Oral Cancer

Oral cancer is cancer that forms within the tissues of a person’s mouth or throat, and it can be fatal if not treated early. According to recent estimates by the American Cancer Society, over 58,000 new cases of oral cancer were reported this year, with over 12,200 deaths caused by this dangerous disease. Fortunately, identifying the cancer early on and starting treatment immediately can increase the chances of survival for patients suffering from oral cancer.

Any kind of cancer can be devastating news for patients and their families. As a nurse, learning about various diseases patients might have is a critical requirement. Besides helping you understand more about improving the quality of care you can provide; the knowledge helps you in educating patients and their families. The more they know about the disease, the better they care able to make informed healthcare decisions.

In this Fast CE For Less guide, we will cover the essential facts you must understand about oral cancer. From an overview of what it is, the symptoms, the risk factors of oral cancer, diagnosis, and treatment, we will cover what you must know to improve your ability to care for and provide education to patients and their families.

What Are the Symptoms of Oral Cancer?

Oral cancer typically forms in the throat or mouth, occurring in the tongue, the floor of the mouth, the gums, the inner cheek lining, or the lips. Dentists are typically the first healthcare providers who can initially identify whether a person has cancer, and that is why it is important to recommend your patients go for dental checkups at least twice a year.

Oral cancer can present with various symptoms, which a regular person can often confuse for less serious conditions and ignore.

Common Symptoms

One of the most common symptoms of oral cancer is the presence of a sore or ulcer in the mouth that does not heal within a few weeks. These sores can be painful, but sometimes, they may not cause any pain at all. Another common symptom is the development of lumps or thickened areas in the mouth or neck.

Difficulty Swallowing and Speaking

Patients with oral cancer may experience difficulty swallowing (dysphagia) or a sensation that something is stuck in their throat. Changes in speech, such as slurred words or hoarseness, can also be a sign of oral cancer, especially if these changes persist for more than a couple of weeks.

Other Symptoms

Other possible symptoms include unexplained bleeding in the mouth, persistent bad breath, loose teeth, and unexplained weight loss. It is important to note that other, less serious conditions can also cause these symptoms. However, if any of these symptoms persist, seeking medical advice for further investigation is essential.

A dentist is the healthcare professional best suited to determine whether any of these symptoms are the result of cancerous development in the mouth. During routine checkups, they look for these signs while checking the overall dental health of their patients.

 Risk Factors that Contribute to Oral Cancer

While cancer can occur due to genetic factors when a person has a family history, oral cancer has several other risk factors. Most people know that using tobacco is a leading cause of oral cancer. Cigarettes, chewing tobacco, and cigars, are all forms of tobacco, and the use of tobacco is undoubtedly considered the biggest risk factor leading to oral cancer. People who also consume large amounts of alcohol are considered to be at a greater risk of developing cancer, especially if they use both tobacco and alcohol regularly. It is also important to note that statistically, men are twice as likely to develop oral cancer compared to women.

In addition to genetics and lifestyle habits like alcohol consumption and smoking, there are several other modifiable and nonmodifiable risk factors believed to increase the chances of developing oral cancer, including:

• Weak immune system
• Infections like HPV
• Constant exposure to the sun
• Poor nutrition
• Family history
• Genetic syndromes

If you see a patient exhibiting possible signs of oral cancer, asking them about these risk factors can help you determine whether the signs are indeed indicating cancer. Educating patients on these risk factors, especially those regarding lifestyle, can help them implement changes to decrease the risk. Additionally, those with nonmodifiable risk factors should have regular screenings to detect the disease.

Diagnosis of Oral Cancer

Diagnosing oral cancer involves several steps, including examination and advanced imaging tests. Early and accurate diagnosis is crucial for effective treatment and better patient outcomes.

Initial Clinical Examination

The first step in diagnosing oral cancer is a thorough clinical examination by a healthcare professional. This includes checking for any unusual sores, lumps, or patches in the mouth. During this exam, the healthcare provider or dentist will look for signs that may indicate cancer, such as persistent ulcers, white or red patches (leukoplakia or erythroplakia), and unexplained bleeding. They may also feel the neck and jaw area for any swollen lymph nodes.

