Oral cancer- cause, symptoms and treatment
Over a third of all cancers are
related to the use of tobacco. Tobacco-related cancers constitute a
major proportion of the so-called ‘preventable cancers’—cancers related
to dietary habits and lifestyle. Both epidemiological and experimental
studies have clearly shown that chronic exposure to tobacco in any form
induces changes in the cells that lead to the development of cancer.
Smokers have a higher risk of lung and throat cancer, while those who
chew tobacco run an increased risk of cancer of the mouth, throat and
food passages. The brunt of the effect of tobacco is borne by the lungs
in smokers and by the oral cavity in tobacco chewers.
The extent of the carcinogenesis of tobacco can be gauged by the fact that even the metabolites of tobacco which are filtered by the kidneys and accumulate in the urinary bladder result in an increased incidence of kidney and bladder cancers in smokers. It is the rampant habit of tobacco-chewing which is responsible for the extremely high incidence of head and neck cancers in India (over a third of all cancers). This chapter deals with how addiction to tobacco has changed the lives of some and also impacted on the health of a nation.
Playing with fire became a dangerous habit
A businessman dealing with the manufacture and sales of ‘fire bricks’ used for lining furnaces in industries in order to provide insulation against the tremendous heat generated. Fire bricks were his passion. As business improved, work pressures increased and to ease his mind, he started playing with another kind of fire—pan masala, a chewable mixture of areca nut and lime paste with aromatic spices. Though technically the mixture he used did not contain tobacco, the effects of its long-term use could be as devastating and debilitating as tobacco-chewing.
In India, tobacco-chewing is not just a habit. It is no surprise, therefore, that the country has one of the highest incidences of oral cancer in the world and has the dubious distinction of being referred to as ‘the oral cancer capital’ of the world. Tobacco is generally consumed as a constituent of the betel nut, locally known as pan. Pan has traditionally been in use since generations by both men and women, young and old. It is even customary to serve pan during marriage functions and festivals. In recent times, tobacco has become commercially available in convenient, ready-to-use, attractive packs in forms such as gutka (a powdered mixture of tobacco and areca nut), khaini, mishri, snuff (which is inhaled through the nose) and pan masala (a mixture of areca nut and lime paste which may or may not contain additional tobacco).
Areca nut by itself has been shown by many scientific studies to be the cause of oral sub-mucous fibrosis, a condition characterized by stiffening of the inner mucosal lining of the cheek and other parts of the oral cavity due to the deposition of fibrous tissue. This restricts the extent to which the mouth can open and in severe cases, can result in a total inability to open the mouth. Though not cancer per se, this is an extremely debilitating condition by itself and very difficult to treat. Oral submucous fibrosis is also pre-cancerous and a significant proportion of people with this condition ultimately succumb to oral cancer. This condition is increasingly being seen among students and young adults who, attracted by the stylish packaging and marketing of pan masala products, start using them at an early age and get addicted. The absence of tobacco engenders the erroneous belief that these products are safe to consume, with disastrous consequences. It is estimated that there are over 20 million adolescents in the age group of 15–20 years who are addicted to some form of tobacco or pan masala in India.
The Indian government has only recently woken up to the reality of the health hazards of these chewable tobacco products. While restrictions on smoking in public places and a ban on the advertisement of all tobacco products have been in existence since 2003, they have done precious little to curb the evil of tobacco-chewing. Subsequent to 2003, a modest reduction in the sale of cigarettes and other smoking products was negated by a significant increase in the sale and consumption of chewed tobacco.
A pictorial warning depicting oral cancer on all tobacco products (including chewed) was to replace the existing warnings from June 2010 on-wards, However pressure from the strong tobacco lobby has put this on hold as of now. The present warnings enforced from 31 May 2009 show an X-ray picture of a cancer stricken lung which is considered too soft to have any real impact Pictorial warnings have significantly reduced the consumption of tobacco products in countries such as Brazil and Mauritius and thus brought down the incidence of oral and lung cancers there.
