Look around you. How many times can you count pan-masala stains on the walls around you? There are at least 375 pan-masala companies in India churning out the finest gutkha that money can buy.
The last time we checked, there was a close connection between chewing tobacco and oral cancer. Underlining the pressing need to regulate flavoured and smokeless tobacco (SLT) products in India, a research paper published in the Journal of Cancer Policy has pointed out that SLT use contributes to over 50% of oral cancer cases in the country.
That’s more than half of oral cancer cases in a country. Let that sink in. Half of all oral cancer cases in India exist because people constantly want to go “khwaaak thoooooo”.
What is oral cancer?
Let’s get the obvious out of the way. Oral cancer is mouth cancer. It is the most common form of head and neck cancer, affecting people aged 60 and older.
Oral cancer impacts the lips, the first parts of the tongue, the mouth roof, and the floor. It also impacts the oropharynx—that last part of your tongue and roof of your mouth—your tonsils, and the sides and back of your throat.
Mouth cancer is a cell growth that begins in the mouth. It can occur in any of the parts that comprise the mouth. Here’s where the cancer occurs most.
Lips
Gums
Tongue
Inner lining of the cheeks
Roof of the mouth
Floor of the mouth
The mouth is also known as the oral cavity. Cancer that occurs in the mouth is occasionally known as oral cancer or oral cavity cancer. Mouth cancer is one of several cancers that are considered to be varieties of head and neck cancer. Mouth cancer and other head and neck cancer often share treatment paths.
There are several types of oral cancer. Some of them are enumerated below.
Squamous cell carcinoma
Most oral cancers come under this category. Such tumours come up within the thin squamous cells which line the throat and mouth. Squamous cell carcinomas are treatable in its early stages with surgery and radiation therapy. However, it might spread into the deeper layers of tissues in and around the oral cavity.
Verrucous carcinoma
This is a subtype of squamous cell carcinoma. It is a slow-growing cancer and normally does not spread. Common symptoms of oral verrucous carcinoma are bad breath, issues with swallowing and pain.
Minor salivary gland carcinoma
Minor salivary gland carcinomas are quite a rare form of oral cancer. Most cases come up in the mouth. This cancer might also happen in the soft palate, voice box or sinuses. Treatment includes surgery, chemotherapy and radiation therapy.
Lymphoma
Lymphoma is a type of cancer that affects the lymphatic system. While not common in the oral cavity, lymphoma might sometimes develop within the soft tissues of the mouth or jaw. Common treatments for oral lymphoma include chemotherapy and radiation therapy.
Mucosal melanomas
Mucosal melanomas are composed of brown or black tumours. They grow to an average of four centimeters. These are quite rare. Bleeding and lumps are the symptoms most commonly seen. For mucosal melanomas, surgery is required. If doctors can’t get rid of the tumour surgically, they might offer chemotherapy, but it’s not as effective.
Oral cancer begins in the squamous cells in the oral cavity. Squamous cells are flat and look like fish scales under a microscope. Regular squamous cells become cancerous when their DNA changes and cells start growing and multiplying. Over time, these cancerous cells can spread to other areas inside the mouth, the head and neck, and other parts of the body.
What causes mouth cancer is not always clear. The cancer begins as a growth of cells in the mouth. It usually starts in cells known as the squamous cells. These flat, thin cells line the lip and inside of the mouth. Usually, oral cancers are squamous cell carcinomas.
Mouth cancer occurs when cells on the lips or in the mouth develop DNA changes. A cell’s DNA holds the instructions that dictate what the cell should do. In healthy cells, the DNA tells the cells to grow and multiply at a set rate. The DNA also tells the cells when to die.
In cancer cells, the DNA gives different instructions. The changes tell the cancer cells to grow and multiply rapidly. Cancer cells can keep living when healthy cells die. This results in too many cells.
The cancer cells might come together to form a mass or a tumour. This tumour can grow, invade, and destroy body tissue. In time, the cancer cells can break away and spread to other body parts. When this occurs, it is known as metastatic cancer.
Risk factors that can increase the risk of having mouth cancer include.
Tobacco
This is never good news. All sorts of tobacco increase the risk of mouth cancer. This includes cigars, pipes, chewing tobacco, cigarettes and snuff. Any kind of tobacco that you partake of can increase your risk of oral cancer.
Drinking Alcohol
Frequent and heavy consumption of liquor increases your risk of mouth cancer. In fact, it is a double whammy if you use tobacco and alcohol together.
Excessive Sun Exposure to the Lips
Exposure to ultraviolet light from the sun and tanning lamps increases the risk of lip cancer.
Being Exposed to Human Papillomavirus
Human papillomavirus, also known as HPV, is a common virus that passes through sexual contact. For the most part, it causes no issues and disappears on its own. For others, it causes changes in the cells that can result in many kinds of cancer, including mouth cancer.
A Weak Immune System
If the immune system is compromised by medicines or illness, there is a higher chance of mouth cancer. Since the immune system fights everything that harms the body, a weaker immune system exposes you to many threats. Cancer is no exception.
Oral cancer has many signs and symptoms that might be confused for common problems or changes in the mouth. For instance, you might notice patches inside the mouth that you cannot scrape away.
Such patches might be pre-cancerous conditions. Below are conditions that appear as patches in the mouth and throat, but they’re different colours.
Leukoplakia - These are flat white or gray patches in the mouth or throat.
