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L CANCER
Oropharyngeal cancer is a disease in which
cancer cells are found within the anatomical
borders of the oropharynx.
Sometimes this is called throat cancer
The majority of oropharyngeal cancers are
squamous cell carcinomas.
Several types of cancers
can start in the mouth or
throat .
A. Squamous Cell Carcinomas
flat, scale-like cells that normally form the lining of the mouth
and throat
B. Verrucous Carcinoma
makes up less than 5% of all oral cavity tumors. It is a low-
grade cancer that rarely spreads to other parts of the body
but can deeply spread into surrounding tissue.
C. Minor Salivary Gland Carcinomas
Minor salivary gland cancers can develop in the glands that
are found throughout the lining of the mouth and throat
D. Lymphomas
tonsils and base of the tongue contain immune system
(lymphoid) tissue that can develop into a cancer
Symptoms of Oropharyngeal
Cancer :
A sore throat that persists
Pain or difficulty with swallowing
Unexplained weight loss
Voice changes
Ear pain
A lump in the back of the throat or mouth
A lump in the neck
Risk factors for Oropharyngeal
Cancer :
Use of alcohol
Use of tobacco
Being infected with the human papilloma virus
(HPV), especially HPV-type-16 (HPV-16)
Stages of Oropharyngeal Cancer :
Stage I
The cancer is 2 centimeters or smaller and has not spread
outside the oropharynx.
Stage II
The cancer is larger than 2 centimeters, but not larger
than 4 centimeters and has not spread outside the
oropharynx.
Stage III
In this stage, cancer is larger than 4 centimeters and has
not spread outside the oropharynx. An alternate form of
this stage is that cancer is any size and has spread to
only one lymph node on the same side of the neck as the
cancer. The lymph node that contains cancer is 3
centimeters or smaller.
Stage IV
This stage contains the sub-stages of IVA, IVB and IVC.
Stage IVA
In Stage IVA, one of the following is the case:
The cancer has spread to tissues near the oropharynx, including the voice
box, roof of the mouth, jaw, muscle of the tongue, or central muscles of the
jaw. The cancer might have spread to one or more nearby lymph nodes,
which are still not larger than 6 centimeters.
The cancer is any size, is only in the oropharynx, and has spread to one
lymph node that is larger than 3 centimeters but no larger than 6
centimeters, or to more than one lymph node, none larger than 6
centimeters.
Stage IVB
In Stage IVB, one of the following is true:
The cancer appears in a lymph node that is larger than 6 centimeters and
might have spread to other tissues around the oropharynx.
The cancer surrounds the main artery in the neck or has spread to bones in
the jaw or skull, to muscle in the side of the jaw, or to the upper part of the
throat behind the nose. The cancer might have spread to nearby lymph
nodes.
Stage IVC
In Stage IVC, the cancer has spread to other parts of the body. The tumor
might be any size and might have spread to lymph nodes.
Treatment by stage:
Stage I - Treatment might be radiation therapy or surgery.
Stage II - Treatment involves surgery to remove the cancer or
radiation therapy.
Stage III - Treatment for this stage of oropharyngeal cancer might
include surgery to remove the cancer, followed by radiation therapy.
Other treatments might include:
Radiation therapy alone
A clinical trial of chemotherapy that is followed by surgery or
radiation therapy
A clinical trial of chemotherapy combined with radiation therapy
A clinical trial of new ways to provide radiation therapy
Stage IV - For cases in which oropharyngeal cancer can be removed
by surgery, treatment might be one of the following:
Surgery to remove the cancer that is followed by radiation therapy
Radiation therapy alone
A clinical trial combining radiation therapy and chemotherapy
A clinical trial of new ways to provide radiation therapy
For cases in which the cancer cannot be removed by
surgery, treatment might include one of the
following:
Radiation therapy
A clinical trial during which chemotherapy is
followed by surgery or radiation therapy
A clinical trial of radiation therapy given with
chemotherapy or radiosensitizers (drugs to make
the cancer cells more sensitive to radiation therapy)
A clinical trial of new ways of giving radiation
therapy
A clinical trial of hyperthermia therapy plus radiation
therapy
Nursing Assessment
Obtain complete history, noting risk factors such as
smoking and alcohol use.
