MULTIDISCIPLINARY APPROACH IN THE TREATMENT OF SQUAMOUS CELL CARCINOMA AT REGIO GLOSSUS

ABSTRACTBackground: Squamous Cell Carcinoma (SCC) is the most common case of oral cancer which often occurs laterally on the tongue and rarely develops on the dorsal surface of the tongue. More than half of the cases are diagnosed late, thereby reducing the survival rate of the patients. Objective: This report was intended as an evaluation for the management of squamous cell carcinoma under multidisciplinary approach between oral surgery and other departments, as well as the provision of further post-operative treatment. Case Report: The author presents a case of 68-years-old female patient with a lump and an ulcer on her tongue. Around six months prior to the visit, patient complained of tongue ulcer followed by the emergence of a lump in a size of a corn seed. The lump was gradually enlarged with constant widening of the ulcer. Pain on the tongue was also perceived. The patient was then referred to Hasan Sadikin Hospital for further treatment. Case Management: Patients underwent hemiglossectomy and Selective Neck Dissection (SND) surgical procedures performed by Oral and Maxillofacial Surgeon in collaboration with Surgical Oncologist. Furthermore, after surgery, the patient was consulted to the Hemato-Oncology Division of Internal Medicine Department for chemotherapy treatment. Conclusions: The exact diagnosis was made based on the histopathological biopsy results of the tongue tissue. Management of tongue cancer must be done multidisciplinary. Some things that must be considered in handling such cases are the eradication of the tumor, the return of oral cavity function, and the aesthetic/functional aspects of the patient. Keywords: Oral cancer, Squamous cell carcinoma, Tongue cancer

Decreased Tongue Volume Post Radiation

Objectives: To evaluate volume changes within the tongue post chemoradiation therapy (CRT) Study Design: Retrospective review Setting: Academic Medical Center Subjects and Methods: Subjects included 19 patients that received CRT as the primary treatment for tonsillar or hypopharynx squamous cell carcinoma. Tongue volumes were calculated by three raters from thin slice computed tomography images collected before treatment and up to 29 months post-CRT. Body mass index (BMI) was also collected at each time point. Results: Inter-rater reliability was high with an ICC of 0.849 (95% CI = 0.773, 0.905). Linear mixed effects modeling showed a mean decrease of 0.45 cm3 (standard error of the mean [SEM] = 0.11) in tongue volume per month post-CRT ( P < .001). However, the addition of BMI to the model was significant (χ2 (4) = 25.0, P < .001), indicating that BMI was a strong predictor of tongue volume, with a mean decrease of 1.75 cm3 (SEM = 0.49) in tongue volume per unit decrease in BMI ( P < .001) and reducing the post-CRT effect on tongue volume decrease per month to 0.23 cm3 ( P = .02). BMI significantly ( P < .001) decreased by 0.11 units (SEM = 0.02) per month post radiation. Conclusion: Tongue dysfunction and decreased tongue strength are significant contributors to the dysphagia that patients experience after receiving CRT. In this study, both tongue volume and BMI decreased post-CRT; therefore, BMI could potentially be used as a predictor of tongue volume post-CRT.

ANALISIS KASUS KANKER LIDAH DALAM KONTEKS ASUHAN KEPERAWATAN DENGAN PENDEKATAN COMFORT THEORY MODEL

ABSTRACT The prevalence of patients with cancer increase every year. Tongue cancer is a type of malignancy of the tongue, and almost 95% is squamous cell carcinoma. Tongue cancer is a cancer with high progression with bad prognosis so that the mortality rate is very high and often causes discomfort. Comfort is the starting point of various healing that will be achieved by the client. Improvements in client conditions will not be achieved if the need of comfort is not fulfilled. In nursing care the problems that arise in tongue cancer are chronic pain, nutrient imbalance: less than body needs, and ineffective breathing patterns. Analysis of residency practice processes shows that comfort theory can be applied to patients with malignancy cases in nursing care, as it can identify patients' holistic discomfort from the physical, psychospiritual, sociocultural and environmental aspects.Keyword : Comfort Theory, Tongue Cancer

Is there a role for adjuvant radiation in T1N0 squamous cell carcinoma tongue with adverse pathological features? Factors affecting local control and the development of a scoring system.

e17565 Background: The patterns of recurrence and the prognostic factors of early tongue lesions have been previously described in literature, often grouping T1 and T2N0 tongue lesions together. Adverse pathological features (APFs) have been used to predict nodal spread, but the prognostic factors predicting local recurrences in T1N0 tongue have seldom been described. We aim to evaluate the APFs associated with poor local control and the possible need for escalation of therapy. Methods: A retrospective analysis of 144 patients of pT1N0 squamous cell carcinoma tongue, extracted from our database of 598 patients of oral cavity who underwent wide local excision with neck dissection in a single institution between 2006-2014 were included in our study. Patients who received any adjuvant therapy were excluded. Results: APFs associated with local control were least margin 5 mm (p=0.004), infiltrative margin (p=0.403), depth ≥ 4mm (p=0.136), lymphovascular invasion (p=0.301) and perineural invasion (p=0.342). We derived a scoring system assigning a score to each of these factors out of a total 10 points, based on the hazard ratio for local failure. Patients with a score ≥ 5 points had a 5-year local control rate of ≤ 60%. Conclusions: Having least margin of 5 mm was the greatest predictor of local failure. This would suggest that all patients having a margin of 5 mm need revision, however if they do not have additional APF (score ≤ 4 points), they still have good local control rates (5-year local control rate of 88%) and may be observed. Those who have margins over 5 mm with a total score ≥ 5 may still benefit from adjuvant therapy for local control. Those with margins over 5mm have improved local control rates (p=0.029). [Table: see text]