Oral cancer is the sixth most common cancer in the world, with India contributing a third of the total burden. Each year, more than 3,50,000 new cases are diagnosed worldwide and 177,000 deaths occur, but with significant geographic variations and risk factors. In India, every year about 1,36,000 new cases and about 57,000 deaths are reported. Oral cancer is the most prevalent cancer in India, accounting for over 30% of all cancers. We are on the verge of an epidemic of oral cancer.
A majority (60-80%) of patients with oral cancer present at an advanced stage, which would have a significant impact on cure rates. Important functions like chewing, swallowing, speaking and breathing are severely impaired.
Squamous cell carcinomas of the mouth (OSCC) account for more than 90% of all oral cancers. It usually results from potentially malignant lesions such as oral submucosal fibrosis, leukoplakia (whitish spot), erythroplakia (reddish spot), oral lichen planus (a chronic inflammatory autoimmune disease), proliferative verrucous leukoplakia are the most common and are currently known as potentially malignant disorders (OPMD). Early detection and management of OPMD are necessary to minimize or even eliminate the risk of transformation into oral cancer.
Some important causative factors of oral cancer
Consumption of tobacco in all its forms: tobacco, beedis, cigarettes, hookah, cigars, electronic cigarettes, smokeless or chewing tobacco, pan masala, gutkha, paan, betel quid, betel nut, khaini, mishri, mawa, kharra , zarda and snuff.
Poor oral hygiene
Sharp tooth or ill-fitting denture causing chronic irritation of the oral mucosa
Diet low in fresh fruits and vegetables.
About 85-90% of oral cancers are linked to tobacco and alcohol consumption, which are the two most important risk factors. According to the Global Adult Tobacco Survey in India, 35% of the country’s adult population uses tobacco in one form or another.
Signs and Symptoms of Oral Cancer
White or red patch in the mouth
Persistent or non-healing sores or ulcers in the mouth for > 2 to 3 weeks
Swelling or bumps on the lips, gums or other areas inside the mouth and in the neck or unexplained numbness
Difficulty chewing or swallowing
Dentures do not fit or become uncomfortable
Difficulty moving the tongue or a gradual decrease in the opening of the mouth
Oral cancer can be detected by:
A proper physical examination of the mouth and neck regions to look for any suspicious changes in the oral cavity and enlarged or prominent lymph nodes in the neck.
A biopsy is the gold standard for diagnosing oral cancer. A tissue sample is taken from the most representative part of the suspicious oral lesion and sent for histopathological examination.
Computed tomography (CT), magnetic resonance imaging (MRI), or positron emission computed tomography (PET) can be used to diagnose oral cancer.
Surgery is the mainstay of curable oral cancer.
It removes cancerous growth and structures involved in the oral cavity with proper margins.
Surgery alone would suffice in the treatment of cancer at an early stage (stages I and II). But, for the advanced stages (stage III and IV), multidisciplinary management involving initial surgery, followed by either radiotherapy or chemoradiotherapy will be necessary as part of the curative treatment.
With early diagnosis and proper treatment of oral cancer, cure rates can be as high as 85-90%. It would also significantly reduce the cost and improve the functional and aesthetic outcomes associated with the treatment.
Smoking is the most important modifiable risk factor for oral cancer. Do not abandon ! Oral cancer is a potentially preventable condition due to its relationship to familiar risk factors and its ease of detection.
(The author is consultant, head and neck oncology)