Question the patient regarding changes in
swallowing, smell or taste, salivation, discomfort
when eating, sore throat, foul breath odor.
Note the quality of voice patterns and odor of breath.
Inspect the oral cavity: erythema, red velvety areas;
white patches; bleeding; swelling; record the size,
location, and description.
Palpate the cervical lymph nodes for size, firmness,
or tenderness.
Nursing Diagnoses:
Pain related to malignant infiltration,
lesion(s), difficulty swallowing, surgery,
radiation therapy
Altered Nutrition: Less Requirements
related to pain, difficulty in chewing or
swallowing, history of Alcohol abuse.
Body Image Disturbance related to
changes in facial contour, cosmetic defect
from surgery.
Nursing Interventions:
A. Achieving an Acceptable Level of Comfort
1. Provide systemic analgesics or analgesics gargles as prescribed.
2. If the patient can tolerate it, provide mouth care with soft toothbrush and
flossing between teeth.
3. If patient cannot tolerate brushing and flossing:
a. Gently lavage oral cavity with a catheter inserted between the patient’s cheek
and gums with warm water and mouthwash.
b.Use power water spray to clean inaccessible areas if patient’s comfort
allows.
4. Encourage use of mouthwashes that do not contain alcohol, which may
irritate the gums.
5. Provide management of decreased salivation, if necessary.
a. Insert a gauze wick in corner of mouth; place basin conveniently to catch
drooling; replace frequently to absorb and direct excess saliva.
b. Suction secretions with a soft rubber catheter as needed; instruct patient on
suctioning methods.
6. Provide management of decreased salivation, if necessary
a. Encourage intake of fluids, if not contraindicated.
b. Instruct the patient to avoid dry, bulky, and irritating food
c. Offer lemon lozenges or chewing gum to stimulate salivation.
B. Improving Nutritional status
A. Handle feeding problems in one or a combination of the
following ways, as ordered: Intravenously, Nasogastric Tube
Feedings or gastrostomy tube feedings, Orally
B. Provide mouth care before and after eating
C. Allow the patient to have meals in privacy, if desired.
D. Offer easily chewed foods, mash or blenderize, if necessary.
C. Strengthening Body Image
1. Allow verbalization of fears, anger and distaste with
body changes in a non defensive manner.
2. Communicate acceptance of appearance in an
honest manner.
3. Encourage the family and friends to visit so patient is
aware that others care about him or her.
4. Provide diversional activities.
LARYNGEAL CANCER
Indirect laryngoscopy
Physical exam
Direct laryngoscopy
CT scan
Biopsy
Treatment
Radiation therapy
Surgery
Chemotherapy
STOMACH CANCER
Surgery
Radiation therapy (also called
radiotherapy)
Chemotherapy
Drug therapy
Clinical trials
BREAST CANCER
Cancers occur when abnormal cells grow in
an uncontrolled way. Almost all breast cancers
occur in women - very few occur in men.
The cancer usually begins as a small lump in
a breast and then grows, either slowly or
quickly.
It can also spread to other parts of the body
after a period of time. Early diagnosis is the
key to survival.
Anatomy
The female breast consists of a core made
up of lobules (milk glands) and ducts. This core
is surrounded by a layer of fat, and overlying this
is skin. Milk is produced on the lobules or milk
glands and collects in small ducts called terminal
ducts. These terminal duct join together to form
larger ducts, which drain, via the nipple.
Each female breast has about 12 to 15 breast
lobules. This understanding of breast anatomy is
important because breast lump including cancer
develop mostly within the milk ducts and glands.
