ORAL CANCER AND INPATIENT CARE

By : DR.HINA ADNAN

ORAL CANCER

Oral cancer or mouth cancer,a type of head and neck cancer, is any cancerous tissue growth located in the oral cavity

TYPES OF ORAL CANCER

There are several types of oral cancers, but around 90% are squamous cell carcinomas, originating in the tissues that line the mouth and lips. Oral or mouth cancer most commonly involves the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth). Most oral cancers look very similar under the microscope and are called squamous cell carcinoma, but less commonly other types of oral cancer occur, such as Kaposi's sarcoma

Signs and symptoms

Skin lesion, lump, or ulcer that do not resolve in 14 days located:

On the tongue, lip, or other mouth areas Usually small Most often pale colored, may be dark or

discolored

Early sign may be a white patch (leukoplakia) or a red patch (erythroplakia) on the soft tissues of the mouth

Usually painless initially May develop a burning sensation or pain

when the tumor is advanced Behind the wisdom tooth Even behind the ear

Additional symptoms that may be associated with this disease:

Tongue problems (moving it) Swallowing difficulty Mouth sores Pain and paraesthesia are late symptoms.

Causes

75 percent of oral cancers are linked to modifiable behaviors such as tobacco use and excessive alcohol consumption. Other factors include poor oral hygiene, irritation caused by ill-fitting dentures and other rough surfaces on the teeth, poor nutrition, and some chronic infections caused by bacteria or viruses. If oral cancer is diagnosed in its earliest stages, treatment is generally very effective

In many Asian cultures chewing betel, paan and Areca is known to be a strong risk factor for developing oral cancer

Diagnosis

An examination of the mouth by the health care provider or dentist shows a visible and/or palpable (can be felt) lesion of the lip, tongue, or other mouth area. The lateral/ventral sides of the tongue are the most common sites for intraoral SCC. As the tumor enlarges, it may become an ulcer and bleed. Speech/talking difficulties, chewing problems, or swallowing difficulties may develop. A feeding tube is often necessary to maintain adequate nutrition. This can sometimes become permanent as eating difficulties can include the inability to swallow even a sip of water. The doctor can order some special investigations which may include a chest x-ray, CT or MRI scans, and tissue biopsy.

Management

Maxillectomy (can be done with or without orbital exenteration)

Mandibulectomy (removal of the mandible or lower jaw or part of it)

Glossectomy (tongue removal, can be total, hemi or partial)

Radical neck dissection Combinational e.g. glossectomy and

laryngectomy done together. Feeding tube to sustain nutrition.

AFTER SURGERY CARE

Following treatment, rehabilitation may be necessary to improve movement, chewing, swallowing, and speech. Speech and language pathologists may be involved at this stage