One of the most commonly diagnosed cancer in India that of the oral cavity. Its incidence has increased compared to the other sites like breast and cervix; which are the leading cancers worldwide. It has become so common that everyone has someone known to them who has been afflicted with oral cancer.?
The main cause of concern is that it is now increasingly affecting females and young to middle-aged population. Being the working and productive age group, it is leading to financial burden on the country.?
The main factor leading to oral cancer is chewing tobacco. Tobacco is fatal for almost half of its users. As per statistics available, around 28.6% of the population is using tobacco, out of which majority are men. In India, over 80% of the oral cancer cases are attributed to tobacco.?It contains a large number of cancer-causing agents. Due to prolonged exposure of these carcinogens to the oral mucosa irreversible damage occurs at a cellular level. Many changes like leukoplakia, erythroplakia and submucus fibrosis occur which have varying potential of turning into frank cancer. Smoking & alcohol are also implicated in its causation but to a lesser extent. Their effect is mostly synergistic to chewing tobacco.?
Due to its free availability and ease of access to chewing tobacco, its usage is very common among the young population. Even people in their teenage have started using due to peer pressure and attraction. And once the habit starts, the addictive potential of tobacco makes it a potential hazard. Despite best efforts by the government, various NGO¡¯s and the health care provides, Tobacco has the nation in its vicious grip.
The primary treatment of oral cancer is surgical resection of the primary tumor with clear margins followed by appropriate clearance of neck nodes. Being the functional and aesthetic part of the body, oral cavity cancers are associated with some unavoidable morbidity. Treatment of advanced disease leaves the patients with deficits in speech and swallowing and with facial deformation of varying extent.?
To reduce these deficits, the defects are generally reconstructed by replacing the tissue from other sites using flaps. Reconstruction of the resected part is generally carried out in the same sitting. Despite best efforts, the function can be restored only to a certain extent. Based on the pathological staging after resection, adjuvant treatment is planned using radiation with or without chemotherapy. ?Radiation therapy uses high-energy beams such as X-ray, protons to eliminate the cancer cells can also be used, depending upon the case. Apart from these, there are few more therapies like immunotherapy, targeted drug therapy which can be used to treat the cancer.
The best way to avoid all this tedious and prolonged process is by early detection and treatment. Oral cancer generally has a staged progression in the form of normal to pre-cancerous to frank cancer. If detected in the pre- cancerous stage, a simple excision and regular follow up can help prevent the incidence of oral cancer. White or reddish-white patches in the mouth, decreased mouth opening and regular burning sensation while eating could all be pre-cancerous. These are considered to be warning signs for people to stop their habits.?
In case of progression to oral cancer, the symptoms are very characteristic. Ulcers over any part of the mouth, that includes tongue, cheek, palate or dental sockets can be seen. These ulcers typically do not heal despite medications. They are painful and maybe associated with loosening of the teeth, bleeding, burning while eating spicy food or restricted movement of tongue. The cancerous lesions are also associated with pain in the ear on the same side. If any of these symptoms are experienced by a person, especially in presence of habits, it should raise a red flag. An immediate consultation with a doctor, preferably by oncologist is warrant at the earliest.
There is a taboo in the general public regarding the outcomes of oral cancer. Their outcome is always thought to be grave and people take it as a death sentence when they are diagnosed with oral cancer. This bias arises as most patients are diagnosed at a late stage which has poorer outcome. The survival rate of oral cancer depends on the location of the cancer and the stage the cancer is diagnosed and treated. Hence, it becomes imperative to detect the cancer early as early detection has proven to show an increase in survival rate significantly.?When treated early, the patients seldom have any deficit and can lead near normal life span along with a reasonably good quality of life.
Oral cancer does not require any major investigations for diagnosis as some other parts of the body. A simple examination by a trained person is sufficient to screen a person. If the expert suspects some abnormalities, they may further recommend to conduct a biopsy. During a biopsy, a small sample or tissue of the affected area is taken and tested in the laboratory. The tissue cells are analysed for cancer or any precancerous occurrences that may indicate a risk of any future malignancies. Early diagnosis simplifies the treatment prevents undue morbidity.?
Oral screening in high-risk population can achieve catching the disease at its onset. Since screening is the most cost-effective measure to reduce the disease burden, it should be stressed upon by every healthcare provider. Together we can conquer this curse by increasing awareness about this preventable & avoidable cancer.
About the author: Dr. Avinash Chaitanya is a Consultant in Head and Neck Surgical Oncology at CARE Hospitals, Hi-Tec City, Hyderabad. All views/opinions expressed in the article are of the author.?