ASKEP KANKER LIDAH

• 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)

PATOFISIOLOGI

• Karsinoma sel squamosa ulserasi dan nyeri• Mestastase awal pada nodus imfatikus

servikalis• Tumor yang terletak pada basis lidah sangat

sulit dideteksi

The Oral Cavity and Oropharynx

10 BESAR CA KEPALA LEHER• Oral Cancer• Throat Cancer• Lip Cancer• Tongue Cancer• Squamous Cell Cancer of the Oral Tongue• Squamous Cell Cancer of the Base of Tongue• Voice Box Cancer• True Cord Cancer• Cancer of the Supraglotic Larynx• Subglottic Squamous Cell Cancer• Medical Director

Squamous cell carcinoma of the tongue in a 50 year old non-smoker

Squamous cell carcinoma of the base of the tongue.

Squamous cell carcinoma of the tongue

ETIOLOGI

• The exact cause of tongue cancer is unknown• Smoking cigarettes, cigars, or a pipe• Use of chewing tobacco, snuff, or

other tobacco products• Heavy alcohol consumption

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 drinking• History of mouth ulcers• Family history due to genetic predisposition

Percentage of nurses identifying risk factors associated with oral cancer.

KELUHAN UTAMA

• Skin lesion, lump, or ulcer on the tongue• Difficulty swallowing /Disfagia• Mouth sores and mouth pain• Numbness or difficulty moving the tongue• Change in speech (due to inability to move the

tongue over the teeth when speaking)• Pain when chewing and speaking• Bleeding from the tongue

Percentage of nurses identifying oral changes associated with oral cancer.

Percentage of nurses identifying anatomical sites for identification during examination of the mouth.

PEMERIKSAAN FISIK & DIAGNOSIS

• Examination of your tongue for lumps or masses• Use of a fiberoptic scope—a thin tube with a tiny

camera to examine the base of the tongue• A tongue biopsy —removal of a sample of tongue

tissue to test for cancer cells• CT scan —a type of x-ray that uses a computer to

make pictures of the mouth• Chest x-ray to determine if the cancer has spread

to the lungs

TREATMENT• Treatment 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.

Rehabilitation and Follow-Up

• Therapy to improve tongue movement, chewing, and swallowing

• Speech therapy, if use of the tongue is affected

• Close monitoring of your mouth, throat, esophagus, and lungs to see if the cancer has come back or spread

HEALTH EDUCATION

• Don't smoke or use tobacco products.• Avoid heavy alcohol consumption.• See doctor regularly for check-ups and cancer

screening exams.

Diagnosa Keperawatan

1. Risk for ineffective airway clearance, related to oral surgery

2. Risk for imbalanced nutrition: Less than body requirements, related to oral surgery

3. Impaired verbal communication, related to excision of a portion of the tongue

4. Disturbed body image, related to surgical excision of the tongue

KRITERIA HASIL

• Maintain 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.

PLANNING AND IMPLEMENTATION

1. Assess airway patency and respiratory status every hour until stable.

2. Maintain semi-Fowler’s position, supporting arms. Encourage to turn, cough, and deep breathe every 2 to 4 hours.

3. Teach the importance of activity, turning, coughing, and deep breathing.

4. Monitor daily weights.5. Consult with dietitian to assess calorie needs and plan

appropriate enteral feeding. Assess response to enteral feedings.

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.