Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cancer, Oral Cavity and Oropharynx


Related Terms

  • Cancer of the Mouth
  • Cancer of the Oropharynx
  • Cancer of the Tongue
  • Lingual Cancer
  • Mouth Cancer
  • Neoplasms of the Oropharynx
  • Oral Cancer
  • Oropharyngeal Cancer
  • Throat Cancer
  • Tongue Cancer

Differential Diagnosis

  • Blood vessel swelling (hemangioma)
  • Cold sores in the mouth and throat
  • Growth of harmless connective tissue (fibroma), fat cells (lipoma), or nerve cells (neurofibroma)
  • Leukoplakia

Specialists

  • General Surgeon
  • Occupational Therapist
  • Oncologist
  • Oral/Maxillofacial Surgeon
  • Otolaryngologist
  • Plastic Surgeon
  • Radiology Oncologist

Comorbid Conditions

Factors Influencing Duration

Factors that may influence the length of disability include the location of the cancer, degree of metastases into other areas of the oral cavity or into other organ systems, the individual's age, use of tobacco and alcohol, stage of the disease at diagnosis, access to adequate health care, type and extent of treatment for the disease, and mental health of the individual during treatment and recovery. The individual's willingness to adapt to a different lifestyle by abstaining from tobacco and alcohol and the ability to reintegrate into society and the workplace following treatment will have a major impact on the length of disability.

Medical Codes

ICD-9-CM:
145.9 - Malignant Neoplasm, Mouth; Unspecified Site, Buccal Cavity NOS, Minor Salivary Gland Unspecified Site, Oral Cavity NOS
146.0 - Neoplasm, Tonsil, Malignant, NOS, Faucial, Palatine
146.1 - Neoplasm, Tonsillar Fossa, Malignant
146.2 - Neoplasm, Tonsillar Pillars, Malignant; Faucial Pillar; Glossopalatine Fold; Palatoglossal Arch; Palatopharyngeal Arch
146.3 - Neoplasm, Vallecula, Malignant
146.4 - Neoplasm, Anterior Aspect of Epiglottis, Malignant; Epiglottis, Free border; Glossoepiglottic Fold(s)
146.5 - Neoplasm, Junctional Region, Malignant
146.6 - Neoplasm, Lateral Wall of Oropharynx, Malignant
146.7 - Neoplasm, Posterior Wall of Oropharynx, Malignant
146.8 - Neoplasm, Other Specified Sites of Oropharynx, Malignant; Branchial Cleft
146.9 - Malignant Neoplasm, Oropharynx, Unspecified
230.0 - Carcinoma in Situ of Lip, Oral Cavity, Oropharynx, Nasopharynx, Salivary Gland, Tongue
235.1 - Neoplasm of Uncertain Behavior of Lip, Oral Cavity and Pharynx; Gingiva, Hypopharynx, Minor Salivary Glands, Mouth, Nasopharynx, Oropharynx, Tongue

Overview

Oral cavity cancer is the development of cancerous (malignant) tumors on the lips, the inner lining (buccal mucosa) of the lips and cheeks, the front two-thirds of the tongue (oral tongue), the bottom of the mouth beneath the tongue, the bony roof of the mouth (hard palate), and the space behind the wisdom teeth (retromolar trigone). All cancers that develop in the mouth and throat are the result of abnormal cells dividing and reproducing uncontrollably. While there are a number of different cancers that can be found in the oral cavity, the most common is squamous cell carcinoma.

Oropharyngeal cancer is the development of cancerous tumors in the back part of the mouth or upper region of the throat. This includes the rear one-third (base) of the tongue, soft palate, tonsils, tonsillar pillars, and the rear wall of the throat (the posterior pharyngeal wall), which make up the oropharynx. Cancers in this region tend to develop open sores (ulcers) and may spread (metastasize) locally or to distant organs throughout the body.

