Watch that mouth, literally

Swati Uppal & Abhishek Puri

When talking about cancer, we usually think of cancer of the blood, breast, bladder and the like. Ironically, despite being the most accessible and visible part of human body, oral cancer gets the least amount of attention. It also accounts for over 30 per cent of cancer deaths in India, amounting to over 1 million annually. India is certainly not in safe space because of the easy availability of tobacco (as per the Global Adult Tobacco Survey) in the country; however, deaths because of oral cancer are preventable.

Because of the lack of knowledge and awareness, oral cancers, as a group, are also not catered to as much in the post treatment or rehabilitation phase. However, early detection, proper treatment plan and execution, followed by good post treatment care, can help the patient get back to his regular lifestyle in most cases.

Head and neck cancers

Head and neck cancers include that of the voice box, throat, lips, mouth, nose and salivary glands. Most commonly, they arise in cells lining moist surfaces such as mouth and throat.

Causes of oral cancer

Men are twice as likely to contact oral cancer than women. As they become older, the risk increases proportionately. Tobacco smoking increases risk by six times; when chewed, it increases by an astounding 50 times! Excessive consumption of alcohol increases the risk proportionately. Certain strains of human papilloma virus (HPV) are associated with cancer of tonsil area.

Read the signs 

Your dentist/ physician will conduct a complete oral examination. You can always be alert for the following symptoms:

• If you feel a lump or swelling inside the mouth or on the neck
• Gradually increasing pain or difficulty in chewing, swallowing or speaking
• Long standing hoarseness of the voice
• Pain or numbness in any area of the mouth
• Loosening of teeth/swelling of the jaw or difficulty wearing dentures
• Abnormal bleeding in the mouth
• A long standing sore on the lips that doesn’t go away
• A persistent earache

The treatment

Depending on the location and extent of disease, several approaches — surgery, chemotherapy or radiation therapy — are advocated. These are given in isolation or in combination. Integrated care, involving dentists, swallowing and speech pathologists, clinical nutritionists and physiotherapists is required for optimal outcome. Smoking cessation is an active part of treatment program that may require medication for tobacco de-addiction.

There is a lot of emotional component to the diagnosis of cancer, so, do not despair. Oral cancer is definitely curable.  Experiencing anxiety and hopelessness is natural. Seek counselling from a clinical psychologist, if required. A trained counsellor is capable of offering guidance for self empowerment and help one see through this traumatic upheaval.

Teeth with poor health need to be extracted before the start of treatment and a thorough cleaning (scaling) to be done to avoid future dental complications. A prosthodontist is a highly specialised maxillofacial rehabilitation specialist, who specialises in functional and aesthetic restoration of any defects. This restoration is critical to the process of complete treatment and care, especially after surgery.

However, despite the intensive therapies (mutilating or non mutilating surgeries and best of chemotherapy along with radiation therapy) five-year survival rates were 91 per cent for stage I disease and fell to about 32 per cent in locally advanced stages.

Prevention is better

Some easy lifestyle changes can go a long way in controlling the onset of the disease.

Quit smoking or the use of any form of tobacco immediately. You might need help with smoking cessation program in order to avoid “smoking pangs”. Remember, nicotine (and the 3,000 other chemicals in cigarette smoke) are highly dangerous to you and your family members. 

Discourage children and young adults from experimenting with harmful lifestyles and habit initiation.

Eat plenty of fresh fruits and green-yellow vegetables (five to six portions per day).

Brush and floss your teeth regularly. Please seek your dentist’s guidance on this. An unhealthy infected mouth hampers your body’s ability to fight off potential cancers. See your dentist every six months and proactively ask for an oral cancer screening to be done. 

Always pay attention to symptoms. 

In the end, as they say, prevention is always better than cure. Oral cancer is both preventable and treatable, provided one is cautious of the causes and watchful for early detection of symptoms.

— Dr Uppal is a Chandigarh-based prosthodontist and Dr Puri is a radiation oncologist