Saturday, January 14, 2006

cancer, mouth, throat, and larynx

The most significant etiologic (cause-related) factor associated with cancer of the mouth and throat is the use of tobacco products. Cancer risk increases dramatically when five cigars or pipe bowls of tobacco are used daily or more than a pack of cigarettes is smoked daily. Chewing tobacco and the use of snuff are also factors in mouth cancer. Other high-risk factors include vitamin deficiency (especially vitamin A), malnutrition, and poor oral hygiene. Almost 60 percent of these tumors are advanced at the time of diagnosis. Survival rate is only 50 percent.
Symptoms of cancer of the mouth, throat and larynx include hoarseness, lumps in the neck, difficulty swallowing, coughing, loosening of teeth, weight loss, and swelling, pain, and ulceration. Squamous-cell carcinoma is found in almost 95 percent of cancers of the nose, mouth, and throat. The usual treatment is surgery, radiation therapy, or a combination of surgery and radiation therapy. Chemotherapy is used less frequently. Complications in treatment are more common in patients over 70 years of age. Postoperative wound breakdown is more frequent in patients who have diabetes mellitus, cardiovascular disease and chronic obstructive pulmonary disease (COPD). Also at risk are patients who suffer a preoperative weight loss of 20 pounds or more, have a hemoglobin count of less than 10, and have a total protein count of less than 3.5. Alcoholics may have gastrointestinal bleeding. Dietary intake and negative nitrogen balance should be corrected prior to surgery.
Patients undergoing neck irradiation and/ or surgery are susceptible to hypothyroidism and should have levels of thyroid hormones checked preoperatively. Hypercalcemia is also a postoperative complication. Calcium levels should be monitored preoperatively. Following treatment, patients will frequently need rehabilitative training, including speech therapy. They also need to be counseled on proper oral habits, nutrition, and the need for elimination or reduction of tobacco and alcohol products. Postoperative management is necessary to closely watch for any recurrence.
Ballenger, J. J. Diseases of the Nose, Throat, Ear, Head and Neck, 13th ed. Philadelphia: Lea & Febiger, 1985.
Steinberg, F. U. Care of the Geriatric Patient, 6th ed. St. Louis: C. V. Mosby Co., 1983.


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