Mouth Cancer in India
Compiled by Dr Suwas Darvekar.
Copyright © 2011 [Sangeeta Darvekar Charitable Trust]. All rights reserved.
Why a program on Oral Cancer?
Oral cancer is the most common cancer in India and according to Dr Geoff Craig “People are dying of oral cancer because of ignorance”. So Sangeeta Darvekar Charitable Trust thought of a mass awareness program about oral cancer, its causes, its treatment and resultant problems and the way of preventing this cancer.
Some Stunning news
We approached Dr Surendra Shastri head of preventive oncology at TATA MEMORIAL HOSPITAL and he gave us a stunning information that "There are about 7,00,000 new cases of cancers ever year in India out of which tobacco related cancers are about 3,00,000, cancer of uteri are 1,00,000 and 80,000 breast cancer. Cost of treatment of oral cancer is about 3.5 lakh. This can be completely prevented by simple changes in lifestyle and regular screening and even have health benefits that reach beyond cancer. About 2000 deaths a day in India is tobacco related."
On receiving this stunning news we thought of enquiring for the reason of such high incidence of oral cancer. We found that the reason for such high prevalence of oral cancer in India was primarily because of the most common form of tobacco consumption is keeping the tobacco in mouth. Be it in the form of Gutka, Quid, snuff or misri and so on. Tobacco when kept in mouth leaches out carcinogens, which act on oral mucosa causing neoplastic changes. Habit of smoking is also equally dangerous. Tobacco contains potent carcinogens including Nitrosamines (nicotine), polycyclic aromatic hydrocarbons, Nitrosodiethanolamine, Nitrosoproline, and polonium. Tobacco smoke contains carbon monoxide, Thiocyanate, hydrogen cyanide, nicotine and metabolites of these constituents.
Common form of tobacco consumption in India
Gutka is a mixture of betel nut and chewing tobacco. It is extremely addictive and is apparently targeted at youngsters.
Quid is the mixture of tobacco and lime and extensively consumed in India.
The tobacco when kept in mouth leaches out carcinogens, which act on the mucosa causing precancerous lesions, which lead to cancer.
According to the B.B.C "4 in 10 of all cancers in India are oral cancers".
This is because of extensive use of tobacco and betel quid.
There are three most common precancerous lesions seen in the mouth and they are
1. Oral leucoplakia
It is characterized by white patch on the buccal mucosa or any place in the mouth and is adjacent to the place where the tobacco quid is kept. The less likely place is floor of the mouth and tongue although 93% of leucoplakia at this sites turn malignant.
This is characterized by red velvety patch, which is not associated with any trauma or inflammation. It may present with or without leucoplakia. This lesion is easily missed out but is considered to have great malignancy potential.
3. Oral sub mucous fibrosis.
This condition is characterized by limited opening of mouth and burning sensation on eating of spicy food. This is a progressive lesion in which the opening of the mouth becomes progressively limited, and later on even normal eating becomes difficult.
It occurs almost exclusively in India and Indian communities living abroad.
Professor Newell Johnson an expert oral surgeon said, "we know this condition, oral sub mucous fibrosis has highest rate of transferring to malignancy of any of the so called pre-malignant lesions in the mouth. It is a very serious condition."
The next stage after the precancerous lesion is the Cancerous lesions. The most common form of cancer is Squamous cell carcinoma. It normally starts from any of the precancerous lesion in the mouth.
The most common sites of the oral cancer are the tongue and the floor of the mouth. The other common sites are buccal vestibule, buccal mucosa, gingiva and rarely hard and soft palate. Cancer of bucco-pharyngeal mucosa is common in smokers.
This cancer is extremely malignant and even if there is slight delay it spreads to lymph nodes of the neck. Once it spreads the prognosis becomes poor and death is inevitable and is because of erosion of major blood vessels and erosion of the base of the skull, Cachexia and secondary infection of the respiratory tract.
Treatment is surgery, and in advanced cases surgery followed by radiation therapy is performed. But even that is not always successful as 70% of the cases after treatment leads to relapse and the result is death. The treatment is successful only if the lesion is diagnosed early, but sadly many times, it is ignored and the patient reports when the lesion has spread so much that the treatment is impossible or even if done the long term prognosis is poor. The cost of the treatment is 3.5 lakh and in spite of this cost there is no guarantee that there is sure cure. And the surgery needs cutting half the face and tongue and extending to the neck and the patient looks horrible after surgery.
Stages of Cancer
The American joint committee on cancer has developed the Tumor (T), Node (N), and Metastasis (M) system of cancer classification. The TNM classification is basically a clinical description of the disease, but can also involve imaging in classification. T is the size of the tumor and T1 is <2 cm, T2 is >2 but < 4 cm, T3 is >4 cm and T4 is >4 cm with invasion of adjacent structures.
N0 is no lymph node
N1 is single ipsilateral node < 3 cm
N2a single ipsilateral node > 3 cm but < 6 cm
N2b multiple ipsilateral node < 6 cm.
N2c bilateral or contra lateral nodes < 6 cm
N3a ipsilateral node > 6 cm
N3b bilateral nodes > 6 cm
M0 is no metastasis and M1 is metastasis present.
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0; any T1 T2 T3, N1 M0
Stage IV T4 ANY N, M0; any T, N2 or N3; ANY T OR N WITH M1
Very important thing to remember
Most important factor in survival is the stage of the disease. Majority of the oral cancer is diagnosed when they become symptomatic. At least half difference in survival has been attributed to late diagnosis. Differences in genetics have not been identified in relation to risk and survival.
The lesion is usually painless in early stages and only when it becomes ulcerated and secondarily infected or invade adjacent nerve pain is the noticeable feature.
Initially oral cancer may be asymptomatic but a check up from a professional is recommended. But patients normally presents when pain and discomfort is predominant and then the prognosis becomes poor.
Diagnosis is established by many ways like applying dyes like Toluidine blue which may give false positive results in inflammatory lesion but never false negative, using X rays and scans to see the extension of the lesion and the bony involvement and the most confirmatory test is biopsy of the lesion and its histo-pathological examination
So friends if you want to save money, lead a healthy life style don’t want to suffer from cancer and its associated problems, stay away from tobacco in any form be it gutka, tobacco Quid, snuff, misri, smoking and so on.
Wish you a healthy life without tobacco and oral cancer.