Name
ORAL CANCER
DESCRIPTION
DETAIL
CAUSES β’ Tobacco use (smokeless or smoked) β’ Use of snuff β’ Excess alcohol consumption β’ Exposure to ultraviolet light in the instances of lip carcinoma β’ Riboflavin or iron deficiency anemia, and Plummer-Vinson syndrome associated with oral cancers β’ Betel nut or leaf chewing -------------------------------------------------------------------------- DIFFERENTIAL DIAGNOSIS β’ Exudative tonsillitis (usually bilateral involvement) β’ Stomatitis or glossitis secondary to infectious etiology, most commonly candidiasis β’ Benign tumors of the oral cavity (slow growing and usually not erosive or ulcerative) β’ Kaposi sarcoma β’ Mycosis fungoides β’ Premalignant lesions such as leukoplakia or erythroplasia β’ Lichen planus* Liver function test - to rule out metastasis to the liver * CT OR MRI HEAD & NECK AREA TO SEE LOCAL SPREAD β’ Chest x-ray to rule out metastasis to the lungs β’ Imaging bone scans if there is pain in the bones suggesting bone metastasis β’ CT or MRI scan if clinical suggestion of intracranial or liver metastasis DIAGNOSTIC PROCEDURES Transoral biopsy as an outpatient makes the defi nitive diagnosis
TYPENOTES
GENERAL MEASURES β’ Unresectable lesions usually are treated with radiation therapy and/or chemotherapy for palliation β’ Nutrition is of prime importance for normal wound healing should patient require surgery. Patients may need nasogastric and/or gastrostomy feedings if orally disabled. SURGICAL MEASURES β’ Wide resection with or without radiation therapy and/or chemotherapy is the treatment of choice β’ Tracheotomy may be necessary if the patient has problems handling secretions or difficulty breathing ACTIVITY As tolerated by patientβs nutritional and physical status DIET β’ Depends on the extent of disease and whether the patient is able to chew or swallow β’ Usually early lesions can be managed with a regular diet. As disease progresses, a soft diet is necessary. DRUG(S) OF CHOICE Narcotics for pain relief PATIENT MONITORING Routine periodic head and neck exams to detect possible second primary or recurrence in the upper respiratory and digestive tract PREVENTION/AVOIDANCE β’ Avoidance of smoking or the use of smokeless tobacco β’ Avoid alcohol use POSSIBLE COMPLICATIONS β’ Functional and/or cosmetic disabilities proportional to the degree of surgery and stage of tumor β’ Stomatitis with or without candidiasis secondary to radiation therapy or chemotherapy β’ Persistent dysphagia secondary to surgery or radiation therapy β’ Persistent problems with articulation or deglutition depending on the amount of tongue resection EXPECTED COURSE/PROGNOSIS Early lesions with adequate treatment leads to a greater than 80% cure
RELATED DISEASE
Not Available Disease
DISEASE
INVESTIGATION
FNAC, CT SCAN HEAD, COMPLETE BLOOD COUNT, CT SCAN THORAX, MRI, CT SCAN, BIOPSY