Many countries of the European Union, Canada, Singapore and others have also adopted pictorial warnings with encouraging results. Hopefully, the Indian government will be able to resist pressures from vested interests to enact this legislation and curb the menace of tobacco-chewing, which has reached epidemic proportions in our country. Whether this rule, once enforced, will also apply to those pan masala products which do not contain tobacco is unclear. These products are equally dangerous and are consumed by a segment of the population that is largely clueless about their catastrophic effects. Maybe only public interest litigation on the lines of what happened in the United States during the eighties in connection with smoking can ultimately result in any significant impact on the evil of tobacco-chewing in our country.
Have you noticed a sore in your mouth that won’t go away? Is there a lump, or pain or numbness anywhere in your mouth or on your lips? If yes, do not neglect these. They could be signs of early oral cancer.
Most oral cancers begin in the tongue or in the floor of the mouth and are squamous cell carcinomas. They begin on the surface layer of the mouth and lips and if left untreated can spread to other parts of your body. Oral cancer includes cancers of the lips, cheeks, tongue, floor of the mouth, hard and soft palate, sinuses and throat (pharynx). It may originate in any of the tissues of the mouth or may be a result of metastasis from a different part of the body. If not diagnosed and treated early, they can be life threatening.
There are many risk factors for developing oral cancer. If you are a man, you are twice as likely to get oral cancer as a woman and the risk increases with age. You are more likely to develop a head and neck cancer if you have a history of cancer. Precancerous (premalignant) lesions are those lesions, which precede the development of full-blown cancer. These lesions are changes in skin or lining of the mouth that are not cancer but could trigger it. Common pre-cancerous conditions that occur in the mouth are Leukoplakia, Erythroplakia and Oral Submucous fibrosis.
Most cases of oral cancer are linked to one or the other form of tobacco use (cigarettes, smokeless tobacco, chewing tobacco, dipping snuff, cigars, bidis, etc.). The longer the duration you use these, the higher the risk. Tobacco contains around 4,000 chemical constituents among which more than two dozen are known carcinogens (cancer causing chemicals). It is the single biggest culprit in the development of almost all pre-cancerous lesions. In India, the incidence of head and neck cancers is extremely high due to rampant tobacco-chewing habit in the form of gutka, quid, misri, snuff, etc.
Heavy alcohol use is another big culprit. Alcohol is known to irritate the lining inside the mouth or gums to a certain extent. And the risk increases if you use both alcohol and tobacco.
Sunlight helps the skin produce vitamin D and facilitates calcium absorption by the body. But did you know that sun exposure over long periods of time may increase the risk of lip cancer?
Some studies also suggest that not eating enough fruits and vegetables may increase the chance of getting oral cancer.
Chronic irritation from rough teeth, dentures, fillings, etc. has been considered to a risk factor for Leukoplakia (a premalignant lesion).
Human Papilloma Viruses (HPV 16 and HPV 18) which cause cervical cancer are also being linked to cancer of the oropharynx (throat, base of tongue, tonsils and soft palate). These viruses are passed from person to person through sexual contact. Cancer at the base of the tongue, at the back of the throat, in the tonsils or in the soft palate may be linked with HPV infection.
Oral cancer may present itself with many symptoms, some of the common ones are listed below. However, you should know that having any of these symptoms does not always mean cancer. A good doctor or dentist will be able to help diagnose it right.
• Red (Erythroplakia) and white (Leukoplakia) patches on your lips or in your mouth
• Non-healing sore on your lip or in your mouth
• Swellings or lumps on the lips, gums, cheek, back of the throat etc.
