2 Definition of oral cancer: Cancer that forms in tissues of the oral cavity (the mouth) or the oropharynx (the part of the throat at the back of the mouth). Estimated new cases and deaths New cases: 39,400 (oral cavity and pharynx)Deaths: 7,900 (oral cavity and pharynx)
3 PATOFISIOLOGI Karsinoma sel squamosa ulserasi dan nyeri Mestastase awal pada nodus imfatikus servikalisTumor yang terletak pada basis lidah sangat sulit dideteksi
6 10 BESAR CA KEPALA LEHER Oral Cancer Throat Cancer Lip Cancer Tongue CancerSquamous Cell Cancer of the Oral TongueSquamous Cell Cancer of the Base of TongueVoice Box CancerTrue Cord CancerCancer of the Supraglotic LarynxSubglottic Squamous Cell CancerMedical Director
7 Squamous cell carcinoma of the tongue in a 50 year old non-smoker
8 Squamous cell carcinoma of the base of the tongue.
10 ETIOLOGI The exact cause of tongue cancer is unknown Smoking cigarettes, cigars, or a pipeUse of chewing tobacco, snuff, or other tobacco productsHeavy alcohol consumption
11 FAKTOR RESIKO Sex: male Poor oral and dental hygiene Age: 40 and over Irritation of the mucous membranes in the mouth due to smoking and drinkingHistory of mouth ulcersFamily history due to genetic predisposition
13 Percentage of nurses identifying risk factors associated with oral cancer.
14 KELUHAN UTAMA Skin lesion, lump, or ulcer on the tongue Difficulty swallowing /DisfagiaMouth sores and mouth painNumbness or difficulty moving the tongueChange in speech (due to inability to move the tongue over the teeth when speaking)Pain when chewing and speakingBleeding from the tongue
15 Percentage of nurses identifying oral changes associated with oral cancer.
16 Percentage of nurses identifying anatomical sites for identification during examination of the mouth.
17 PEMERIKSAAN FISIK & DIAGNOSIS Examination of your tongue for lumps or massesUse of a fiberoptic scope—a thin tube with a tiny camera to examine the base of the tongueA tongue biopsy —removal of a sample of tongue tissue to test for cancer cellsCT scan —a type of x-ray that uses a computer to make pictures of the mouthChest x-ray to determine if the cancer has spread to the lungs
18 TREATMENTTreatment depends on the stage of the cancer, as well as the size and location of the tumor.Surgery This is surgical removal of the cancerous tumor and nearby tissue, and possibly nearby lymph nodes. This is often the preferred treatment when the tumor is on the visible side of the tongue, when it is quite small (less than 2 cm), and when it is lateralized to one side and does not involve the base of the tongue.Radiation Therapy (or Radiotherapy) This is the use of radiation to kill cancer cells and shrink tumors. This method is used when the cancer is at the back of the tongue.Chemotherapy Chemotherapy is sometimes used with radiation to destroy the cancerous growth, especially if surgery is not planned.
19 Rehabilitation and Follow-Up Therapy to improve tongue movement, chewing, and swallowingSpeech therapy, if use of the tongue is affectedClose monitoring of your mouth, throat, esophagus, and lungs to see if the cancer has come back or spread
20 HEALTH EDUCATION Don't smoke or use tobacco products. Avoid heavy alcohol consumption.See doctor regularly for check-ups and cancer screening exams.
22 Diagnosa KeperawatanRisk for ineffective airway clearance, related to oral surgeryRisk for imbalanced nutrition: Less than body requirements, related to oral surgeryImpaired verbal communication, related to excision of a portion of the tongueDisturbed body image, related to surgical excision of the tongue
23 KRITERIA HASILMaintain a patent airway and remain free of respiratory distress.Maintain a stable weight and level of hydration.Effectively communicate with staff and family using a magic slate and flash cards.Communicate an increased ability to accept changes in body image.
24 PLANNING AND IMPLEMENTATION Assess airway patency and respiratory status every hour until stable.Maintain semi-Fowler’s position, supporting arms. Encourage to turn, cough, and deep breathe every 2 to 4 hours.Teach the importance of activity, turning, coughing, and deep breathing.Monitor daily weights.Consult with dietitian to assess calorie needs and plan appropriate enteral feeding. Assess response to enteral feedings.
25 PLANNING AND IMPLEMENTATION Demonstrate and allow to practice using magic slate and flash cards prior to surgery.Allow adequate time for communication efforts.Keep emergency call system in reach at all times and answer light promptly. Alert all staff of inability to respond verbally.Encourage expression of feelings regarding perceived and actual changes.Provide emotional support, encourage self-care and participation in decision making.