Oral cancers – King of all Cancers in India

Introduction

India the land of Chewing tobacco is also the land of Oral Cancer. India ranks the highest in the World in terms of both incidence and prevalence of Oral Cancers. And more than that we have the highest number of people harboring premalignant lesion in the mouth potential to turn malignant. Fortunately, oral cancers are the easily detectable, easily curable and more importantly easily preventable. But tragically most of the patients reach the health care facility in late stage with dismal anatomical, functional and life expectancy outcome.

April is designated as the oral cancer awareness month with a purpose to make all out efforts to reach out to public, physicians, surgeons and dental specialists so that they incorporate the knowledge in their practice which will make a huge difference in the incidence as well as outcome for these patients. Further the common problem of tobacco, Submucosal fibrosis and premalignant lesions needs to be handled by the primary doctors themselves to prevent and control at the primary level itself. For this it is important that the healthcare workers be updated with the knowledge. There is a huge gap and more of the primary health care specialists need to be trained.

For a common public and especially those into tobacco use both smoking or chewing have to practice self-examination of oral cavity as a routine.

In India, oral cavity cancer is among the three most common types of cancer. In India, the age standardized incidence rate of oral cancer is 12.6 per 100 000 population accounting for 30-40%of all malignancies in India.

Oral malignancies occur mostly as squamous cell carcinomas (SCCs) presenting as ulcers. They have a long period of premalignancy stage and mostly associated with a preventable cause. The treatment and outcome of these cancers depends on the stage at diagnosis. Early cancers 5 year survival can be 80% however most cancers present at late stage with a dismal 5 year survival of 20-30%. The only way to change the scenario in India is by early detection of these king of all cancers in India, and more importantly work for prevention of these cancers by stopping the cause- Tobacco

ICanCaRe understands the need of oral cancer screening in India and therefore have started Oral cancer screening and Tobacco Cessation Program in multiple hospitals including RSD Hospital Moradabad, Omaxe Green Valley Plaza Faridabad, Max Super Speciality Hospital Vaishali and more. 

Oral Cancer Prevention

The oral cavity starts from the lip upto the oral anterior pillar of the oropharynx. This consists of the following parts – the lips, the lining of the lips and cheeks, the teeth, the floor of the mouth under the tongue, the front two-thirds of the tongue, the glands that secrete saliva, the bony top of the mouth (hard palate), the gums, and the small area behind the wisdom teeth (retromolar trigone). Oral cancers can occur at any of these areas – the commonest areas being – sulcus between cheek and teeth, and the tongue, mostly related to the tobacco chewing habits the are where the quid is kept.

Oral cancer risk factors

Who have the higher chances of having these oral cancers? Risk factors determine the increase chance of having the cancers. Fortunately most of these risk factors are preventable or modifiable, unfortunately people are not ready to change!

• Tobacco and Alcohol Use: Tobacco consumption both smoking (cigarettes, bidi, hookah, etc) form or non smoking form (gutka, zarda, mawa, kharra, khaini, etc) is the commonest factor causing oral cancer. Oral cancers are in the rise in the young as well as the adult Indian population. This is mostly related to tobacco habit being started at early age. Alcohol, any form increases the risk of developing oral cancer. Alcohol accentuates the permissiveness of tobacco substantially increasing the chance of cancers of oral cavity. Alcohol alone also increases the risk. Stopping the use of tobacco and/or alcohol will decrease the risk of oral cancer.
• HPV:  The sexually transmitted human papillomavirus (specifically the HPV 16 type) has been linked to a subset of oral cancers, Although not common it is increasing in India.
• Diet: A diet high in fruits, vegetables, and fiber may decrease the risk of oral cancer.
• Age: The risk of developing oral cancer increases after 45 years of age. The age is rapidly decreasing in India due to starting of tobacco use at early age.
• Dentures and sharp teeth: Ill-fitting dentures or sharp teeth causing chronic trauma and friction is a risk factor for developing oral cancers.
• Sun Exposure: Sun avoidance or the use of sunscreen may decrease the risk of cancer of the lower lip. These cancers we commonly see in farmers exposed to sun for long duration.

Who are at risk of Oral Cancer?

•  Tobacco smokers/chewers.
• Drink excessive amounts of alcohol.
• Feel difficulty in swallowing or chewing food.
• Oral habits such as cheek or lip biting.
• Wear dentures that are old or ill fitting.
• Any swelling or lumps anywhere in the mouth.
• White, red or dark patches anywhere in the mouth.
• Repeated bleeding anywhere in the mouth.

Symptoms of oral cancer

•  Ulcer in the mouth that is not healing for more than 2 weeks (most common symptom).
• Any Non healing painless ulcer or growth anywhere in the mouth, which bleeds on touch.
• White or red patches (leukoplakia or erythroplakia) in the oral cavity.
• A lump or thickening in the cheek. 
• Notice any tingling or numb feeling anywhere in the mouth, neck or facial regions.
• Pain during swallowing.

Oral cancer early detection Quitting Tobacco

The oral cavity can be easily examined physically by self and by clinician. Many malignancies can be diagnosed at early stage and many lives saved

With awareness, self and clinical oral examination the number of new cases of oral cancer, as well as the number of deaths from oral cancer, has been decreasing.

Oral cavity examination – Once only once a month

The examination of the oral cavity is the best single modality that can detect oral abnormal lesions.  Self oral examination is easy to perform and is free. Mostly done self by standing in front of a mirror or by spouse or colleagues. Examine each and every area of oral cavity including by pushing the tongue to the opposite side. Look for any lesion – white, red patches, nodules, ulcers, swelling, bleeding points needs to be consulted by specialists. Self oral examination as an effective screening technique that includes extraoral and intraoral examination. A simple test of extent of mouth opening (by TrisCaRe) can detect the development of Submucosal fibrosis and the chance of harboring some Premalignant or frank malignancy in the oral cavity.

Each individual must self -examine the oral cavity atleast once a month and if they notice any of the symptoms mentioned above should immediately visit the doctor.

A clinical examination by a specialist is advised on a regular basis. For a tobacco user please get yourself examined every 6 monthly and continue this even after you quit tobacco. The health professional will examine your oral cavity and when needed with advise more tests.  

Clinical oral examination by a trained or certified specialist is a must every 6 months for those who consume tobacco and/or smoke.

Oral cancer prevention – Quitting Tobacco!

This is the single most important factor can change the outcome. Quitting Tobacco can help you prevent many other associated diseases as well. Quitting tobacco is possible through proper medical evidence intervention technique by medication,7D behavioral therapy, and co-morbidity management.

Please visit ORAL SCREENING AND TOBACCO CESSATION CENTRE at the nearest centre to you for early detection and treatment of oral cancer.

Visit www.icancare.in/quittobacco or call 011-430-77695 for seeking assistance in quitting tobacco and preventing oral cancers.

(The Author – Dr. Pawan Gupta M.Ch. is Director of Surgical Oncology at Max Super Speciality Hospital, Vaishali. Patparganj and Noida. He is author the book – Win Over Tobacco Made Easy, Be Smart Do Not Start and is highly recognized for his work on Oral Cancer and Tobacco Cessation. He is the convenor for Certified Course in Tobacco Cessation under the Gujarat University)