Francis Anthony B.

Losloso
MAN-AHN
Oncology Nursing

Activity 1: Epidemiological Survey

My experience being an otorhinolaryngology nurse helped me determine the

common cancers in the head and neck area. Most of which involves the neck and the
oral cavity. The top five cancer diagnosis that we have are as follows:

Common Cancer in Ward 10- Department of Otorhinolaryngology

1. Papillary Thyroid Carcinoma
2. Laryngeal Squamous Cell Carcinoma
3. Nasopharyngeal Carcinoma
4. Oral Cavity Malignancies (Oral, Oro/hypopharyngeal, Buccal, Tongue Carcinoma)
5. Parotid Malignancies

Most of the medical diagnosis of patients above concerns airway clearance and
passage way of food wherein nurses together with the medical team’s primary focus is
to prevent further obstruction. In my department, I have interviewed so many patients
for the past 3 years regarding these kinds of disease processes; and for the purpose of
this activity, I have chosen 6 patients who are diagnosed with Papillary Thyroid
Carcinoma (2), Glottic Malignancies (2) and Tongue Squamous Cell Carcinoma (2).

For those diagnosed with Papillary Thyroid Carcinoma, to answer the question,
they have learned that they have cancer from the time that they had their biopsy results
but for the purpose of determining what they have experienced at first is that they both
noticed a marble size/shaped anterior neck mass that is non-tender. soft and moves.
One was diagnosed after 4 years and the other was after 2 years. Both of them ignored
their anterior neck mass at first but as time goes by, they noticed a gradual enlargement
of mass size that made them seek for consultation. Laboratory work-ups such as FT4,
FT3, TSH for thyroid functions, CT scan of the neck and Ultrasound were done and as
confirmatory for malignancy, biopsy were also done confirming their diagnosis as
Papillary Thyroid Carcinoma. The first patient believed that she got it from her dietary
intake and was discovered later on that her mother also had an anterior neck mass but
diagnosed as benign which undergone total thyroidectomy and concluded that it may be
a familial disease. On the other hand, the second patient believed that it was his lifestyle
being an alcoholic with an average intake of 6 bottles of beer weekly which caused his
disease.

Next would be those patients diagnosed with Tongue Squamous Cell Carcinoma.
Same as written above, they knew that they had cancer by the time biopsy results were
in however, the first patient concluded that due to accidentally biting his tongue which
bled afterwards were the cause of his tongue mass. For tongue SCCA, the prognosis of
it is very fast wherein less than a year, significant changes are noticeable. They started
to feel burning sensations specially during manipulation. Pea-shaped mass were noted
and started growing rapidly within months that eventually lead to oral airway obstruction
that needs immediate intervention. Both of them experienced it early this year (4/2019)
and was admitted this month (9/2019) due to its aggressiveness. They both undergone
CT scan, ultrasound and biopsy. The first patient thought that the cause of his cancer
was not being able to seek immediate health care and because of his work as a tricycle
driver in Rizal further exposing him to smoke and dust pollution. Meanwhile, the second
patient thought that his cancer were caused genetically since his uncle had an
oral(undetermined) cancer as well. Secondary to it, he also used “nga-nga”/ betel nut 5
times per day for 5 years.

Lastly, those patients currently admitted were diagnosed with glottic mass to
consider malignancy but were not officially diagnosed yet since they are both waiting for
the biopsy results. If it is truly to be diagnosed as malignant, it may be considered as
laryngeal carcinoma. Both of them experienced symptoms of dysphagia at first and felt
that there is something obstructing their throat. They felt it last March and April this 2019
and immediately sought consult in their local hospital. Scoping were done and it was
noted that the first patient had a grape-size glottic mass and the second one has a little
than new one (1) peso coin. Both of them immediately undergone direct laryngoscopy,
biopsy and tracheostomy as airway prophylaxis to prevent further obstruction. CT scan
were also done and ultrasound confirming the mass. The first patient thought that his
mass were caused by work (cutting/trimming grass/ cornfields/ plants etc.). During
interview, I have discovered that he is a smoker with 37 pack years wherein fact, he was
not able to realize that it may be the primary cause of his current disease. Furthermore,
the second patient was also a smoker for 8.5 pack years. He knew that his lifestyle of
being a chronic smoker led him to his illness. I was able to discover that aside from
being a smoker, he also worked in an industrial factory of cement that forms or builds
hollow blocks which further exposed him to dust and cement fragments that may
contributed to his disease.

The methodology in obtaining my data is by tallying the results from our ward
kardex. I listed down all patients currently admitted and diagnosed with cancer and
ranked it having papillary thyroid carcinomas as number 1. I chose 2 patients for 3
different categories (Thyroid Carcinoma, Oral Cavity and Laryngeal). I interviewed each
one of them using the guide questions given and also gathering their thorough history.

Head and neck cancers arise from multifactorial causes mainly due to dietary
intake, lifestyle and occupational hazards. Being exposed to such increases their risk of
developing cancer. Most of them noticed or felt a small lump that gradually increases in
size depending on its aggressiveness and further progresses to large masses that may
obstruct their airway and food passageway resulting to decrease in nutritional status
and worst, completely blocking their airway that may result in respiratory arrest. It is
important for nurses to pro-actively teach those who are at risks to prevent or at least
lessen their exposure to such carcinogens. Early detection by campaigning early
diagnostic or screening procedures may help them in preventing or delaying the
prognosis of the disease process. For those who are already diagnosed with cancer,
supportive care should be maintained such as tube feeding for those who have oral
obstructions, tracheostomy care, suctioning, nebulization and good deep breathing and
coughing techniques for those who have ineffective airway clearances etc., aseptic
techniques and assisting in their activities of daily living will make their life more
comfortable lessening their burden during treatment. Patients special senses are also to
be recognized because some procedures may involve removing their eyes (orbital
exenteration), anosmia, loss of hearing and unable to taste food. Likewise, same
management may also be done to terminally ill patients with special considerations to
their families and relatives by supporting them hoslitically including their spiritual needs.

In conclusion, caring for patients with head and neck cancer is very important
since priority interventions such as maintaining good airway, providing nutritional
support and of course, increasing their self-esteem due to impaired body image may
arise due to flap recontructions and other surgical procedures and it is not something
that can be hidden since it involves the head.

References:
Primary source: Patient
Secondary source: Patient chart, brother
Brunner, L. S., Suddarth, D. S., Smeltzer, S. C. O., & Bare, B. G. (2004). Brunner &
Suddarth's textbook of medical-surgical nursing (10th ed.). Philadelphia: Lippincott
Williams & Wilkins.