Chapter 41: Oral Cancer

Question 1

Name 2 types of oral cancer and what they are

Answer 1

1. Oral cavity cancer: starts in the mouth
2. Oropharyngeal cancer: develops in the part of the throat just behind the mouth (the oropharynx).

Question 2

List predisposing factors to head and neck cancer. (Think of head and neck cancer risk factors) (9)

Answer 2

Male
Over 35, average 65
Black
Alcohol
Tobacco
HPV
Outdoor occupation
Sun exposure
Pipe Smoke

Question 3

Contrast leukoplakia and erythroplakia. (3)

Answer 3

*(both part of the clinical manifestations of head and neck cancer)

*Leukoplakia: white patch on the mouth mucosa or tongue. Precancerous lesion d/t smoking, becomes hyperkeratosis (leathery and hard…ew)

*Erythroplakia: A red velvety patch that develops on the tongue or mucosa. Precancerous lesions often progress to squamous cell cancer.

Question 4

Identify clinical manifestations of oral cancer. (13, name 7)

Answer 4

1. Leukoplakia
2. Erythroplakia
   indurated, painless ulcer on the lips
3. Ulceration of the mouth
4. Sore spots
5. Dysphagia
6. Lump or thickening in the cheek
7. Sore throat or feels like something is stuck in your throat
8. Difficulty doing all the things (chewing, speaking, moving your tongue)
9. Thickened, ulcerated tongue
10. Increased salivation
11. Slurred speech
12. Toothache
13. Ear ache

Question 5

Describe the toluidine blue screening test for oral cancer. (5)

Answer 5

*Screening for oral cancer
1. Topical stain applied to area
2. Cancer cells would take up the dye
*Negative cytologic smear does not rule out oral cancel
*Once dxed, other scans (PET, MRI, CT) are used for staging the cancer

Question 6

Describe various surgical procedures used for oral cancer. (Minimal vs Radical (5))

Answer 6

1. Either minimally invasive (Robotic) or radical
2. Radical:
   a. Partial mandibulectomy: removal of the mandible
   b. Hemiglossectomy: removal of half the tongue
   c. Glossectomy: removal of the tongue
   d. Resection of buccal mucosa and floor of mouth: aptly named
   e. Radical neck dissection: removing everything (tissue, muscle, nerves, nodes, etc) from mandible to clavicle

Question 7

Review the use of radiation in combination with surgical interventions to treat oral cancer. (3)

Answer 7

1. Rad may be used alone with small cancers ir when lesions cannot be removed surgically
2. Pts usually don’t have Rad before surgery (harder to remove radiated tissue)
3. Most pts begin Rad about 6wks post surgery

Question 8

Review the use of Chemo in combination with surgical interventions to treat oral cancer. (2)

Answer 8

*Can shrink lesions before surgery, decrease metastasis, sensitize cancer cells to radiation, or treat distant metastases.
*Common chemo combo (love the alliteration): cisplatin and fluorouracil (idk if we need to know that but…why not)

Question 9

Identify nutritional interventions in case a patient is unable to take in food by mouth. (4)

Answer 9

1. May need EN or PEG before surgery or radiation
2. PN given the first 24-48hrs post radical neck surgery
3. After that timeframe, EN is given via NG, gastrostomy, or jejunostomy.
4. Assess pt for feeding intolerance and adjust amount, time, and formula as needed to avoid n/v, diarrhea, or distention.

Question 10

Cite 4 overall goals & expected outcomes for patients with cancer of the oral cavity.

Answer 10

1. Patent airway -> have no resp complications
2. Able to communicate -> be able to communicate
3. Adequate nutrition for wound healing -> maintain adequate nutritional intake to promote good wound healing
4. Relief of pain and discomfort -> have minimal pain and discomfort with eating, drinking, and talking