ORAL CANCER 1 P a g e ORAL CANCER P 968 971 Types of Cancer Oral cavity cancer Oropharyngeal cancer Head and neck squamous cell carcinoma Etiology and Pathophysiology Definitive cause unknown Predisposing factors Tobacco use 7 to times higher risk of developing oral cancer Excess alcohol intake 75 80 o o o Diet low in fruits and veggies o Chronic irritation from jagged tooth or poor oral care o Outdoor occupations o HPV 30 40 multiple sex partners Signs and Symptoms Leukoplakia smoker s patch precancerous lesions Erythroplakia Ulcerations Sore that bleeds easily and does not heal Rough area Chronic sore throat Sore mouth Voice changes First Signs of Carcinoma Ulcer Area of thickening Soreness or pain of tongue Cancerous lesions on half of tongue Later Signs of Carcinoma Increased salivation Slurred speech Dysphagia Toothache Earache 30 asymptomatic neck mass Later Signs and Symptoms Pain Dysphagia Difficulty moving the jaw Diagnostic Tests Oral exfoliative cytology scraping lesion and spreading on slide Toluidine blue test toluidine blue applies to stain area and cancer cells take up dye CT MRI PET Collaborative Care Surgical Therapy Depends on location and extent of tumor Mandibulectomy removal of the mandible Hemiglossectomy removal of half of the tongue Glossectory removal of the tongue Resection of buccal mucosa and floor of mouth Radical neck dissection commonly performed ORAL CANCER 2 P a g e Nonsurgical Therapy Chemotherapy and radiation Palliative treatment when prognosis is poor Gastronomy tube Analgesic medication Frequent suctioning of oral cavity Nutritional Therapy PEG placement before surgery Parenteral fluids first 24 48 hours after neck surgery Enteral nutrition via NG gastronomy nasointestinal tube o Observe for tolerance o o Give small amounts of water Adjust the amount time and formula if nausea and vomiting occurs Nursing Assessment Subjective Data Assessment PMH o Recurrent oral herpetic lesions o o Syphilis Exposure to sunlight Medications o Immunosuppressants Surgery or other treatments o Removal of prior tumors or lesions Functional Health Patterns Health perception health management o Use of alcohol o Use of tobacco o o Pipe smoking Poor oral hygiene Nutritional o Reductions in oral treatment o Weight loss o Difficulty in chewing food o o Increased salivation Intolerance to food or temperatures of food Cognitive perceptual Pain Toothache Earache o Mouth or tongue soreness o o o o Neck stiffness o Dysphagia o Difficulty speaking Nursing Assessment Objective Data Integumentary o o Indurated Painless ulcer on lip ORAL CANCER 3 P a g e o Painless neck mass Gastrointestinal Areas of thickening or roughness Leukoplakia Erythroplakia on tongue or oral mucosa Limited movement of tongue Increased salivation o o Ulcers o o o o o Drooling o o Slurred speech Foul breath odor Possible Diagnostic Findings o o Positive exfoliative smear cytology Positive biopsy Nursing Diagnoses Imbalanced nutrition less than body requirements r t oral pain difficulty chewing and swallowing surgical resection and radiation treatment Chronic pain r t tumor surgery and or radiation Anxiety r t diagnosis of cancer uncertain future potential for disfiguring surgery potential for recurrence prognosis Ineffective coping r t body image change Ineffective Health maintenance r t lack of knowledge of disease process and therapeutic regimen and unavailability of support system Nursing Implementation Health Promotion Identify patients at risk tobacco alcohol poor dental care pipe smokers Provide information regarding predisposing factors Inform about smoking cessation programs Teach patient to report unexplained pain or soreness of mouth unusual bleed dysphagia sore throat voice changes etc Acute Intervention Preoperative Care o Consider physical and psychosocial needs o o o o o o Thoroughly assess alcohol intake Physical preparation hygiene Assess alcohol intake Provide explanations and emotional support Explain surgical procedure Ensure patient understands information Keep tracheostomy at bedside Maintain patent airway Maintain fluid electrolyte and nutritional balance Administer TPN Enteral tube feeds Relieve dryness of mouth by frequent saline mouthwashes and ample fluids if client is receiving radiation therapy Consider time and distance in relation to radioactive implants when giving nursing care o Distention