) 0.63 Low
(ENZYMATIC)
CRP <5.0 (mg/L) 194.26 High
WBC 4.5-11 (10^3/uL) 4.13 Low
RBC 4.2-5.6 (10^6/ul.) 3.79 Low
HB 13.1-17.2 (g/dl) 11.2 Low
NE% 35-80 (%) 82.1 High
LY% 24-44 (%) 8.7 Low
HAEMATOCRI T 39-50(%) 34.8 Low

PLATELET 150-440 (10^3/ul) 128 Low

COUNT
 Investigation
Laboratory Test Normal Values Patient value Remark

PH 7,35-7.45 7.454 High

PO2 36-44 (mmHg) 43.9 Normal
Paco2 35 _ 48 mmhg 42.8 Normal
Hco3 22 _ 26 mE q/L 29.4 High
SO2 70-80 (% ) 84.1 % High
LACTATE 0.56-1.39 mmol/l 0.94 mmol/L Normal
NA 136-145 mmol/l 136.7 mmol/l Normal
CL 98-107 (mmol/L) 98.8 (mmol/L) Normal

IONIZED CA 1.15-1.35 (mmol/L) 0.940 Low

K 3.5-4.5 (mmol/L) 3.05 Low

 RADIOLOGICAL PROCEDURES

CT Abdomen • Findings: Bilateral enlarged cervical LN necrosis, left IIA

1.8 cm, right lb SMG 1.3 cm, the tongue and floor of
mouth structures degraded by artifact
• Pulmo : No intra abdominal mets, small hypodense liver
lesion
Medication
 Medication
Name Dose Route Action Side effects
ACETYLSALICYL 100 MG Oral Produce analgesia and GI BLEEDING,
IC ACID reduce inflammation dyspepsia, nausea,
and fever by inhibiting abdominal pain
the production of Bronchospasm
prostaglad- ins. Skin problems
Decreases platelet
aggression
bisACODYL 5 mg Oral Stimulates peristalsis. abdominal cramps,
Once in Alters fluid and nausea, diarrhea
every electrolytes, transport, Hypokalemia,
8 producing fluid muscle weakness
Hour(s) accumulation in the
colon
IPRATROPIUM Tid IPRATROPIUM It is an anticholinergic nausea, upset
drug. It works by stomach, dry
relaxing the muscles in mouth or
the airways, opening constipation or
them up. dizziness may
occur..
 Dose / Indications Action Side effect if Nursing
Rout
Drug name Frequen present Responsibilities
e
cy
Acetaminoph PO 1 g / TID In general, Pain relief CNS: agitation, ●Monitor vital
en ( acetaminoph may result anxiety, dizziness, signs. Monitor
paracetamol) en is used for from inhibition insomnia, blood pressure to
the treatment of headache, pyrexia, evaluate drug
of mild to prostaglandin fatigue efficacy.
moderate synthesis in CV: hypotension, ●Consider 10
pain and CNS, with peripheral edema, Rights
reduction of subsequent periorbital ●Administer
fever blockage of edema, without regard
pain impulses. GI: nausea, of food.
vomiting, ●Be alert for
diarrhea, adverse reactions
dyspepsia, and drug
abdominal pain interactions
Respiratory: ●Observe for
abnormal breath acute toxicity
sound, dyspnea, and overdose
hypoxia,
Name Dosage Actions Possible Side Effects Nursing Implications
Enoxaparin 40 mg OD Uses CNS: Fever, confusion Assess
subcutaneo GI: Nausea
Sodium us Therapeutic anticoagulation HEMA: Hemorrhage Blood studies (Hct/Hgb, CBC,
from site, hypochromic coagulation studies, platelets (for
DVT prophylaxis HIT), occult blood in stools),
anemia,
thrombocytopenia. anti–factor Xa (should be checked 4
Action
INTEG: Ecchymosis, hr after inj);
Binds to antithrombin III inj site hematoma
Neurologic status: those with
inactivating factors Xa/IIa, META: Hyperkalemia
epidural catheters are at greater
thereby resulting in a higher in renal failure
chance for impairments Injection-site
ratio of anti–factor Xa to IIa MS: Osteoporosis
reactions: inflammation, redness,
SYST: Edema,
Therapeutic Effect: Produces hematoma
peripheral edema,
anticoagulation. . angioedema, Monitor for and report immediately
any sign or symptom of unexplained
bleeding.

