CARE OF PATIENT WITH

ORAL CAVITY CANCER

MODERATOR PRESENTED BY
Ms. Ujjwal Dahiya Shubham Gaur
Associate Professor Msc Nursing 1st year
CON,AIIMS CON,AIIMS
 OBJECTIVES
1.Define oral cavity cancer
2.Enlist causes of oral cavity cancer
3.Enumerate warning signs of oral cavity cancer
4.Describe sign and symptoms of oral cavity cancer
5.Explain management of patient with oral cavity cancer
6.Explain nursing management of patient with oral
cavity cancer
7.Discuss prevention of oral cavity cancer
 INTRODUCTION
In India 4 in 10 of all cancers are oral cancers.

Only 30-40 percent of those diagnosed will survive more than five years; a
pattern largely unchanged in the last 50 years despite advances in
treatment.

Early detection offers the best chance of survival, yet only one-third of oral
cavity cancer is found in the earliest stages when treatment is most effective.

About 2/3rd of cancer of the mouth or oral cavity occurs in the floor of mouth
and tongue, but can occur in the upper or lower jaw, lips, gums and cheek
lining.

1/3rd of oral cancer now occurs in patients younger than 55.

 GLOBAL SCENARIO

6th MC malignancy worldwide,

6% of all cancer cases

1%–2% of all cancer deaths

Oral cavity and laryngeal cancers are the MC head and neck
cancers globally (age-adjusted standardised incidence rate
3.9 and 2.3 per 100 000, respectively).
 ANATOMY

Oral cavity: extends from vermillion border of lips to

plane between junction of hard palate and soft palate.

Include : oral cavity

Buccal Mucosa
Tongue
Gingiva
Floor Of Mouth
Hard palate
 RISK FACTORS

Tobacco: About 90% of people with oral cavity and

oropharyngeal cancer use tobacco

Alcohol: Drinking alcohol strongly increases a smoker's

risk of developing oral cavity and oropharyngeal cancer .
Ultraviolet light: More than 30% of patients with
cancers of the lip have outdoor occupations associated
with prolonged exposure to sunlight.

Irritation: Long-term irritation to the lining of the mouth

caused by poorly fitting dentures
Poor nutrition: A diet low in fruits and vegetables is
associated with an increased risk.

Mouthwash: Some studies have suggested that

mouthwash with a high alcohol content.
Human papillomavirus (HPV) infection

Immune system suppression

Age: The likelihood of developing oral and oropharyngeal

cancer increases with age, especially after age 35.

Gender: Oral and oropharyngeal cancer is twice as common

in men as in women
 WARNING SIGNS

Red or white patches in the mouth

Mouth sores or ulcers that bleed easily and do not heal.
Unexplained lump in the neck, throat or floor of the mouth
Difficulty or discomfort swallowing
Pain and tenderness in teeth or gums
 Change in the fit of dentures or partial dentures
 Visible change in mouth tissue
 Unpleasant sensations (pain, discomfort, numbness)
 Diminished ability to perform normal functions such as
opening jaw, chewing or swallowing
 Unexplained swelling or fullness in the neck
MOLECULAR BIOLOGY ?
 PRE MALIGNANT LESIONS

Leukoplakia –
 Chronic, white plaque
 Severity linked to the duration and quantity of tobacco
and alcohol use
 Occur anywhere in the oral cavity
Erythroplakia - non-inflammatory erythematous plaque
Submucous fibrosis
generalized white discoloration of oral mucosa with
progressive fibrosis, painful mucosal atrophy and restrictive
fibrotic bands
 SITE OF ORAL CANCER

Tongue : 35%

Floor of mouth: 30%

Buccal mucosa: 10%

Hard palate: 8%

Lips: lower-93%, upper-5%, commissure- 2%

 SIGN & SYMPTOMS

 a sore in the mouth that does not heal (most common

symptom)
 pain in the mouth that doesn't go away (also very common)
 a persistent lump or thickening in the cheek
 a persistent white or red patch on the gums, tongue, or
lining of the mouth
 a sore throat or a feeling that something is caught in the
throat that doesn't go away
 Increased salivation
 difficulty chewing or swallowing
 difficulty moving the jaw or tongue

 swelling of the jaw that causes dentures to fit poorly or
become uncomfortable
 loosening of the teeth or pain around the teeth or jaw
 voice changes
 a lump or mass in the neck
 weight loss
 persistent bad breath
 STAGING OF THE CANCER

Stage Ι – Cancer< 2cm and has not spread to lymph nodes in

the area.

