Oral Cancer/ Cancer of Oral Cavity/ Oral Cavity Cancer
Oral cancer is part of a group of cancers called head and neck cancers.
Oral cancer starts in mouth or oral cavity or oropharynx.
Oral cavity includes;
Lips, inside lining of lips and cheeks (buccal mucosa), teeth, gums, tongue, floor of mouth below tongue, soft palate, hard palate, area behind wisdom teeth.
Risk Factors of Oral Cancer
1. Tobacco use
Smoking, cigarette, cigars, pipes, dipping snuff.
2. Alcohol use
Alcohol increases penetration DNA - damaging chemicals in lining of oral cavity and oropharynx.
3. Sunlight
4. Chronic irritation
Chronic irritation in lining of mouth
5. Lack of fruits and vegetables in diet
6. Human papillomavirus (HPV) infection
7. Immune system suppression
Pathophysiology
Lip and or cavity cancers start in squamous cell, thin, flat cells that line lips and oral cavity called squamous cell carcinomas.
Uncontrolled growth of cell that spread into deeper tissue.
Classification of TMN
T;
N;
M;
Stages of Oral Cancer
1. Stage 0
Abnormal cell found in lining of the lips nd oral cavity.
2. Stage l
3. Stage ll
4. Stage lV
Clinical Manifestations
1. Patches inside mouth or lip, red and white or mixture of red and white.
2. White patches (leukoplakia)
3. Red patches (erythroplakia)
4. Erythroleukoplakia (mixed red and white patches)
5. Sore in mouth doesn't heal
6. Pain in mouth, norlt relieved
7. Lump or thickening on lips or gums or in the mouth
8. Sore throat; not relieved
9. Difficulty in chewing or swallowing
10. Difficulty in moving jaw and tongue
11. Numbness of tongue or area of mouth
12. Pain around teeth
13. Voice changes
14. Lump or mass in neck
Diagnostic Evaluation
1. Physical Examination
Physical exam of lips and oral cavity for abnormal areas.
Use small, long handled mirror to check inside of cheeks and lips, gums, roof and floor of mouth, top, bottom and sides of tongue.
2. Endoscopy
3. X-ray of head neck and chest
4. Biopsy
5. CT scan
6. Barium swallows
7. PET (positron emission tomography) scan
8. Exfoliative cytology
Exfoliative cytology is procedure to collect cells from lip or oral cavity.
Management
1. Surgery
1. Primary tumor resection
Remove the entire tumor.
2. Mandible resection
Remove all or parts of jaw bone.
3. Total Maxillectomy or partial Maxillectomy
4. Moh's Micrographic Surgery
In this method, tumor is removed in very thin slices to minimize amount of normal tissue removed.
5. Laryngectomy
Surgical removal of all or part of the larynx (voice box).
6. Neck dissection
Major surgery done to remove lymph nodes of neck that contain cancer.
2. Radiation therapy
3. Chemotherapy
Nursing Diagnosis
1. Infective airway clearance related to pain, edema
2. Impaired verbal communication related to laryngectomy.
3. Impaired skin or tissue integrity related to surgery
4. Acute pain related to tissue swelling
5. Alteration in nutrition; less than body requirement related to NPO status, decreased appetite
6. Body image disturbance related to loss of voice.
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