India emerging as a major change for Photo-Dynamic therapy (PDT) and Photo-biomodulation (PBM) for Oral lesion management.

As a follow-up to my presentation and learning at the International Photodynamic Association Conference 2023 at FINLAND, and my quest to know more about photodynamic and photo-biomodulation for the oral cavity I was invited to the “WORKSHOP on PHOTOBIOMODULATION THERAPY IN HEAD AND NECK CANCER” at Indore on 11th September 2023 at the Indian Institute of Head and Neck Oncology, Indore.

It was an opportunity to understand the diverse use of the new modality of PBM and PDT in Oral Lesions. Although PDT has been available for quite some time and I have had some successful cases with PDT for oral cancers, the new molecules with fewer side effects and ease of use is going to change the way cancer will be treated in the future.

It is also good to know that so much is being done in this field in India and many takers for this.

I got to meet some of the pioneers in this field:

Dr. Praveen Arany, Past President of WALT (WORLD ASSOCIATION OF LASER THERAPY), Oral Biologist, Biomedical Engineering and Surgery, School of Dental Medicine, University of Buffalo, USA.

Dr. Rene Jene Bensandaoun, President, WORLD ASSOCIATION for PHOTOBIOMODULATION Therapy. He is from France and promoting PBM extensively the world over with new insights and use for the same.

Dr. Digpal Darkar, President of the Indian Institute of Head and Neck Oncology the pioneer and probably the first in India to do PBM for his patients of Oral cancers. He has shown that it is easy to do and gives immense relief to the patients. Would be starting the course on PBM at his Institute.

Dr. Rajkumari Sachdeva, ENT surgeon and HN oncologist is using the PBM for her patients extensively. She gave a demonstration of the same.

Here, I had the opportunity to meet the Director of RRCAT, Dr. Shankar V Nakhe, who invited me to his center where extensive research is being done for oral diagnosis and treatment with optics – spectroscopy, PBM, and PDT.  

The emerging technology and use of light as therapy and for the diagnosis of oral lesions it is going to change the way we treat oral lesions and cancers in the future.

https://www.linkedin.com/pulse/india-emerging-major-change-pdt-pbm-oral-lesion-management-gupta-1f

Oral cancers – Importance of Self Oral Examination: Identifying Chota Daana

April is recognized as Oral Cancer Awareness Month.

Head and Neck experts from multiple specialties’ unite together across the country to create sensitization about the importance of oral examination and hold oral screening camps for early detection and prevention of oral cancer. Experts always recommend to perform self examination once every month to detect the chota dana – the pre-malignant lesions that are curable, less dangerous and do not cause financial losses.

Importance of Self Oral examination Cannot be Underestimated

Any one with the habit of tobacco – chewing or smoking in any form is at a higher risk of cancers of oral cavity and it can happen anytime in life. But luckily oral cancer does not happen in just one day it takes few years of this habit to establish the changes required to get oral cancers. There is a long incubation period and you can take steps to rectify your life style.

Two things that is important for all tobacco users:

  1. Prevention
  2. Early detection

Prevention – Cancer can be prevented easily by quitting tobacco use and smoking. Most of the early mucosal changes can regress with quitting of smoking and tobacco. But if more advanced changes have taken place – like dysplasia and submucosal fibrosis they are likely to progress. The best thing any tobacco user can do is take help of the experts and quit tobacco and alcohol completely. This may halt or decrease the progression of the mucosal changes. Quitting tobacco is now easy with specialist care providing specific medicines, behavioral therapy, co-morbidity management and follow up by quit coaches. Download the ICanCaRe app (http://app.icancare.in). You can get your own book ‘WIN OVER TOBACCO – MADE EASY’. Or just call 011-43077695

Early Detection – Oral Cancers just do not happen in one day. If you had few smoking or chewing tobacco in your lifetime maybe you are at a low risk, but for those who had regular tobacco products and especially started as a teen, are at high risk throughout life even after quitting tobacco. Luckily the oral lesions can be self-examined and early changes detected easily by just self-examining the mouth and checking all the areas inside the mouth – inner walls of the cheeks, upper palate, below the tongue, on the gums, towards the epiglottis, etc. Just notice for occurrence of red patches, white patches or small white ulcer like lesions in the mouth. If such changes are noticed, medical assistance should be immediately taken to detect any malignant lesions early and treat them in the early stage itself. Checking the mouth once every month is advised by the experts. Following points should be notices again:

For all who are at high risk of oral cancers (all smokers and tobacco chewers) must examine their mouth at least once a month.

Steps of Oral Examination:

  • Rinse your mouth with plain water to remove all the removable stains from the paan masala
  • Wash your hands with soap, Stand in front of the mirror.
  • Look for any swelling or puckering on the face or neck.
  • Feel with your fingers for any hardness or lumpy areas on face or neck.
  • Check for any lesions on the lips both upper and lower.
  • Check your mouth opening
  • Measure mouth opening with TrisCaRe instrument or otherwise a rough estimate with the vertically placed number of fingers that can easily pass with the mouth open. Normally more than 3.5 cm on TrisCaRe or 4 fingers (atleast 3 fingers) will be considered as adequate.
Self-check for Trismus

TriCaRe for Mouth Opening Measurement and Jaw Motion Rehab System

Now open your mouth and in a clockwise direction visualize all the areas in the mirror for any lesion. Take help of your fingers to push the cheek and tongue. The cheek, both the sulcus, alveolus, Floor of mouth, hard palate and soft palate. Look for any restrictions of tongue movement. Protrude the tongue out and look at all the areas for any lesions. With the fingers feel for any lump, hardness in any area of the oral cavity.

If you find any abnormality please report to a specialist (trained for the purpose).

If you have decreased mouth opening it may be start of the submucosual fibrosis which would immediately require intervention to halt the progress. This would warrant regular use of TrisCaRe through out life.

Oral Cancer king of all cancers in 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. To control the disease you are important. Be the Tobacco Marshal  in the society, and crusade the change to save the youth from tobacco and cancer.

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.

Max Super Specialty Hospital understands the need of oral cancer screening in India and therefore have started Oral cancer screening program in association with ICanCaRe at Max Noida and Vaishali.

(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 convener for Certified Courses in Tobacco Cessation under the Gujarat University. Launched the campaign #SAVEtheyouth #winovertobacco)

Make quitting tobacco a pleasure journey. Talk to the experts. Call ICanCaRe Quitline 011-43077695  or visit www.icancare.in/quittobacco to join the tobacco/smoking quit program today.

Make your appointment today for ORALSCREENING at MAX HOSPITAL  – Noida and Vaishali.