Stage ΙΙ – Cancer> 2cm but <4 cm and has not spread to lymph
nodes in the area.

Stage ΙΙΙ – Cancer > 4cm or any size and has spread to only
one lymph node on the same side of the neck and lymph node <
3cm

Stage ΙV – Cancer any size and has spread to more than one
lymph node on the same side of the neck or to both sides with
distant metastasis.
 DIAGNOSIS

 History
 Clinical examination
 Investigations :
Toluidine blue test
Biopsy
FNAC
Orthopantogram
Chest X-Ray
ECG
Routine blood investigations
Investigations: for staging

- CT face, neck, chest

- USG of neck(lymph node involvement)
- PET scan
ORAL BRUSH BIOPSY
ORTHOPANTOGRAM
MRI & CT
 PATTERN OF SPREAD

 Carcinomas usually originate in the mucosa; they initially grow

by local infiltration.

 Locoregional invasion occurs early into muscles, and later into

bones and nerves

 Lymphatic dissemination patterns depend on the degree of

differentiation, tumour size and primary tumour site. 5% of
patients present only with neck lymphadenopathy.

 Haematological spread occurs later (10%–12%). Lung

followed by bones are the organs more commonly affected.
Spread occurs more often in hypopharyngeal cancer.
SCREENING
 TREATMENT

 Surgery

 Radiotherapy

 Chemotherapy

 Immunotherapy
 SURGERICAL PROCEDURES

○ Glossectomy

○ Mandibulectomy

○ Maxillectomy

○ Mohs micrographic surgery

○ Neck dissection

○ Commando procedure
GLOSSECTOMY
MANDIBULECTOMY
MAXILLECTOMY
MOHS MICROGRAPHIC SURGERY
NECK DISSECTION
RADICAL NECK DISSECTION
 COMMANDO SURGERY

1.COMbined
MAndibulectomy and
Neck Dissection
Operation

2.Indication-
1st degree malignancy of
tongue
 RADIOTHERAPY

Palliative : 20gy x 5 daily fractions x 1wk.

-Combined therapy.
-Preoperative.
-Postoperative.
 Small (t1/t2), superficial (<5mm thickness) lesions of
tongue & FOM: interstitial brachytherapy.
 Dose: 60 gy for 6days with iridium-192
 CHEMOTHERAPY

Curative
- Adjuvant

Palliative
- Recurrence
- Metastatic disease

Drugs - Cisplatin, Methotrexate, 5 FU

 IMMUNOTHERAPY

The most common immunotherapy drug used to treat

oral cancer is Nivolumab (Opdivo).

It is usually given in a vein in the arm (by IV) every 2

weeks.
 Nursing
Management
 ASSESSMENT

 Assess client’s mouth for any ulcers,

dysphagia,white/red patches, bleeding, lumps in neck,
referred pain to ear, foul odour,& hoarseness

 Obtain smoking, alcohol & tobacco use.

 Enquire about oral hygiene habits & sun light

exposure.
 NURSING DIAGNOSIS

Imbalance nutrition – less than body requirements related to

oral pain, difficulty , chewing & swallowing , surgical resection
and radiation treatment.

Chronic pain related to the tumor , surgery, and, or radiation.

Risk for ineffective airway clearance ,related to oral surgery.

Impaired verbal communication related to excision of a portion

of tongue.

Disturbed body image, related to surgical excision of tongue.

imbalance nutrition – less than body requirements
related to oral pain, difficulty , chewing & swallowing ,
surgical resection and radiation treatment.
Weight daily ,assess oral intake for adequate of protein , calories
and nutrients

Offer soft , bland food with supplements as indicated. Provide

small, frequent feedings, making mealtimes pleasant.

Provide enteral feedings per gastrostomy tube as ordered ,

elevate the head of the bed 30 to 40 degree .
Assess for gastric residual volume per facility protocol for the
type of feeding.

Consider a nutritional consultant to assess diet and plan

appropriate suppliments.
Chronic pain related to the tumor ,
surgery, and, or radiation.
Assess the level of pain , intensity , place and duration.
Provide analgesics as prescribed .
Provide diversional therapies such as listening music , talking to
family members.
Encourage family members to be with patient.
Risk for ineffective airway
clearance ,related to oral surgery.
1.In the initial postoperative period ,assess airway patency &
respiratory status at least hourly , a patent airway is vital to
maintain respiratory & oxygenation of tissues.