Cancer of the tongue is characterized by the progressive and uncontrolled growth of abnormal tongue cells. Up to 97% of tongue cancers are squamous cell carcinomas (Wein 1296). The tongue is divided into two anatomical areas: the oral tongue (the part that can be "stuck out,") which extends back to a v-shaped group of lumps on the back of the tongue that are specialized taste buds, and the base of the tongue, which is the region behind these taste buds. Most tongue cancers are found on the side (lateral margin) of the middle third of the oral tongue, and often extend onto the bottom (ventral aspect) of the oral tongue. Approximately 20% occur on the front (anterior) third of the lateral margin, and only about 4% of occur on the top surface (dorsum) or the tip of the oral tongue (Wein 1296). The tongue has an extensive blood and lymphatic supply; consequently, cancer of the tongue can spread easily, and the prognosis for individuals with advanced tongue cancer is poor.

Cancers of the oral cavity or oropharynx (including the tongue) are treated according to the stage of the cancer. The staging system used for oral and oropharyngeal cancer, including the base of the tongue, is the tumor/node/metastasis (TNM) system devised by the American Joint Committee on Cancer. Briefly, it applies progressive designations as follows: T1 tumor is 2 cm or less, T2 is greater than 2 cm but not over 4 cm, T3 tumor is greater than 4 cm; N1 has metastasis to a single lymph node 3 cm or less in size, N2 has metastasis to a single node greater than 3 cm but not over 6 cm, N3 has metastasis in a lymph node greater than 6 cm; distant metastases are designated as Mx for unable to assess metastases, M0 for no metastases, and M1 when distant metastases are confirmed (Wein1298). Additional staging designations apply to specific tumor locations.

The number stages of oropharyngeal cancers are as follows: stage I is a 2 cm or less tumor; stage II is a greater than 2 cm but less than 4 cm tumor (in stages I and II there is no spread to lymph nodes, nor distant metastasis); stage III is a larger than 4 cm tumor, without spread to lymph nodes or metastasis, or a smaller tumor with spread to regional lymph nodes, but without signs of metastasis; stage IV is advanced cancer, and is further divided as follows: IVA: any invasive tumor without lymph node involvement, or spread to only one lymph node in the same side, or more significant lymph node involvement, without metastasis; IVB: any tumor with extensive lymph node involvement, but without metastasis; and IVC: evidence of distant spread.

Incidence and Prevalence: The American Cancer Society predicted that about 36,540 new cases of oral cavity and oropharyngeal cancer would be diagnosed in 2010, including 25,420 in men and 11,120 in women, with 7,880 deaths ("Oral"). New diagnoses and deaths from oral cavity and oropharyngeal cancer have been decreasing over the last 20 years, possibly in part due to reduced tobacco use in the US (“Detailed Guide”).

The incidence of oral and oropharyngeal cancers vary widely around the world, believed to be associated with environmental risk factors. Highest incidence is in Hungary and France (where it is higher even than in the US) and lowest in Mexico and Japan.

Source: Medical Disability Advisor



Causation and Known Risk Factors

The greatest risk factor for cancer of the oral cavity is tobacco use, including smokeless tobacco; about 90% of people who develop oral cancer use tobacco (Detailed Guide). Risk to smokers for developing squamous cell carcinoma is directly influenced by the number of cigarettes smoked per day (Wein 1263). Smokers who consume large amounts of alcohol, which promotes the carcinogenic effects of smoking, are about 35 times more likely to develop oral cavity or oropharyngeal cancer than people who do not smoke and do not drink (Wein 1263). Users of smokeless tobacco are 4 times more likely to develop oral cavity carcinoma as nonusers (Wein 1263).

Other risk factors are poor oral hygiene with bacterial irritation, poor nutrition, and immunosuppressed states, including long-term use of immunosuppressive drugs following transplantation or to treat autoimmune disease, human immunodeficiency virus (HIV) infection, and acquired immune deficiency syndrome (AIDS). Human papilloma virus (HPV) has been detected in tissue samples from squamous cell carcinoma and may play a role in development of oral and oropharyngeal cancer (Wein 1264). Individuals who spend a lot of time outdoors have a 30% increased risk for lip cancer (“Detailed Guide”) because of increased exposure to ultraviolet light. Occupational health hazards include exposure to man-made vitreous or wool fibers such as fiberglass and blown-in insulation, mustard gas, vinyl chloride polymers, isopropyl alcohol, hexavalent chromium, tannin extract, azo dyes, and aryl hydrocarbon hydroxylase.