Patient & Family Teaching

Usual length of therapy is 7–10 days

Do not discontinue current blood

thinning regimen or take any newly
prescribed medications unless
approved by the prescriber who
originally started treatmen
Nursing care plan
 Nursing care plan
Assessment Nursing diagnosis (Expected Nursin Rational Evaluat
outcome) g interventions ion
S ubjective Ineffective S hort Term Goal 1. Assess the 1. Changes in breathing The goal met
Data breathing pattern After 12 hour of pt patterns may indicate a
related to nursing respiratory deterioration in After 1 week of
Patient secretions intervention, the status, rate, respiratory status. nursing
complaints secondary to patient will be able depth, and 2. Identify the status of interventions
of difficult of tongue cancer to: Demonstrate breath ventilation and
breathing evidence by pt methods to sound at oxygenation. The patient will
restlessness reports of shortness maintain airway least every 4 3. The patient should be maintain an
of breath and patency. hours. upright to enhance effective breathing
Objective coughing and Long term Goal: 2. Monitor lung expansion and pattern as
Data tachypnea. After 7 days of arterial ventilation evidenced by
nursing blood gases respiration rate,
patient with intervention, the 3. Elevate the 4. This is to clear the depth, and
little cough client will be able head of the blockage in the airway rhythm being
and had to: Achieve airway bed. within normal
secretions patency. 4. S uction limits. No
demonstrate secretions, secretions present
Vital signs normal oxygen as
Tem: 37.7 c exchange as necessary
Pr: 75 bpm, evidenced by:
RR: 21/ bpm Normal
(Tachypnea) respirations clear
BP : 103/58 breath sounds
mmHg
S pO2 94 %
 Nursing care plan

Assessment Nursing Expected Nursing Rationales Evaluation

Diagno Goals Interventions
ses

Subjective risk for Short term: 1. Early detection of signs and After q
Data Infection After 3 days 1. Monitor symptoms of infection, such 7 days of
Patient in related to of nursing vital signs hyperthermia, tachypnea nursing
chemotherapy compromised intervention, and allows for intervention and intervention
course immune symptoms of treatment. After the
O bjective Data function The patient will infection 2. An elevated white blood cell nursing
secondary demonstrate regularly count can indicate a interventions,
to infection control 2. Check and systemic infection the patient will
Vital signs
che motherapy precautions. monitor lab 3. Handwashing is an effective be free of signs
Tem: 37.7 c
treatment for results infection control and symptoms
Pr: 75 bpm,
tongue cancer 3. Maintain intervention that reduces of infection and
RR: 21/ bpm Long term:
strict hand the risk of pathogen v/s is stable
(Tachypnea)
hygiene transmission..
BP : 103/58 mmHg The patient
4. Repositioning reduces
SpO 2 94 % will be free of 4. Change the
patient's pressure and prevents skin
infection .
position damage, which creates a
frequently. breeding ground for
5. Administer bacterial growth.
antibiotics, 5. To prevent or reduce
as indicated. infections in patient
undergoing chemotherapy
or surgery.
 References
• Irani S. (2020). New Insights into Oral Cancer-Risk Factors and
Prevention: A Review of Literature. International journal of preventive
medicine, 11, 202. https://doi.org/10.4103/ijpvm.IJPVM_403_18
• Gonzalez, M., & March, A. R. (2023, May 2). Tongue cancer. Treatment
& Management | Point of Care. https://www.statpearls.com/point-of-
care/97302
• Charles H. Brown, MS Pharm, RPh, CACP Professor Emeritus of Clinical
Pharmacy Purdue University College of Pharmacy West Lafayette,
Indiana. (2015, July 20). Tongue Cancer: A Review. U.S. Pharmacist.
https://www.uspharmacist.com/article/tongue-cancer-a-review
• Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses,
interventions, & outcomes. St. Louis, MO: Elsevier.

https://wtspee.com/967716954868
‫تم بحمد هللا‬