• Bleeding in the mouth
• Numbness, loss of pain in any area of the mouth, neck or face
• Difficulty in moving the jaw or tongue
• Difficulty in chewing, swallowing or speaking
• Loosening of teeth
• A change in the fit of denture
• Ear pain
• Swollen lymph nodes in the neck
• Unexplained weight loss
Early detection followed by appropriate treatment is very important for increasing survival rate and improving the quality of life. Hence a once a year screening for oral cancer is important. Most of the oral cancers can be diagnosed from lesions in the mouth. Your dentist will check for white or red patches, ulcerations, lumps and other signs in the mouth. If there is any area that is suspicious, he/she may use toluidine blue for vital staining which aids early recognition and hastens biopsy. However, Biopsy is the only definitive method of diagnosing oral cancer. Dental x-rays may show abnormalities in the bone. Other tests may include CT scan, Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET).
Read more about causes, symptoms, diagnosis and treatment of oral cancer.
Like all other cancers, treating oral cancers requires a multidisciplinary approach comprising of dental practitioners, surgeons, oncologists, nutritionists and rehabilitation specialists. If your tumour is small it is usually excised with surgery. The affected tissue is removed with minimal damage to other structures of the mouth. In advanced and extensive cancer a part of your mouth lining may be removed. If the cancer involves your tongue or jaw bone, they may need to be partially or completely removed. This may cause disfigurement of your face, head and neck which can be corrected with reconstructive surgery using bone grafts and surgical flaps. Depending on the stage of your cancer, radiotherapy and/or chemotherapy may be used along with surgery. You may find it difficult to chew, swallow and speak after your treatment. In such instances, rehabilitation may be necessary for you to return to normal activities as soon as possible. Dental or facial prostheses may be fabricated for cosmetic and functional reasons. They help in restoring speech and swallowing to normal. Prostheses also support the lip and cheek.
After the treatment it is very important to follow-up with your doctor who will monitor your recovery and check if there is any recurrence of cancer.
THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES. PS- THOSE INTERESTED IN RECIPES ARE FREE TO VIEW MY BLOG- https://gseasyrecipes.blogspot.com/
FOR INFO ABOUT KNEE REPLACEMENT, YOU CAN VIEW MY BLOG- https:// kneereplacement-stickclub.blogspot.com/
FOR CROCHET DESIGNS https://my crochet creations.blogspot.com/
The extent of the carcinogenesis of tobacco can be gauged by the fact that even the metabolites of tobacco which are filtered by the kidneys and accumulate in the urinary bladder result in an increased incidence of kidney and bladder cancers in smokers. It is the rampant habit of tobacco-chewing which is responsible for the extremely high incidence of head and neck cancers in India (over a third of all cancers). This chapter deals with how addiction to tobacco has changed the lives of some and also impacted on the health of a nation.
Playing with fire became a dangerous habit
A businessman dealing with the manufacture and sales of ‘fire bricks’ used for lining furnaces in industries in order to provide insulation against the tremendous heat generated. Fire bricks were his passion. As business improved, work pressures increased and to ease his mind, he started playing with another kind of fire—pan masala, a chewable mixture of areca nut and lime paste with aromatic spices. Though technically the mixture he used did not contain tobacco, the effects of its long-term use could be as devastating and debilitating as tobacco-chewing.
In India, tobacco-chewing is not just a habit. It is no surprise, therefore, that the country has one of the highest incidences of oral cancer in the world and has the dubious distinction of being referred to as ‘the oral cancer capital’ of the world. Tobacco is generally consumed as a constituent of the betel nut, locally known as pan. Pan has traditionally been in use since generations by both men and women, young and old. It is even customary to serve pan during marriage functions and festivals. In recent times, tobacco has become commercially available in convenient, ready-to-use, attractive packs in forms such as gutka (a powdered mixture of tobacco and areca nut), khaini, mishri, snuff (which is inhaled through the nose) and pan masala (a mixture of areca nut and lime paste which may or may not contain additional tobacco).