Plummer-Vinson syndrome (mucosal atrophy of the mouth, pharynx, and esophagus, achlorhydria, and iron deficiency anemia), chronic syphilis, and poorly fitting dentures also increase risk. Gene mutations are associated with the loss of molecular signaling mechanisms that control cell growth and the mutation of specific genes (e.g., ras family genes that have been linked to HPV infection) may predispose individuals to oral cavity cancer development.

Although oral and oropharyngeal cancers are found in adults of all ages, races, and ethnic groups, they are more common in blacks than in whites, and are generally found in individuals over the age of 35, with an average age at diagnosis of 62 (“Detailed Guide”). Oral cancer is rare in children. Tongue cancer occurs in older adults, especially those with a history of chronic alcohol and tobacco use. Nutritional deficiencies and infectious agents such as HPV and fungi may increase risk of tongue cancer.

Source: Medical Disability Advisor



Diagnosis

History: Cancer of the oral cavity and oropharynx often is painless in its early stage. Individuals may complain of irritation in the throat but usually report pain only when the cancer develops into a crater-like ulcer (lesion). Individuals also may report a lump in the neck that represents metastasis of the cancer from the oropharynx. Individuals may report a change in their voice, persistent bad breath (halitosis), loss of appetite (anorexia), and weight loss.

Cancer of the base of the tongue usually is quite advanced when diagnosed because in the early stages it cannot be seen and creates few, if any symptoms. In some cases, the cancer will spread quickly into the lymphatic system, and the individual may report only a lump in the neck. Later in the course of the disease, a lesion that is several centimeters in diameter may be found. The individual usually complains of increasing pain, a sense of fullness, changes in the voice, and difficulty swallowing (dysphagia). Pain can be severe and constant and may radiate to the neck and ears. There may be a history of cancer on the lips, inside the cheeks, on the roof of the mouth, or in the upper throat area. Obtaining a history of alcohol and tobacco use, medications, allergies, prior diagnoses, treatments, and surgeries, is important to diagnosis.

Physical exam: A comprehensive head and neck examination and physical exam are essential in evaluating possible oral cavity cancer. Examination of the mouth, including fit of dentures, gum condition, possible sources of bleeding, and presence of halitosis, as well as dysphagia, and facial sensitivity or numbness, must be performed. The upper aerodigestive tract is examined for cancerous lesions. Early stage oral cavity and oropharyngeal cancer may appear as small, apparently harmless areas of hardness (induration) or ulceration. Areas of tissue induration or areas of ulceration usually represent tissue that is being infiltrated by a tumor. As the disease progresses, destruction of the inner lining in the back of the mouth or throat (erosion), redness (erythema) or inflammation of mucus membranes in the oropharynx, induration in normally soft throat tissues, oropharyngeal sores that do not heal, hardening or enlargement of the lymph nodes (lymphadenopathy), or white patches on the oropharyngeal mucosa (leukoplakia) are commonly observed. Eroded areas may appear ulcerated with irregular or raised edges. The individual may have enlarged, nontender lymph nodes in the neck.

In tongue cancer, a grayish ulcer in the bottom of a furrow (fissure) or on the surface of the oral tongue may be evident. Lesions that can be white (leukoplakia) or pink to red (erythroplakia), and which do not wipe off, may or may not be associated with the ulcer. Later in the course of the disease, the ulcer may become hard, with heaped-up (everted) edges. The floor of the ulcer may be grainy (granular) and hardened (indurated) and may bleed easily. There are often other areas of dead tissue (necrosis) on the tongue. Metastasis of the cancer to lymphatic modes is common in later stages, and many individuals will have enlarged nodes that are detectable by touch (palpable).

