Oral Cancer: Early Warning Signs You Shouldn't Ignore

Oral cancer is a significant health concern in India. Understanding the oral cancer warning signs symptoms every Indian should know is crucial for early detection and improved treatment outcomes. This blog post, authored by Dr. Vidhyadharan Sivakumar, Clinical Director & Senior Consultant at THANC Hospital in Chennai, aims to provide comprehensive information about oral cancer, its risk factors, symptoms, and treatment options available in Chennai.

Understanding Oral Cancer: An Indian Perspective

Oral cancer, also known as mouth cancer, is a type of head and neck cancer that can occur in any part of the oral cavity. This includes the lips, tongue, gums, the lining of the cheeks, the floor of the mouth, hard and soft palate, and the oropharynx (the part of the throat at the back of the mouth). In India, oral cancer is one of the most common cancers, largely due to widespread tobacco use and betel quid chewing.

The incidence of oral cancer in India is significantly higher compared to many other countries. According to the National Cancer Registry Programme (NCRP) of India, oral cancer accounts for a substantial proportion of all cancer cases in men. Early detection and timely intervention are vital for improving survival rates.

Key Risk Factors for Oral Cancer in India

Several factors contribute to the development of oral cancer. Being aware of these risk factors can help individuals make informed lifestyle choices and take preventive measures.

• Tobacco Use: Smoking cigarettes, bidis, and cigars, as well as chewing tobacco, gutka, and betel quid, are major risk factors for oral cancer in India. The harmful chemicals in tobacco damage the cells in the mouth, leading to cancerous changes. A study published in The Lancet showed a strong correlation between tobacco consumption and the incidence of oral cancer in South Asia.
• Alcohol Consumption: Excessive alcohol consumption, especially when combined with tobacco use, significantly increases the risk of oral cancer. Alcohol can irritate the lining of the mouth and make it more susceptible to the effects of tobacco.
• Betel Quid Chewing: The practice of chewing betel quid (paan) is prevalent in many parts of India. Betel quid contains areca nut, which is a known carcinogen. Regular betel quid chewing can lead to oral submucous fibrosis, a precancerous condition that increases the risk of oral cancer.
• Human Papillomavirus (HPV): Certain types of HPV, particularly HPV-16, are associated with oral cancers, especially those occurring in the oropharynx (tonsils and base of the tongue). HPV-related oral cancers are often diagnosed in younger individuals who do not have a history of tobacco or alcohol use.
• Poor Oral Hygiene: Maintaining good oral hygiene is essential for preventing oral cancer. Chronic irritation and inflammation in the mouth due to poor oral hygiene can increase the risk of cancerous changes.
• Diet: A diet lacking in fruits and vegetables may also contribute to the risk of oral cancer. Fruits and vegetables contain antioxidants and other nutrients that protect the cells from damage.
• Sun Exposure: Prolonged exposure to sunlight, especially without protection, can increase the risk of lip cancer.

Recognizing the Warning Signs and Symptoms

Early detection of oral cancer is crucial for improving treatment outcomes. It's important to be aware of the oral cancer warning signs symptoms every Indian should know. If you notice any of the following symptoms, consult a doctor or dentist immediately:

• Persistent Sore or Ulcer: A sore or ulcer in the mouth that doesn't heal within two weeks is a common sign of oral cancer. These sores may be painless initially but can become painful as the cancer progresses.
• White or Red Patch: A white (leukoplakia) or red (erythroplakia) patch on the gums, tongue, or lining of the mouth can be a sign of precancerous or cancerous changes. Erythroplakia has a higher risk of being cancerous than leukoplakia.
• Unusual Bleeding: Bleeding in the mouth, especially without an obvious cause, should be investigated.
• Difficulty Swallowing or Chewing: Difficulty or pain when swallowing (dysphagia) or chewing can be a sign of oral cancer, especially if the cancer is located in the tongue or throat.
• Lump or Thickening: A lump or thickening in the cheek, tongue, or neck can be a sign of oral cancer.
• Numbness or Pain: Numbness, pain, or tenderness in any area of the mouth can be a symptom of oral cancer.
• Hoarseness: Changes in your voice, such as hoarseness, can be a sign of cancer in the larynx (voice box), which is often linked to oral cancer risk factors.
• Loose Teeth: Unexplained loosening of teeth can be a sign of oral cancer affecting the gums or jawbone.
• Jaw Pain or Stiffness: Pain or stiffness in the jaw can be a sign of oral cancer affecting the jawbone or surrounding tissues.
• Change in Denture Fit: If your dentures no longer fit properly, it could be a sign of changes in the mouth due to oral cancer.

If you're experiencing [symptoms], early consultation is crucial. Book an appointment with Dr. Vidhyadharan at THANC Hospital, Chennai.

Diagnosis and Staging of Oral Cancer

If you suspect you have oral cancer, your doctor or dentist will perform a thorough examination of your mouth and throat. If a suspicious lesion is found, a biopsy will be performed. A biopsy involves taking a small tissue sample from the affected area and examining it under a microscope to determine if cancer cells are present.

If cancer is diagnosed, further tests may be needed to determine the stage of the cancer. Staging helps determine the extent of the cancer and whether it has spread to other parts of the body. Common staging tests include:

• Imaging Tests: CT scans, MRI scans, and PET scans can help determine the size and location of the tumor and whether it has spread to nearby lymph nodes or other organs.
• Endoscopy: An endoscope (a thin, flexible tube with a camera) can be used to examine the throat and other areas.
• Lymph Node Biopsy: If the lymph nodes in the neck are enlarged, a biopsy may be performed to determine if they contain cancer cells.

The stage of oral cancer is determined based on the size of the tumor (T), the involvement of lymph nodes (N), and the presence of distant metastasis (M). The stages range from Stage 0 (carcinoma in situ) to Stage IV (advanced cancer).

Treatment Options for Oral Cancer in Chennai

The treatment for oral cancer depends on the stage and location of the cancer, as well as the patient's overall health. Common treatment options include:

• Surgery: Surgery is often the primary treatment for oral cancer, especially in early stages. The goal of surgery is to remove the tumor and any affected lymph nodes. Dr. Vidhyadharan Sivakumar at THANC Hospital specializes in advanced surgical techniques for oral cancer, including Transoral Robotic Surgery (TORS). In my practice, TORS has allowed for more precise and less invasive removal of tumors, leading to better outcomes for patients.
• Radiation Therapy: Radiation therapy uses high-energy rays to kill cancer cells. It may be used alone or in combination with surgery and chemotherapy.
• Chemotherapy: Chemotherapy uses drugs to kill cancer cells throughout the body. It may be used in combination with surgery and radiation therapy, especially for advanced cancers.
• Targeted Therapy: Targeted therapy uses drugs that target specific molecules involved in cancer cell growth and survival.
• Immunotherapy: Immunotherapy uses drugs that help the body's immune system fight cancer cells.
• Rehabilitation: Rehabilitation, including speech therapy, swallowing therapy, and physical therapy, is an important part of oral cancer treatment. It helps patients regain function and improve their quality of life.

Here's a comparison table of common oral cancer treatment options:

| Treatment Option | Description hallenges | Surgery