Areca nut by itself has been shown by many scientific studies to be the cause of oral sub-mucous fibrosis, a condition characterized by stiffening of the inner mucosal lining of the cheek and other parts of the oral cavity due to the deposition of fibrous tissue. This restricts the extent to which the mouth can open and in severe cases, can result in a total inability to open the mouth. Though not cancer per se, this is an extremely debilitating condition by itself and very difficult to treat. Oral submucous fibrosis is also pre-cancerous and a significant proportion of people with this condition ultimately succumb to oral cancer. This condition is increasingly being seen among students and young adults who, attracted by the stylish packaging and marketing of pan masala products, start using them at an early age and get addicted. The absence of tobacco engenders the erroneous belief that these products are safe to consume, with disastrous consequences. It is estimated that there are over 20 million adolescents in the age group of 15–20 years who are addicted to some form of tobacco or pan masala in India.
The Indian government has only recently woken up to the reality of the health hazards of these chewable tobacco products. While restrictions on smoking in public places and a ban on the advertisement of all tobacco products have been in existence since 2003, they have done precious little to curb the evil of tobacco-chewing. Subsequent to 2003, a modest reduction in the sale of cigarettes and other smoking products was negated by a significant increase in the sale and consumption of chewed tobacco.
A pictorial warning depicting oral cancer on all tobacco products (including chewed) was to replace the existing warnings from June 2010 on-wards, However pressure from the strong tobacco lobby has put this on hold as of now. The present warnings enforced from 31 May 2009 show an X-ray picture of a cancer stricken lung which is considered too soft to have any real impact Pictorial warnings have significantly reduced the consumption of tobacco products in countries such as Brazil and Mauritius and thus brought down the incidence of oral and lung cancers there.
Many countries of the European Union, Canada, Singapore and others have also adopted pictorial warnings with encouraging results. Hopefully, the Indian government will be able to resist pressures from vested interests to enact this legislation and curb the menace of tobacco-chewing, which has reached epidemic proportions in our country. Whether this rule, once enforced, will also apply to those pan masala products which do not contain tobacco is unclear. These products are equally dangerous and are consumed by a segment of the population that is largely clueless about their catastrophic effects. Maybe only public interest litigation on the lines of what happened in the United States during the eighties in connection with smoking can ultimately result in any significant impact on the evil of tobacco-chewing in our country.
Have you noticed a sore in your mouth that won’t go away? Is there a lump, or pain or numbness anywhere in your mouth or on your lips? If yes, do not neglect these. They could be signs of early oral cancer.
Most oral cancers begin in the tongue or in the floor of the mouth and are squamous cell carcinomas. They begin on the surface layer of the mouth and lips and if left untreated can spread to other parts of your body. Oral cancer includes cancers of the lips, cheeks, tongue, floor of the mouth, hard and soft palate, sinuses and throat (pharynx). It may originate in any of the tissues of the mouth or may be a result of metastasis from a different part of the body. If not diagnosed and treated early, they can be life threatening.
There are many risk factors for developing oral cancer. If you are a man, you are twice as likely to get oral cancer as a woman and the risk increases with age. You are more likely to develop a head and neck cancer if you have a history of cancer. Precancerous (premalignant) lesions are those lesions, which precede the development of full-blown cancer. These lesions are changes in skin or lining of the mouth that are not cancer but could trigger it. Common pre-cancerous conditions that occur in the mouth are Leukoplakia, Erythroplakia and Oral Submucous fibrosis.
Most cases of oral cancer are linked to one or the other form of tobacco use (cigarettes, smokeless tobacco, chewing tobacco, dipping snuff, cigars, bidis, etc.). The longer the duration you use these, the higher the risk. Tobacco contains around 4,000 chemical constituents among which more than two dozen are known carcinogens (cancer causing chemicals). It is the single biggest culprit in the development of almost all pre-cancerous lesions. In India, the incidence of head and neck cancers is extremely high due to rampant tobacco-chewing habit in the form of gutka, quid, misri, snuff, etc.
