Free cancer support
Oral cancer (including tongue cancer, floor of mouth cancer, etc.)
Oral cancer refers to malignant tumors arising from the oral mucosa, tongue, floor of mouth, gingiva, buccal mucosa, and other oral cavity subsites, with tongue cancer and floor-of-mouth cancer being the most common subtypes. It predominantly affects middle-aged and elderly males and is strongly associated with tobacco smoking, betel quid chewing, excessive alcohol consumption, and chronic oral inflammation. Early-stage disease is often asymptomatic or presents with subtle lesions, leading to frequent delayed diagnosis. Therefore, early screening and proactive nursing intervention are critical for preserving quality of life, speech, mastication, and swallowing function.
Major risk factors include:
- Tobacco smoking and betel quid/areca nut chewing: Direct mucosal irritants and potent carcinogens (nitrosamines, tobacco-specific nitrosamines); the single strongest modifiable risk factors, with synergistic effects when combined.
- Chronic heavy alcohol consumption: Acts synergistically with smoking/betel quid, promoting acetaldehyde-mediated DNA damage and mucosal permeability to carcinogens.
- Chronic oral inflammation and premalignant lesions: Periodontal disease, chronic mechanical trauma (ill-fitting dentures), oral lichen planus, leukoplakia, erythroplakia, and oral submucous fibrosis significantly elevate risk through sustained inflammation and field cancerization.
- Poor oral hygiene: Long-standing dental plaque, caries, and periodontal pockets contribute to chronic irritation and dysbiosis-linked carcinogenesis.
- Genetic and familial predisposition: Family history of head and neck cancer, inherited DNA repair defects, or polymorphisms in carcinogen-metabolizing genes (e.g., CYP1A1, GSTM1) increase susceptibility.
Early screening in high-risk populations (smokers, betel quid chewers, heavy drinkers), regular oral examination, health education, and comprehensive nursing support are essential to slow disease progression and preserve speech, chewing, swallowing, and aesthetic function.
Early-stage oral cavity cancer often presents with nonspecific or subtle symptoms that may be mistaken for benign conditions. As the tumor progresses, the following manifestations may emerge:
- Oral ulceration: Persistent (non-healing >2–3 weeks) or recurrent ulcers, typically painless initially; a common early warning sign, especially with indurated base or rolled margins.
- Oral pain or foreign-body sensation: Discomfort during mastication, swallowing, or at rest, indicating mucosal invasion or ulceration.
- Mass in tongue or floor of mouth: Palpable firm, indurated nodule or thickening; may enlarge or become fixed in advanced stages.
- Oral bleeding: Spontaneous, intermittent, or contact bleeding (particularly during toothbrushing), often from friable tumor surface.
- Functional impairment: Progressive difficulty with chewing (trismus if masticator space involved), dysphagia, dysarthria, or tongue mobility restriction as tumor bulk or fixation increases.
- Cervical lymphadenopathy: Painless, firm, enlarged lymph nodes (most commonly levels I–III), frequently the first presenting sign and indicative of regional metastasis.
- Constitutional symptoms: Unintentional weight loss, fatigue, anorexia, and cachexia suggestive of advanced disease or paraneoplastic effects.
Some patients may also experience xerostomia, halitosis, or chronic dental pain, necessitating prompt clinical evaluation and nursing intervention.
Diagnosis of oral cavity cancer employs a multimodal approach aimed at early detection, precise subsite classification, accurate staging, and formulation of individualized nursing care plans:
- Clinical examination
- Thorough visual inspection and palpation of the oral cavity, tongue, floor of mouth, gingiva, and buccal mucosa to identify ulcers, masses, indurated lesions, leukoplakia, erythroplakia, or submucous fibrosis.
- Imaging studies
- Contrast-enhanced CT neck and MRI (with gadolinium): Primary modalities for evaluating tumor size, depth of invasion, bone involvement (mandible/maxilla), perineural spread, and cervical lymph node metastasis.
- 18F-FDG PET-CT: Indicated for detection of regional nodal disease, distant metastases, synchronous second primaries, and restaging in advanced or recurrent cases.
- Histopathological examination
- Incisional or punch biopsy (under local anesthesia): Gold standard for definitive diagnosis, confirming squamous cell carcinoma (or variant histologies), WHO/ISUP grading, depth of invasion, perineural/lymphovascular invasion, and margin status.
- Tumor biomarkers and molecular testing
- Serum markers (limited specificity; SCC-Ag, CYFRA 21-1 occasionally used for surveillance of recurrence).
- HPV testing (p16 IHC ± HPV DNA PCR) in selected cases (especially oropharyngeal-extension tumors).
- Next-generation sequencing for actionable alterations (e.g., TP53, EGFR, PIK3CA, NOTCH1) and PD-L1 expression to guide targeted therapy, immunotherapy eligibility, prognostic stratification, and personalized long-term nursing and surveillance strategies.
Nursing and supportive care strategies for oral cavity cancer can be divided into conventional modalities and personalized supportive approaches, aimed at delaying disease progression, preserving oral function (speech, mastication, swallowing), and improving overall quality of life:
Surgical Management
- Indicated for early-stage and resectable tumors; procedures include partial or total glossectomy, floor-of-mouth resection, marginal or segmental mandibulectomy, maxillectomy, or wide local excision with appropriate reconstruction (local/regional/free flaps).
- Postoperative care integrates rigorous oral hygiene, nutritional support (enteral feeding if needed), wound/stoma management, speech–language therapy, swallowing rehabilitation, and psychological counseling to promote healing and restore chewing, swallowing, and speech function.
Radiation Therapy and Chemotherapy
- Radiotherapy (adjuvant or definitive, often intensity-modulated) to reduce locoregional recurrence in high-risk or advanced cases.
- Chemotherapy (concurrent cisplatin-based or induction regimens) for locally advanced, recurrent, or metastatic disease; combined with aggressive oral care, hydration, antiemetics, and nutritional optimization to minimize mucositis, xerostomia, osteoradionecrosis, and systemic toxicity.
Targeted and Immunotherapy
- Personalized regimens based on molecular profiling (e.g., PD-L1 expression, EGFR status); includes immune checkpoint inhibitors (pembrolizumab, nivolumab) as first- or second-line therapy in recurrent/metastatic disease.
- Integrated with immune enhancement, nutritional support, and functional rehabilitation to improve host resistance and quality of life.
Nutritional and Intravenous Supportive Therapy
- High-dose intravenous vitamin C, glutathione, amino acids, and trace elements to support energy metabolism, antioxidant defense, immune function, and tissue repair.
- Dietary recommendations: soft, moist, high-protein, nutrient-dense foods that are easy to chew and swallow; strict avoidance of spicy, hard, acidic, or rough foods to protect compromised oral mucosa and reduce irritation.
Individualized Monitoring and Long-term Care
- Regular imaging (CT/MRI/PET-CT), clinical oral examination, serum markers, and molecular surveillance to detect recurrence early.
- Patient-specific care plans with ongoing adjustment of nutrition, lifestyle, dental/prosthetic management, and psychosocial support.
- Specialized nursing protocols for patients with impaired oral function, immunosuppression, trismus, xerostomia, or high recurrence risk to optimize long-term survivorship and quality of life.
