Oral cancer is a major problem in the Indian subcontinent where it ranks among the top three types of cancer in the country. Age-adjusted rates of oral cancer in India is high, that is, 20 per 100,000 population and accounts for over 30 per cent of all cancers in the country. The variation in incidence and pattern of the disease can be attributed to the combined effect of ageing of the population, as well as regional differences in the prevalence of disease-specific risk factors.

Oral cancer is of significant public health importance to India. First, it is diagnosed at later stages which result in low treatment outcomes and considerable costs to the patients who typically cannot afford this type of treatment. Second, 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 offers the best chance for long term survival and has the potential to improve treatment outcomes and make healthcare affordable. Third, oral cancer affects those from the lower socioeconomic groups, that is, people from the lower socio-economic strata of society due to a higher exposure to risk factors such as the use of tobacco. Last, even though clinical diagnosis occurs via examination of the oral cavity and tongue which is accessible by current diagnostic tools, many cases present to a healthcare facility at later stages of cancer subtypes, thereby reducing chances of survival due to delays in diagnosis.

Causes: Mouth cancers form when cells on the lips or in the mouth develop changes (mutations) in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. The mutations changes tell the cells to continue growing and dividing when healthy cells would die. The accumulating abnormal mouth cancer cells can form a tumour. With time they may spread inside the mouth and on to other areas of the head and neck or other parts of the body. Mouth cancers most commonly begin in the flat, thin cells (squamous cells) that line your lips and the inside of your mouth. Most oral cancers are squamous cell carcinomas.

Prevention: There’s no proven way to prevent mouth cancer. However, you can reduce your risk of mouth cancer if you:

• Stop using tobacco or don’t start.
• Drink alcohol only in moderation, if at all.             
• Avoid excessive sun exposure to your lips.
• See your dentist regularly. As part of a routine dental exam, ask your dentist to inspect your entire mouth for abnormal areas that may indicate mouth cancer or precancerous changes.

Treatment:

Surgery: Tumour present in lips, mouth, tongue can be removed with surgery. Surgical excision leads to disfigurement of face, drooling of saliva from angle of mouth, partial or complete loss of tongue and voice, reduced mouth opening in case of lip cancer. Disfigurement can be corrected cosmetically by plastic surgery. Functional losses may persist.

Radiation therapy: Treatment of cancer by rays (gamma, electron, photos and protons) is called radiation therapy. IMRT, IGRT are advanced form of radiation therapy that have the ability to spare surrounding organs as well as precisely deliver accurate dose to tumour. Post-surgery radiation therapy is called adjuvant therapy and reduces possibility of locoregional recurrence.

Chemotherapy: Chemotherapy is a medicine which is given in form of injections or tablets under supervision of oncologist. Mostly, it is given on a weekly basis during radiation therapy to enhances effects. Common side effects are hair loss, loss of appetite, nausea, vomiting, constipation and reduced blood count.

The Writer is Dr Arun Kumar Verma Senior Oncologist at MAX HOSPITAL,NEW DELHI