Tobacco and Oral Cancer

Every year, 31 May is marked as World No Tobacco Day highlighting the health and additional risks associated with tobacco use and advocating for effective policies to reduce tobacco consumption.

Out of all the diseases like cardiovascular diseases, chronic obstructive pulmonary disease and others linked to use of tobacco, Oral Cancer is most common. It is among the top three types of cancers in India

Cancer of the mouth has emerged as the most common among men, followed by lung cancer; among women, breast cancer and cervical cancer continue to be the most common, according to a report released by the Indian Council of Medical Research.

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. 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. Use of tobacco in any form account for about 30% of all cancers in men and women & 80% of all head and neck cancers say no to tobacco for good health.

High prevalence of oral cancer in India is attributed primarily to the most common form of tobacco consumption i.e. keeping the tobacco in mouth. Be it in the form of Gutka, Quid, snuff and so on. 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.

Oral Cancer

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 mainly because of erosion of major blood vessels and erosion of the base of the skull, Cachexia and secondary infection of the respiratory tract.

Check out best cancer specialist hospital in India.

Your treatment team

Oral cancer treatment requires a team effort which includes surgical, medical and radiation oncologists along with Dietician, Physiotherapist, prosthodontists, Speech and Swallowing therapists and often a Psycho-Oncologist.

TREATMENT:

1. Surgery

For mouth cancer treatment, the aim of mouth cancer surgery is to remove any affected tissue while minimising damage to the rest of the mouth.

If your cancer is advanced, it may be necessary to remove part of your mouth lining and, in some cases, facial skin. This can be replaced using skin taken from elsewhere in the body, such as your forearm or chest.

2. Radiotherapy

Radiotherapy uses doses of radiation to kill cancerous cells. In mouth cancer, it's usually used after surgery to prevent the cancer returning. In throat cancer, it's often the first treatment to be given, in combination with medication (chemoradiotherapy).

The treatment is usually given every day over the course of six weeks, depending on the size of the cancer and how far it's spread.

3. Chemotherapy

Chemotherapy is sometimes used in combination with radiotherapy when the cancer is widespread.

Chemotherapy is a category of cancer treatment that uses one or more anti-cancer drugs.

4. Targeted Therapy

Targeted therapy is a special type of chemotherapy that takes advantage of differences between normal cells and cancer cells.

Targeted therapy is a cancer treatment that uses drugs.The drugs known as targeted therapy help stop cancer from growing and spreading. They work by targeting specific genes or proteins. These genes and proteins are found in cancer cells or in cells related to cancer growth, like blood vessel cells.

Targeted drugs can be used as the main treatment for some cancers, but in most cases they’re used with other treatments such as chemo, surgery, and/or radiation therapy. 

Research & Development

Since oral cancer is diagnosed at later stages, it results in low treatment outcomes. Rural areas in middle- and low-income countries also have inadequate access to trained providers and limited health services. As a result, delay has also been largely associated with advanced stages of oral cancer.

Earlier detection of oral cancer can decrease the death ration to some extent.

Regarding diagnosis and treatment, there are giant strides in immuno-histo-chemistry for pathological diagnosis, good imaging modalities with MRI and PET scans, excellent organ preserving surgeries without much damage to the functioning of speaking and swallowing using lasers, etc, and also good precision radiation therapy by way of IMRT, IGRT and Brachytherapy. There new and less toxic chemotherapy and targeted therapies available which act by itself or in tandem with surgery and radiation for optimal outcomes.