Risk Factors
Age
Personal history of Breast cancer
Family history
Certain breast changes
Gene changes (BRCA1, BRCA2)
Reproductive and menstrual history
Race
Radiation therapy to the chest
Breast density
Taking DES (diethylstilbestrol)
Being overweight or obese after menopause
Lack of physical activity
Drinking alcohol
Clinical Manifestations
Common symptoms of breast cancer include:
Dietary Factors
Smokers who eat a diet low in fruits and vegetables have an
increased brisk of developing lung cancer. the actual active agents in
a diet rich in fruits and vegetables
Have yet to be determined. It has been hypothesized that carotenoids,
particularly
Carotene or vitamin A may be important. Several ongoing trials may
help determine whether carotene supplementation has anticancer
properties. Other nutrients, including vitamin E, selenium, vitamin C
fat, and retinoids are alsobeing evaluated regarding their protective
role against lung cancer.
CLINICAL
MANIFESTATIONS
Often lung cancer develops insidiously and is asymptomatic until late in its
course. the signs and symptoms depend on the location and size of the
tumor, the degree of obstruction, and the existence of metastases to regional
or distant sites. The most frequent symptom of lung cancer is cough, without
sputum production. When obstruction of airways occurs, the cough may
become productive due to infection. Dyspnea occurs in 35% to 50% of
patients (Baldwin, 2003). Hemoptysis or blood tinged sputum may be
expectorated. Chest or shoulder pain may indicate
Chest wall or pleural involvement by a tumor. Pain also is a late manifestation
and may be related to metastasis to the bone. In some patient, a recurring
fever is an early symptom in response to a persistent infection in an area of
pneumonitis distal to the tumor. In fact,cancer of the lung should be
suspected in people with repeated unresolved upper respiratory tract
infections.if the tumor spreads to adjacent structures and regional lymph
nodes,the patient may present with chest pain and tightness,
hoarseness(involving the recurrent laryngeal nerve).dysphagia, head and
neck edema, and symptoms of pleural or pericardial effusion. The most
common sites of metastases are lymph nodes, bone, brain,contralateral lung,
adrenal glands,and liver.Nonspecific symptoms of weakness,anorexia,and
weight loss also may be present.
Assessment and
Diagnostic Findings
If pulmonary symptoms occur in heavy smokers, cancer
of the lung should always be considered chest x-ray is
performed to search for pulmonary density, a solitary
pulmonary nodule (coin lesion), atelectasis, and infection.
CT scans of the chest are used x-ray and also to serially
examine areas for lymphadenopathy.sputum cytology is
rarely used to make a diagnosis of lung cancer.Fiberoptic
bronchoscopy is more commonly used; it provides a
detailed study of the tracheobronchial tree and allow for
brushings, washings, and amenable to bronchoscopic
biopsy, a transthoracic fine- needle aspiration may be
performed under CT guidance to aspirate cells from a
suspicious area. In some circumstances, an endoscopy
with esophageal ultrasound may be used to obtain a
transesophageal biopsy of enlarged subcarinal lymph
nodes that are not easily accessible by others means.
Medical Management
The objective of management is to provide a
cure, if possible. Treatment depends on the cell
type, the stage of the disease, and the patient’s
physiologic status (particularly cardiac and
pulmonary status).In general,treatment m may
involve surgery,radiation therapy, or
chemotherapy—or a combination of
these.Newer and more specific therapies to
modulate the immune system(gene therapy,
therapy wiyh defined tumor antigens) are under
study and show promise.
Surgical Management
Surgical resection is the preferred method of treating
patients with localized non-small cell tumors, no evidence of
metastatic spread, and adequate cardiopulmonary function.
If the patient’s cardiovascular status are safisfactory,
surgery is generally well tolerated. However, coronary artery
disease, pulmonary insufficiency, and other comorbidities
may contraindicate surgical intervention. The cure rate of
surgical resection depends on the type and stage of the
cancer surgery is primarily used for NSCLCs, because
small cell cancer of the lung grow rapidly and metastasizes
early and extensively. Lesons of many patients with
bronchogenic cancer are inoperable at the of diagnosis.