Tests: Cells may be scraped from the lesion(s) and examined microscopically to determine if they are malignant (exfoliative cytology). If exfoliative cytology indicates that the cells are malignant or if the lesion looks suspiciously like cancer, a small piece of tissue may be taken from the lesion (incisional biopsy) and examined microscopically. The lymph nodes may be biopsied if it is still unclear whether the primary oropharyngeal lesion is cancerous. In this case, the entire lymph node can be removed (excisional biopsy) and examined. Alternatively, a fine needle aspiration biopsy is an accurate technique for identifying oropharyngeal lesions that have spread to the lymph nodes.

After an oropharyngeal tumor is identified as malignant, imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) may be done to evaluate the depth of infiltration of cancer into the affected tissue and the extent of tumor growth. Positron emission tomography (PET) or single photon emission computed tomography (SPECT) may be done to stage the cancer. Endoscopy, which may include bronchoscopy, esophagoscopy, and/or direct laryngoscopy, usually is performed before surgery for an existing oral cavity cancer to assess for second primary tumors (synchronous lesions), which are present in 5% to 10% of cases (Wein 1276). A pre-operative barium swallow and radiograph of the esophagus may also be done to exclude synchronous lesions.

X-rays of the jaw typically are performed to evaluate tissue for infiltration by the cancerous lesion or the presence of a synchronous lesion. Chest x-rays may be done to assess for pulmonary metastasis.

Source: Medical Disability Advisor



Treatment

The stage of the cancer at diagnosis guides treatment of oral cavity and oropharyngeal cancer. The primary forms of treatment are surgery and/or radiation therapy, although advances in chemotherapy have encouraged the use of certain drugs in conjunction with surgery and radiation for advanced stage (III and IV) cancers. The site of the malignancy also affects treatment options. In general, surgery is the treatment of choice for tumors not sensitive to radiation, recurrent tumors in the oropharynx previously treated with radiation therapy, and in situations where the side effects of radiation are more severe than the defects produced by surgery.

Surgical treatment frequently involves removal (local excision or resection) of the tumor and as much surrounding tissue as necessary, along with the associated lymph nodes (lymphadenectomy) that may contain cancerous cells. Prophylactic antibiotics will be administered to reduce the chance of infection. If the tumor has spread to other areas of the mouth or jaw, these areas also may be removed. Depending on the depth of infiltration of the tumor and the extent of regional metastasis, this surgery may include removal of part of the neck and throat (radical neck dissection). Surgical treatment may have the disadvantage of sacrificing function of the vocal cords if the larynx is removed. If the cancer has spread to other areas of the mouth, cosmetically and functionally important structures such as the lip(s), lower jaw (mandible), and in some special cases, the eye, may be removed. If this is the case, artificial body parts (prostheses) are often used to reconstruct the face and mouth during surgery. Resection of tumors from the floor of the mouth usually requires immediate reconstruction to obtain a watertight closure, avoid fistula formation, and retain tongue mobility. Plastic surgery and skin grafts may be used to reconstruct smaller defects in soft tissue.

Radiation therapy often is used as a single treatment for small and superficial oropharyngeal tumors that have not produced an abundance of necrotic tissue. Radiation is preferable in many cases when surgical removal of the cancer will result in severe impairments. However, radiotherapy in the mouth area also can be debilitating, as it may result in decreased salivary function and taste sensation, making it difficult for the individual to maintain weight and general health status. Combination treatment using radiation therapy and surgery may be used if the lesion has metastasized, is large or deeply invasive, or if bone is involved. Combination treatment often is advantageous if the tumor has entered the lymph nodes, since a greater number of cancerous lymphatic structures can be treated. Radiation of lymph nodes also may be done to reduce risk of lymphatic metastases.

Chemotherapy by itself has not been used successfully to treat oral cavity cancer, including tongue cancer. However, it has been used in combination with surgery or radiation therapy, particularly to reduce the amount of resection needed and to increase survival. Preoperative chemotherapy may be used to shrink cancer before surgery or radiation therapy (neoadjuvant chemotherapy). Postoperative chemotherapy may be used to increase survival in patients who have already had lymph node involvement. Chemotherapy may also be part of palliative care.