Biopsy Procedures

If an area of concern is found, a biopsy will be performed to confirm the diagnosis. There are different types of biopsies:

• Incisional biopsy: A small part of the suspicious tissue is removed for examination.
• Excisional biopsy: The entire suspicious area or lump is removed.
• Fine needle aspiration: A thin needle is used to remove a sample of cells from a lump or mass.

The tissue sample is then examined under a microscope by a pathologist to check for cancer cells.

Imaging Tests

Imaging tests are used to determine the extent of the cancer and whether it has spread to other parts of the body. These tests include:

• X-rays: Used to see if cancer has spread to the jaw or chest.
• MRI: Offers high-resolution images of soft tissues, helping to detect cancer spread to nearby structures.
• PET Scans: Detects cancerous cells by measuring their glucose uptake, useful in finding metastasis.
• CT Scans: Provides detailed cross-sectional images of the body to identify the size and location of the tumor.

These diagnostic tools help cancer specialists create an effective treatment plan tailored to the patient’s condition that you can implement to maximize the chances of a favorable health outcome.

Stages of Oral Cancer

Understanding the stages of oral cancer is essential for determining the prognosis and treatment plan. The TNM staging system is commonly used, considering the tumor’s size, lymph node involvement, and metastasis’s presence.

Stage I

• Tumor size: Less than 2 cm
• Lymph nodes: No spread to lymph nodes
• Metastasis: No distant metastasis

Stage II

• Tumor size: Between 2 and 4 cm
• Lymph nodes: No spread to lymph nodes
• Metastasis: No distant metastasis

Stage III

• Tumor size: Larger than 4 cm or any size if it has spread to one lymph node on the same side of the neck
• Lymph nodes: Involvement of one lymph node
• Metastasis: No distant metastasis

Stage IV

• Tumor size: Any size with extensive spread to local structures
• Lymph nodes: May involve one or more lymph nodes on one or both sides of the neck
• Metastasis: May have distant metastasis

Knowing the cancer stage can help nurses, doctors, and patients understand the severity of the cancer and the likely outcomes, which is crucial for planning the best possible treatment approach.

Treatments for Oral Cancer

Treating oral cancer involves a multidisciplinary approach, including surgery, radiation therapy, and chemotherapy. The choice of treatment depends on the stage and location of the cancer, as well as the patient’s overall health.

Surgery

Surgery is often the first line of treatment for oral cancer. Depending on the tumor’s size and location, different surgical procedures may be performed:

• Tumor resection: Removing the tumor and some surrounding healthy tissue to ensure no cancer cells remain.
• Mandibulectomy: Removing part or all of the jawbone if the cancer has spread there.
• Glossectomy: Removing part or all of the tongue in severe cases.

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. It is often used after surgery to destroy any remaining cancer cells or as the primary treatment if surgery is not an option. Techniques include:

• External beam radiation: Directs radiation from outside the body to the cancer site.
• Brachytherapy: Places radioactive seeds close to or inside the tumor.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It can be administered orally or intravenously and is often used in combination with radiation therapy or surgery to enhance the treatment’s effectiveness. Common drugs include cisplatin, fluorouracil, and carboplatin.

These treatments aim to eliminate cancer, prevent its spread, and preserve as much function and appearance as possible, ensuring the best possible quality of life for the patient.

The outcome and prognosis for oral cancer depend largely on how early the cancer is detected and treated. Early-stage oral cancers generally have a better prognosis and higher survival rates. Factors such as the tumor’s size, location, and whether the cancer has spread also play a crucial role in determining the patient’s outcome. Regular follow-up care is essential for monitoring recovery and detecting any recurrence.

As a nurse, you are on the front line of patient care and education. Helping patients and their families understand their diagnosis, treatment options, and the importance of follow-up care can be crucial in improving outcomes.

If you have not completed your nursing continuing education requirements to renew your license and want to learn more, online nursing CEUs offered by Fast CE For Less can help.

To access flexible and affordable nursing continuing education courses and state bundles, visit www.fastceforless.com.