cancer

CANCER

1. Oral cancer

2. Breast Cancer

The goals of cancer management are cure, control and palliative care.

Cancer is a disease in which certain body cells multiply without apparent control, destroying healthy tissue and organs and endangering life.

There are three main classifications of cancer- 1. Carcinoma 2. Sarcoma 3. Lymphoma.

Carcinoma: which is cancer of the epithelial tissue that forms the skin and the linings of the internal organs.

Sarcoma: which is cancer of connective tissue such as cartilage, muscle or bone.

Lymphoma: which affects the blood stream and the lymph system.

1.  Oral Cancer

There are two types of oral cancer, oral cavity cancer which starts in the mouth and the oropharyngeal cancer which develops in the part of the throat just behind the mouth of the oropharynx.

Investigation:

·           History and physical examination

·           Biopsy

·           Oral exfoliative cytology

·           Toluidine blue test

·           CT scan

·           MRI scan

·           PET scan

Types of oral cancer

·           Lip cancer

·           Tongue cancer

·            Oral cavity cancer

Lip cancer

Predisposing Factors

Constant over exposure to sun radiation and fair complexion, recurrent herpetic lesions, irritation from pipe stem, syphilis and immune suppression.

Clinical Manifestations

 Indurated painless ulcer

Management

·            Surgical excision and radiation

Tongue cancer

Predisposing Factors

·            Tobacco, alcohol, chronic irritation, syphilis

Clinical Manifestations

Management

·            Surgery (hemiglossectomy or glossectomy, radiation)

Predisposing Factors

·            Poor oral hygiene, tobacco usage (pipe and ciger smoking, snuff, chewing tobacco) chronic alcohol intake, chronic irritation (jagged tooth, ill-fitting prosthesis, chemical or mechanical irritants) human papillomavirus (HPV)

Clinical Manifestations

·            Leukoplakia, erythro plakia ulceration, sore spot, rough area, pain, dysphagia, lump or thickening in the cheek. A sore throat or a feeling that something is stuck difficulty in chewing and speaking (lateral signs)

Management

·            Surgery mandibulectomy radical neck dissection resection of buccal muscosa internal and external radiation.

2. Breast Cancer

Definition:- cancer is a disease process whereby cells proliferate abnormally, ignoring growth regulating signals in the environment surrounding the cell.

Causes

·            No definite cause

·            Hormones and genetics play some role in causing breast cancer

Risk Factors

·            Breast cancer may be seen after the age of 50

·            Personal or family history of breast cancer may lead to a main cause

·            Persons with early menarche may have more chances of getting breast cancer

·            Females who are not having children are more prone to breast cancer

·            Late maternal age at first birth

·            Late menopause also one of the cause  Exposure to ionizing radiation

·            Obesity also rarely cause breast cancer

Signs and Symptoms

·            Non tender, fixed, hard mass with irregular border in the breast

·            Peau d’ orange (orange peel) appearance of the skin seen on the breast

·            Nipple retraction in advanced cancer

·            Ulcerating and fungating lesions

Investigation

·            Self breast examination

·            Fine needle biopsy

·            Open biopsy

·            Incisional biopsy

·            Core biopsy

·            Histologic examination

Management

Surgical Management:

·            Mastectomy – removal of the affected breast  Modified radical mastectomy

·            Breast conservation surgery  Lumpectomy

·            Partial mastectomy

·            Segmental mastectomy

·            Quadrantectomy. (Axillary lymph node dissection)

·            Radiotherapy

·            Chemotherapy

·            Hormonal therapy

·            Bone marrow transplantation

Nursing Management

·            Family support

·            Exercise

·            Psychological exercise or emotional support to patient and family members

·            Dressing

·            Relieving pain and comfort

·            Maintain skin integrity

·            Educate post operative exercise

Family Support:

Family and members should be supported with proper counselling. Explain them about the management modalities available now. Family members are advised to support the patient who is suffering with cancer.

Post Operative Exercises:

·            Wall climbing exercise: Advise to stand near the wall and face the wall, advise to put the affected side on the wall, and slowly move the hand on the wall with finger walk.

·            Rope pulling exercise: Advise to hang the rope on a rod and hold the two ends of the rope with two hand and lift the hand one by one in opposite direction.

·            Rope turning exercise: Tie a rope on the door and the turn the rope with hand of affected side.

Dressing:

·            Breast binder may be applied if necessary