CANCER OF THE ORAL CAVITY

Mr. Jils Suresh MSc (N)

• Cancers of the oral cavity, which can occur in any part of the mouth or throat, are curable if
discovered early.
• About 95% of cases of oral cancer occur in people older than 40 years of age, but the
incidence is increasing in men younger than age 30 because of the use of smokeless tobacco,
especially snuff (Centers for Disease Control and Prevention, Men are afflicted more often
than women; however, the incidence of oral cancer in women is increasing, possibly because
they use tobacco and alcohol more frequently than they did in the past.
 CAUSES/RISK FACTORS
 These cancers are associated with the use of alcohol and tobacco.
 The combination of alcohol and tobacco seems to have a synergistic
carcinogenic effect.
 Chronic irritation by a warm pipe stem or prolonged exposure to the sun and
wind may predispose a person to lip cancer.
 Predisposing factors for other oral cancers are exposure to tobacco (including
smokeless tobacco), ingestion of alcohol, dietary deficiency, and ingestion of
smoked meats.
 PATHOPHYSIOLOGY
 At least 28 chemicals in smokeless tobacco have been found to cause cancer
 The most harmful chemicals in smokeless tobacco are tobacco-specific nitrosamines, Other
cancer-causing substances in smokeless tobacco include polonium–210 (a radioactive
element found in tobacco fertilizer) and polynuclear aromatic hydrocarbons.
 Any cancerous tissue growing in the mouth is called oral cancer.
 This type of cancer may come about as
1. a primary lesion originating in any of the oral tissues,
2. by metastasis from cancer located elsewhere at a distant site of origin,
3. or by extension from any of the neighboring anatomic structures Including the nasal cavity
or the maxillary sinus.
 PATHOPHYSIOLOGY
 Oral cancers can originate in any of the tissues of the mouth. The cancer may be from a variety of cell
types include Teratoma (A true neoplasm made up of
different types of tissue, none of which is native to the area in which it occurs, usually found in
the ovary or testis), adenocarcinoma from a some sort of salivary gland, lymphoma coming from the
Tonsils or other lymph tissue, or melanoma from the cells in the oral mucosa which produce pigment
 The most common cancer of the oral cavity is squamous cell carcinoma. This type of cancer originates in
the tissues which line the mouth and lips. Most frequently involves the tissue of the lips or the tongue.
In addition, it can also affect the floor of the mouth, the cheek lining, gums, or roof of the mouth.

 The cells are malignant and tend to spread rapidly both in the mouth and elsewhere in the body.
 Any area of the oropharynx can be a site for malignant growths, but the lips, the lateral aspects of the
tongue, and the floor of the mouth are most commonly affected.
 CLINICAL MANIFESTATIONS

 Many oral cancers produce few or no symptoms in the early stages.

 Later, the most frequent symptom is a painless sore or mass that will not heal.
 A typical lesion in oral cancer is a painless hardened ulcer with raised edges.
 Tissue from any ulcer of the oral cavity that does not heal in 2 weeks should be examined
through biopsy.
 As the cancer progresses, the patient may complain of tenderness; difficulty in chewing,
swallowing, or speaking; coughing of blood-tinged sputum; or enlarged cervical lymph nodes.
 ASSESSMENT AND DIAGNOSTIC FINDINGS

1. Oral examination as well as an assessment of the cervical lymph nodes to detect

possible metastases.
2. Biopsies are performed on suspicious lesions (those that have not healed in 2
weeks).
3. High-risk areas include the buccal mucosa and gingiva for people who use snuff
or smoke cigars or pipes. For those who smoke cigarettes and drink alcohol, high-
risk areas include the floor of the mouth, the ventrolateral tongue, and the soft
palate complex (soft palate, anterior and posterior tonsillar area, uvula, and the
area behind the molar and tongue junction).
Medical Management
Surgical resection, radiation therapy, chemotherapy, or a combination of these therapies may be
effective.
1. CANCER OF THE LIP
In cancer of the lip, small lesions are usually excised liberally;
 Larger lesions involving more than one third of the lip may be more appropriately treated by
radiation therapy because of superior cosmetic results.
 The choice depends on the extent of the lesion and what is necessary to cure the patient while
preserving the best appearance. Tumors larger than 4 cm often recur.
2.CANCER OF THE TONGUE
 Cancer of the tongue may be treated with radiation therapy and chemotherapy to preserve
organ function and maintain quality of life.
 A combination of radioactive interstitial implants (surgical implantation of a radioactive
source into the tissue adjacent to or at the tumor site) and external beam radiation may be
used.
 If the cancer has spread to the lymph nodes, the surgeon may perform a neck dissection.
 Surgical treatments leave a less functional tongue; surgical procedures include

1. Hemiglossectomy (surgical removal of half of the tongue)

2. Total glossectomy (removal of the tongue).
Often cancer of the oral cavity has metastasized through the Extensive lymphatic channel
in the neck region, requiring a neck dissection and reconstructive surgery of the oralcavity. A
common reconstructive technique involves use of a radial forearm free flap (a thin layer of skin
from the forearm along with the radial artery).
 NURSING MANAGEMENT
 The nurse assesses the patient’s nutritional status preoperatively, and a dietary consultation
may be necessary.
 The patient may require enteral (through the intestine) or parenteral (intravenous) feedings
before and after surgery to maintain adequate nutrition.
DIAGNOSES
• Risk for ineffective airway clearance, related to oral surgery
• Risk for imbalanced nutrition: Less than body requirements, related to oral surgery
• Impaired verbal communication, related to excision of a portion of the tongue
• Disturbed body image, related to surgical excision of the tongue
 NURSING MANAGEMENT
Interventions
• Assess airway patency and respiratory status every hour until stable.
• Maintain semi-Fowler’s position, supporting arms. Encourage to turn, cough, and deep
breathe every 2 to 4 hours.
• Teach the importance of activity, turning, coughing, and deep breathing.
• Monitor daily weights.
• Consult with dietitian to assess calorie needs and plan appropriate enteral feeding. Assess
response to enteral feedings.
• Demonstrate and allow to practice using magic slate and flash cards prior to surgery.
• Allow adequate time for communication efforts.
• Keep emergency call system in reach at all times and answer light promptly. Alert all staff
of inability to respond verbally.
• Encourage expression of feelings regarding perceived and actual changes.
• Provide emotional support, encourage self-care and participation in decision making.