Heavy alcohol use is another big culprit. Alcohol is known to irritate the lining inside the mouth or gums to a certain extent. And the risk increases if you use both alcohol and tobacco.
Sunlight helps the skin produce vitamin D and facilitates calcium absorption by the body. But did you know that sun exposure over long periods of time may increase the risk of lip cancer?
Some studies also suggest that not eating enough fruits and vegetables may increase the chance of getting oral cancer.
Chronic irritation from rough teeth, dentures, fillings, etc. has been considered to a risk factor for Leukoplakia (a premalignant lesion).
Human Papilloma Viruses (HPV 16 and HPV 18) which cause cervical cancer are also being linked to cancer of the oropharynx (throat, base of tongue, tonsils and soft palate). These viruses are passed from person to person through sexual contact. Cancer at the base of the tongue, at the back of the throat, in the tonsils or in the soft palate may be linked with HPV infection.
Oral cancer may present itself with many symptoms, some of the common ones are listed below. However, you should know that having any of these symptoms does not always mean cancer. A good doctor or dentist will be able to help diagnose it right.
• Red (Erythroplakia) and white (Leukoplakia) patches on your lips or in your mouth
• Non-healing sore on your lip or in your mouth
• Swellings or lumps on the lips, gums, cheek, back of the throat etc.
• Bleeding in the mouth
• Numbness, loss of pain in any area of the mouth, neck or face
• Difficulty in moving the jaw or tongue
• Difficulty in chewing, swallowing or speaking
• Loosening of teeth
• A change in the fit of denture
• Ear pain
• Swollen lymph nodes in the neck
• Unexplained weight loss
Early detection followed by appropriate treatment is very important for increasing survival rate and improving the quality of life. Hence a once a year screening for oral cancer is important. Most of the oral cancers can be diagnosed from lesions in the mouth. Your dentist will check for white or red patches, ulcerations, lumps and other signs in the mouth. If there is any area that is suspicious, he/she may use toluidine blue for vital staining which aids early recognition and hastens biopsy. However, Biopsy is the only definitive method of diagnosing oral cancer. Dental x-rays may show abnormalities in the bone. Other tests may include CT scan, Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET).
Read more about causes, symptoms, diagnosis and treatment of oral cancer.
Like all other cancers, treating oral cancers requires a multidisciplinary approach comprising of dental practitioners, surgeons, oncologists, nutritionists and rehabilitation specialists. If your tumour is small it is usually excised with surgery. The affected tissue is removed with minimal damage to other structures of the mouth. In advanced and extensive cancer a part of your mouth lining may be removed. If the cancer involves your tongue or jaw bone, they may need to be partially or completely removed. This may cause disfigurement of your face, head and neck which can be corrected with reconstructive surgery using bone grafts and surgical flaps. Depending on the stage of your cancer, radiotherapy and/or chemotherapy may be used along with surgery. You may find it difficult to chew, swallow and speak after your treatment. In such instances, rehabilitation may be necessary for you to return to normal activities as soon as possible. Dental or facial prostheses may be fabricated for cosmetic and functional reasons. They help in restoring speech and swallowing to normal. Prostheses also support the lip and cheek.
After the treatment it is very important to follow-up with your doctor who will monitor your recovery and check if there is any recurrence of cancer.
THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES. PS- THOSE INTERESTED IN RECIPES ARE FREE TO VIEW MY BLOG- https://gseasyrecipes.blogspot.com/
FOR INFO ABOUT KNEE REPLACEMENT, YOU CAN VIEW MY BLOG- https:// kneereplacement-stickclub.blogspot.com/
FOR CROCHET DESIGNS https://my crochet creations.blogspot.com/
Labels: alcohol, areca nut, dentures, dietary habits, kidney & bladder cancers, lip cancer, lung & throat cancers, Oral cancer, rough teeth, smokers, sub-mucous fibrosis, sun exposure, tobacco, Vitamin D
posted by G S Iyer at 11:29 PM
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