3/1/2011

Overview of Oral Cancer

Squamous cell carcinoma

ORAL & SKIN CANCER

Presented by Jay Wolf and Christine Britt

Cancers of the oral cavity. Commonly include: lips, floor of the mouth, buccal mucosa, tongue, hard and soft palate, and gingiva. Risk factors for developing oral cancer include: tobacco use, alcohol use, and excessive sun exposure. Clients need to know the difference between mutable and nonmutable risk factors. Squamous Cell carcinoma, which originates in the cells that make up the lining of the nose, throat, and mouth, is the most common form of head and neck cancer.

Common Skin Cancer Lesions

Actinic Cheilitis is a dry, thickening of the border of the lip. The lip may become flaky and indurated and develop into squamous cell carcinoma. It is often painless, and most common in older males that experience long term sun exposure. Solar Keratosis is a precancerous growth on the skin that is caused by sun exposure. Commonly begins as a flat, dry area, and later develops into a hard, rough, wart-like spot. Prevent skin cancers by avoiding mid day sunlight, long sleeve clothing & hats, sun block, and sun glasses, and self screening.

Overview Continued
Systematic professional and self examination is vital in catching early cancer from metastasizing into deeper tissue- particularly in high risk patients. Head and neck radiation, surgery, surgery and chemotherapy are the most common treatment and control options. Such treatments have great influences on the oral cavity, causing the role of the dental hygienist to be a crucial component in this patients life.

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Causes/Risk Factors
Tobacco and Alcohol use, especially in combination Sunlight Long Exposure Environmental Occupational Viruses: Burketts, Hep. C, Human Papillomavirus (HPV) Socioeconomic: Poor health care = late diagnosis = poor prognosis.

Signs and Symptoms

White and red patches in the mouth or lips A sore or blister in your mouth Difficulty swallowing Earaches Change in the way teeth fit together Bleeding in the mouth Any lesion that doesnt heal after 2 weeks

Risk Factors for Skin Cancer

Fair skin and skin sensitivityeasily burns Age-skin loses elasticityprotectiveness Geographic location-hotter climates li t Weak immune system-dont fight off disease as well Tanning Beds-2.5 xs more likely to develop SCC. 1.5xs more likely to develop BCC

ABCs of skin lesions

A- asymmetry. Assessed by comparing one half of the mole to the other to see if they are equal in size. B-border. If the border is irregular, notched, scalloped, or indistinct it is more likely to be precancerous. C-color. Variations of color within the mole are concerning along with colors of blues, reds, browns, and blacks. bl d b d bl k D-diameter. Any mole larger than the size of a pencil eraser (6 mm) is considered suspicious. E-elevation. Any mole that is raised is considered suspicious. Basically any mole that is CHANGING should be checked out!

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What to look for during your EOIOE

Closely examine the floor of the mouth, lower lip, soft palate, and surrounding mucous membranes White/Red Areas Ulcers/Masses Pigmentation All types should be looked at with suspicion. Any lesion not healed in 2 weeks should be considered malignant and should be biopsied.

Documentation of Lesions
Lesion: shape, size, color, consistency, and location should be recorded Question the patient about the lesion: How long h i b l has it been there? h ? Has it undergone any changes? Is there any bleeding associated with the lesion?

Drugs Commonly Prescribed

Types of agents used for chemotherapy include: alkylating agents antibiotics anti metabolites plant alkaloids(vincristine,vinbl astine,etoposide) steroid/hormones

Drugs Continued
Radiation: External beam: radiation that is applied outside the body b d Internal: The source (such as implants or seeds) of the radiation is placed inside the body.

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Oral Cancer Treatment Planning

Rehabilitation is an essential part to the cancer care treatment plan. Includes several medical professionals. Schedule treatment in consultation with the oncologist if necessary. As dental hygienists, we serve to provide the prophylaxis and oral hygiene instruction.