Source: Medical Disability Advisor



Prognosis

Staging, or the determination of the depth of invasion of squamous cell carcinoma into local tissue and spread to lymph nodes and distant sites, is predictive of outcome in oral cavity carcinoma. A lower depth of invasion (less than 2 cm) and a lower extent of regional metastases can have a 5-year survival rate as high as 95% (Wein 1274). As the depth of invasion and metastasis increase, the survival rate decreases significantly. Average five-year survival rates for stage I oral cavity cancers is 59.8%; for stage II, 46.3%; for stage III, 36.3%; and for stage IV, 23.3% (Wein 1274).

The predicted outcome specifically of tongue cancer varies depending upon the stage of the lesion and the adequacy of the initial treatment. Early detection and prompt treatment of tongue cancer with radiation therapy produces a 5-year survival rate of 80% to 90%; 5-year survival rates for more advanced tongue cancer (stages III and IV) range from 30% to 50% if lymph nodes are not involved, and 15% to 30% if they are (Kelley). The possibility of disease recurrence is increased considerably in individuals who smoke or chew tobacco. In more advanced tumors, recurrence is likely in 39% of cases (Kelley). The outcome for advanced tumors is poor if the cancer involves large areas of the tongue, or if there have been metastases into the lymphatic system or other tissues.

Source: Medical Disability Advisor



Rehabilitation

If surgery is required, rehabilitation following excision often prescribed as the individual may experience voice and swallowing dysfunction. Rehabilitation for oral cavity or oropharynx cancer requires a team approach including a clinical social worker vocational rehabilitation counselor, occupational therapist, and speech-language pathologist to treat individuals with muscle dysfunction by retraining altered facial muscles affected by the disease and/or treatment, and retraining swallowing function. Dental professionals may also be involved with individuals with oropharynx cancer, especially to ensure the proper fit of dentures or a proper bite after surgery to remove an oral cavity tumor, or to craft an orofacial prosthetic device or reshape the hard palate if needed to enable speech and swallowing.

The occupational therapist instructs the individual on maintaining oral hygiene, preparing foods and liquids to facilitate swallowing, and using adaptive equipment as needed to ensure adequate nutrition and hydration. The therapist may also teach postural exercises for the head, neck, and upper body to help the individual manage secretions and enable safe swallowing during meals. Instruction in energy conservation techniques and strategies for pacing activities of daily living may also be necessary following surgical treatment.

The speech-language pathologist may use a real-time x-ray (videofluoroscope) to help determine the appropriate thickness and consistency of foods and liquids for safe swallowing (e.g., purée diet, thickened liquids), and works with the individual on the timing and coordination of swallowing to avoid aspiration of oral contents into the airway. Swallowing exercises may include sensory enhancement techniques that help normalize swallowing patterns by using alterations in temperature, taste, and volume of the food bolus. The speech therapist also instructs the individual in range of motion exercises for the jaw, tongue, and lips; breath and tongue control during speech; and alternative methods of communication if speech is no longer physically possible.

The rehabilitation program may need modifications based on the various degrees of oropharynx cancer. Modifications are also made when surgery is required. The extent of surgery affects the nature and the progression of the rehabilitation.

Source: Medical Disability Advisor



Complications

Complications of oral cavity and oropharyngeal cancer may include local infections, general infections (e.g., septicemia, pneumonia), excessive weight loss (cachexia), anemia, and abnormal enlargement of neck, jaw, and facial features due to tumor growth. Severe bleeding (hemorrhage) may also occur as a result of the tumor destroying blood vessels that lie in close proximity. Risk for recurrence of a mouth tumor on the opposite side or development of a second primary tumor (synchronous lesion) within 6 months to 2 years after diagnosis of smoking-related head and neck cancers is 14%, and much greater if the patient has continued to smoke after treatment (Wein 1274).

Complications of external beam radiation therapy may include dryness of the mouth (xerostomia) or the more serious complication of bone death (osteoradionecrosis or ORN).