2.Unless contraindicated, place in fowler’s position, supporting

arms.

3.Assist the client to turn , cough, and deep breathe at least

every 2 to 4 hours.

4.Maintain adequate hydration (2000 to 3000ml/day unless

contraindicated)& humidity of inspired air.
Impaired verbal communication related to
excision of a portion of tongue.
1.Before surgery , establish & practice a communication plan
such as using a magic slate or flash card .

2.Provide ample time for communication efforts by the client, be

alert for nonverbal communications .use yes/ no questions &
simple phrases .

3.If indicated refer to or consult with a speech therapist .

Disturbed body image, related to surgical
excision of tongue.
1.Assess coping style, self perception and responses to altered
appearance or functions

2.Encourage verbalization of feelings regarding perceived and

actual changes.

3.Provide emotional support , encourage self care and provide

decision making opportunities .
 ORAL HYGIENE

 Brush teeth often, especially after eating and at bedtime

 Use soft, nylon toothbrush with even bristles.

 Rinse mouth several times daily. This helps relieve dryness,

promotes comfort, cleansing and healing.

 For patient with dentures instruct to clean inside of the mouth gently
with moist clean gauze and massage gums gently with finger.
 Clean dentures everyday with denture brush and denture
cleaner( soap and water or baking soda and water)

 Change dental soaking cup and brush frequently every two

weeks.

 Store dentures in container of water to keep shape when not

in mouth.
 REHABILITATION

 Dietary counseling: Many patients recovering from oral cancer

surgery have difficulty eating, so it is often recommended that
they eat small meals consisting of soft, moist foods.

 Surgery: Some patients may benefit from reconstructive or

plastic surgery to restore the bones or tissues of the mouth,
returning a more normal appearance.
 Prosthesis: If reconstructive or plastic surgery is not an option,
patients may benefit from dental or facial-part prosthesis to
restore a more normal appearance. Special training may be
needed to learn to use a prosthetic device.

 Speech therapy: If a patient experiences difficulty in speaking

following oral cancer treatment, speech therapy may help the
patient relearn the process.
 PREVENTION

 Avoid use of tobacco, alcohol, very hot beverages & food .

 Regular meticulous oral hygiene.

 Limited Sun exposure .

 Well balanced diet .

 Follow regular oral screening after 40 years.

 Get treat pre-cancerous growths.

 Avoid HPV infection and get vaccination .

 Use properly fitted dentures.

 RESEARCH INPUT

Cancer Statistics, 2020: Report From National Cancer

Registry Programme, India

By Prashant Mathur ; Krishnan Sathishkumar ,; 

Meesha Chaturvedi ,; Priyanka Das ,  Kondalli
Lakshminarayana Sudarshan ; Stephen Santhappan 
PURPOSE OF STUDY
The systematic collection of data on cancer is being performed by
various population-based cancer registries (PBCRs) and hospital-
based cancer registries (HBCRs) across India under the National
Cancer Registry Programme.

METHOD OF STUDY
This study examined the cancer incidence, patterns, trends,
projections, and mortality from 28 PBCRs and also the stage at
presentation and type of treatment of patients with cancer from 58
HBCRs (N = 667,666) from the pooled analysis for the composite
period 2012-2016.
RESULTS
Aizawl district (269.4) and Papumpare district (219.8)
had the highest age-adjusted incidence rates among
males and females, respectively

The projected number of patients with cancer in India is

1,392,179 for the year 2020, and the common 5 leading
sites are breast, lung, mouth, cervix uteri, and tongue.
 SUMMARY

1.Epidemiology
2.Risk factors
3.Warning signs
4.Pathophysiology
5.Staging
6.Diagnostic measures
7.Treatment
8.Nursing management
9.Rehabilitation
10.Preventive aspects
 CONCLUSION

With the increasing burden and deaths due to this

disease, it is the responsibility of nurses to educate
people about risk factors of oral cavity cancer and
prevent the occurrence of this disease as “ prevention
is better than cure.
 REFERENCES

1.http://en.wikipedia.org/wiki/Head_and_neck_cancer

2.Otto E Shirley, Oncology Nursing, 4th Edition, Page no.618-

662

3.www.cancer.gov.com

4.http://cancerstaging.blogspot.com/2005/02/head-and-neck-
tumours.html
THANK YOU