Erythroplakia - These are slightly raised or flat red patches. Such patches might bleed when scraped.
Erythroleukoplakia - Such patches are red and white.
Common signs and symptoms of oral cancer include:
Sores on the lip or inside of the mouth, which bleed easily, and might not heal within two weeks.
Areas in the mouth that bleed for no obvious reason.
Numbness, pain or tenderness on the face and neck or in the mouth happen without apparent reason.
Issues with chewing and swallowing, speaking or moving the jaw or tongue.
Unintentional weight loss.
Earache
Chronic bad breath.
Your dentist might spot potential oral cancer when you go for one of your regular checkups. They might follow up with preliminary tests or send you to an oral and maxillofacial surgeon, or head and neck surgeon. Such specialists are also known as ear, nose and throat specialists.
Oral cancer tests include.
Physical Examination
Your doctor will look at the entire inside of your mouth and might feel around your mouth. They might also examine your head, neck and face for potential signs of pre-cancer or cancer.
Brush Biopsy
Also known as scrape biopsy or exfoliative cytology. In this procedure, doctors use a small brush or spatula to slowly scrape the area in question to obtain cells to examine for cancer.
Incisional Biopsy
Your doctor will remove tiny bits of tissue to get cells to be examined for cancer.
Indirect Laryngoscopy and Pharyngoscopy
Your doctor might use a small mirror with a long, thin handle to inspect the throat, base of the tongue, and part of the larynx.
Direct Pharyngoscopy and Laryngoscopy
Doctors might use an endoscope to look at areas of the throat and mouth you cannot see with mirrors. An endoscope is a thin, flexible tube with an attached light and a viewing lens.
The three main treatment options for oral cancer are surgery, chemotherapy and radiation therapy. Speak to your doctor regarding purpose, ways to manage side effects, and side effects for all your options.
Your doctor considers many factors prior to recommending treatment. These factors are -
The kind of cancer that you have.
If the oral cancer you have has managed to spread from the original site to other parts of the mouth and throat to other body parts.
Your general health.
Your age.
The most common surgeries for oral cancer are -
Primary tumour surgery - Doctors get rid of tumours through your mouth or an incision in the neck.
Glossectomy - This is the partial or total removal of the tongue.
Mandibulectomy - This is surgery for oral cancer in the jawbone.
Maxillectomy - This surgery removes part or all of the hard palate, the bony roof of the mouth.
Sentinel lymph node biopsy - This test helps doctors figure out whether the cancer has spread beyond the original oral cancer.
Neck dissection - This surgery is done to get rid of lymph nodes from the neck.
Reconstruction - Surgery that gets rid of large areas of tissue might be followed by reconstructive surgery to fill gaps left by the tumour or replace part of the lips, jaw, palate or tongue. In certain cases, constructive surgery is performed taking healthy bone and tissue from other areas of the body.
Radiation therapy
This therapy uses strong beams of energy to kill cancer cells or prevent them from growing. Your doctor might combine this with other treatments.
Targeted therapy
This cancer treatment depends on drugs or other substances to precisely identify and attack certain kinds of cancer cells without hurting normal cells. Monoclonal antibodies are immune system proteins that are created in the lab and used to treat cancer.
Chemotherapy
Your doctor might use anti-cancer drugs that kill cancer cells, including treatments that impact most other body parts.
Immunotherapy
This is a cancer treatment that engages the immune system to fight the disease. This treatment is occasionally called biological therapy.
You can prevent oral cancer, in fact, you can play an active role in preventing it.
Stop tobacco.
Stop drinking.
Use sunscreen.
Get vaccinated for human papillomavirus.
Eat a balanced diet.
Have regular dental check-ups.
In conclusion, oral cancer is the most common cancer in India. What can we do to prevent people from falling prey to this? Guthka needs to be banned, for starters. Apart from that, alcohol, tobacco and other harmful substances need to be curbed.
There are many ways to treat oral cancer but why talk about treatment when we can talk about prevention? Make sure you take the necessary steps to remain cancer free.
What is oral cancer?
Oral cancer refers to cancer that develops in the tissues of the mouth or throat, including the lips, tongue, gums, cheeks, hard palate, and the floor of the mouth. It can also affect the salivary glands and the back of the throat.
What are the main causes of oral cancer?
The leading causes of oral cancer include:
Tobacco use (smoking and smokeless tobacco)
Heavy alcohol consumption
Human papillomavirus (HPV) infection
Poor diet (low in fruits and vegetables)
Sun exposure (which can lead to lip cancer)
A history of oral cancer or other cancers
What are the early signs of oral cancer?
Early symptoms of oral cancer may include:
A persistent sore or ulcer in the mouth that doesn’t heal
Red or white patches in the mouth or on the lips
Pain or difficulty swallowing or chewing
A lump or thickening in the cheek, neck, or mouth
Unexplained bleeding in the mouth
Numbness or pain in the mouth, lips, or tongue
How is oral cancer diagnosed?
Oral cancer is typically diagnosed through:
A thorough physical examination by a dentist or doctor
A biopsy of suspicious areas in the mouth or throat
Imaging tests (such as X-rays, CT scans, or MRIs) to check for cancer spread
Is oral cancer preventable?
Yes, oral cancer can be prevented to some extent by:
Avoiding tobacco products
Limiting alcohol consumption
Practicing good oral hygiene
Eating a healthy diet rich in fruits and vegetables
Using sunscreen on your lips when exposed to the sun