Cancer of the tongue may be complicated if it spreads to other areas of the mouth and throat because large tumors may impair tongue function by creating rigidity in tongue muscles. Following removal of a cancerous lesion from the tongue, secondary lesions have occurred more often in individuals infected with human papillomavirus (HPV) and in women who have cervical cancer. Continuing to smoke substantially increases the likelihood of tumor recurrence.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Most individuals require temporary reassignment to more sedentary duties due to weakness and fatigue following surgery, radiation therapy, or chemotherapy. Frequent breaks may be needed, and heavy or prolonged physical exertion may have to be avoided until recovery is complete. Accommodations must be made for individuals with restricted vocal capabilities following treatment, especially among who must use their voice extensively in the workplace. Accommodations also may be necessary for individuals with swallowing difficulties following surgical treatment.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was diagnosis of oral cavity or oropharyngeal cancer confirmed through exfoliative cytology, incisional biopsy, and/or lymph node biopsy?
  • After an oropharyngeal tumor was identified as cancer, was CT or MRI performed to determine the extent of tumor infiltration into tissue?
  • Has the tumor metastasized into the lymph nodes?
  • Does individual have poor oral hygiene?
  • Has individual had persistent physical trauma to the tongue?
  • Does individual use tobacco in any form? What is daily usage? Consume alcohol? How much alcohol is consumed daily?
  • Does individual have HIV or AIDS?
  • Is an ulcerated lesion on the tongue present?
  • Does individual have pain or a sense of fullness?
  • Did individual's voice change? Is speech difficult?
  • Has individual experienced trouble swallowing?
  • Does individual have severe and constant pain? Does it radiate?
  • Does individual have a history of cancer anywhere near the tongue?
  • Were other conditions such as fibroma, lipoma, neurofibroma, hemangioma, and various herpes viruses that produce cold sores in the mouth ruled out?

Regarding treatment:

  • Was surgery the treatment of choice? If so, were prostheses used to reconstruct the face and mouth during surgery? Is additional reconstruction anticipated?
  • Would individual benefit from the addition of radiation therapy to current treatment plan?
  • If radiation therapy was the treatment, what is being done to counteract the side effects of decreasing salivary function and taste sensation making if difficult for individual to maintain weight and general condition?
  • Is a support system in place consisting of a clinical social worker and a vocational rehabilitation counselor? Has individual taken advantage of these services?
  • Was chemotherapy used with surgery and radiation? Preoperatively? Postoperatively? As palliative treatment?

Regarding prognosis:

  • At what stage was the cancer diagnosed?
  • Was treatment started promptly?
  • Has the cancer recurred?
  • Does individual have infection with HPV or have cervical cancer?
  • How are individual's general health, coping abilities, and emotional status?
  • What has individual done to modify risk factors? Has individual stopped using tobacco and alcohol?
  • Does individual have another underlying condition such as diabetes or hypertension that may affect recovery?
  • Have complications developed such as local infections and bleeding, general infections (septicemia or pneumonia), anorexia, weight loss, anemia, and abnormal enlargement of neck, jaw, and facial features due to tumor growth?
  • Has individual experienced any other complications as a result of the oropharyngeal cancer?
  • Would individual benefit from additional psychological or vocational counseling?
  • Is individual active in a rehabilitation program?
  • Can individual's employer make necessary accommodations?
  • Is individual having regular follow-up exams? Has metastatic cancer been diagnosed in the oral cavity, cervical lymph nodes, or another organ system?

Source: Medical Disability Advisor



References

Cited

"Oral Cancer." National Cancer Institute. New Media Systems, LLC. 2 Jun. 2011 <http://www.cancer.gov/cancertopics/types/oral>.

American Cancer Society. "Detailed Guide: Oral Cavity and Oropharyngeal Cancer." American Cancer Society. 2009. 12 Sep. 2009 <http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=60>.

Kelley, Daniel J. "Malignant Tumors of the Base of the Tongue." eMedicine. Eds. Benoit J. Gosselin, et al. 17 Nov. 2008. Medscape. 12 Sep. 2009 <http://emedicine.medscape.com/article/847955-overview>.

Wein, Richard O., and Randal S. Weber. "Malignant Neoplasms of the Oral Cavity." Otolaryngology: Head and Neck Surgery. Ed. Charles W. Cummings. 4th ed. 5 vols. Mosby, Inc., 2005. 1263-1305.

Source: Medical Disability Advisor






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