Oral Hygiene Instruction

Patients should remove biofilm daily by gentle brushing teeth with extra soft bristles and fluoride toothpaste after every meal and b f d before bed. b d Floss gently and thoroughly every day. Swish with mixture of baking soda, salt, and lukewarm water every 2-3 hours while awake.

Our Goals
Prevent demineralization and caries, dry mouth. Provide tobacco or alcohol cessation if necessary. Be cautious of any oral lesions and sensitivity. Be encouraging to the patient. Provide positive reinforcement and be creative. Show acceptance. Stress daily biofilm removal, mouth rinsing/xerostomia.

Oral Hygiene Instruction

Maintaining good oral health throughout the continuum of treatment is vital. Patients undergoing radiation or chemotherapy must use an at home fluoride tray regimen. regimen Patients should avoid products containing alcohol, astringent, oils, and antiseptics. Hot, spicy, and hard foods should also be avoided to prevent irritation.

Considerations/Modifications
Radiation Therapy Prevention and palliative care for oral infections and ulcerations Short appointments and frequent active follow up Potential bleeding problem Prompt treatment of dental related infections Evaluate need for antibiotic premedication

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Treatment After Cancer Therapy

For the first 6 months after cancer treatment, recall patient for NSPT every 4 to 8 weeks or as needed needed. Reinforce importance of daily personal oral hygiene.

Biopsy
Exfolative cytology Cells are scraped off and prepared on a slide for mailing. No longer recommended in dentistry and dental hygiene Brush Biopsy - transepithelial oral biopsy Vixilite - FDA approved-client rinses and hygienist examines with light stick.

Lesion Test Report Categories

Class I.-Normal Class II.-Atypical cell changes-few-no malignancy Class III.-Intermediate-malignancy suggested-unclear Class IV.-Suggestive of cancer-malignant characteristics present in cells Class V.-Positive for cancer-malignant cells Unsatisfactory-specimen not adequate for dx. CLASS III, IV, or V the patient should be referred for biopsy*

Oral Neck and Cancer Screening Week

Jeanna Richelson-oral cancer survivor-started the oral cancer walk in Chattanooga. Her cancer was first diagnosed because of a swollen lymph node in her neck. After the removal of both lymph nodes and tonsils it then moved to the base of her tongue and after that the thyroid. After several radiation and chemotherapy treatments she has been cancer free for four years. We can be the ones to identify early signs of cancer in the EOIOE. We can make a difference. We can save and improve lives. Lets do it This year the walk is April 23rd www.oralcancerfoundation.org

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References
Terracciana-Mortillla, Lynn D. (2010) 8 Keys to Implant Maintenance Dimensions of Dental Hygiene, 8 (9), 66-69. Darby, Michele Leonardi. (Ed.). (2006). Mosbys Comprehensive Review of Dental Hygiene (6th edition). St. Louis, Missouri: Mosby Elesvier, Book Aid International, Sabre Foundation. Wilkins, Esther M. (Ed.). (2009). Clinical Practice of the Dental Hygienist (10th Edition). Baltimore, MD, Philedelphia, PA: Lippincott Williams and Wilkins, a Wolters Kluwer business.

"What You Need to Know About Oral Cancer". Cancer Topics. National Cancer Society: What You Need to Know About Oral Cancer. 09 Sptember 2004. Accessed 14 July 2008. http://www.cancer.gov/cancertopics/wyntk/oral/page9

http://oralcancerfoundation.org/

http://www.jaapa.com/oral-cancer-how-to-find-this-hidden-killer-in-2-minutes/article/130902/

http://www.omnimedicalsearch.com/conditions-diseases/actinic-keratosis.html http://www.tanninginfocenter.com/tanning-beds-and-skin-cancer.html http://www.google.com/images?q=melanoma&rls=com.microsoft:en-us:IE-SearchBox&oe=UTF-8&rlz=1I7ADRA_en&um=1&ie=UTF8&source=og&sa=N&hl=en&tab=wi&biw=1003&bih=516 http://www.oralcancerfoundation.org/presskit/pr/Hundreds-Chattanooga-Awareness-2010.pdf