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Cancer of the mouth often begins as a small ulcer or lump on the tongue, cheek or gums. Historically at least 75% of those diagnosed are tobacco users. Those who both smoke and drink, have a 15 times greater risk of developing oral cancer than others. Chronic irritation from a sharp tooth is also known to initiate these changes.
Thirty percent of the total cancers in India are from the head and neck region as compared to 5% in the western world. Tobacco, betel nut and ‘paan’ chewing, in addition to smoking and alcohol abuse are the reasons for the increased number of oral cancers in the Indian subcontinent.
Most oral cancers could be prevented if people did not use tobacco or drink
Initially, chronic irritation produces a white patch (leukoplakia) or a red patch (erythroplakia) in the mouth and these can sometimes become cancer. Submucous fibrosis, is a unique condition associated with ‘pan’ chewing. It produces a burning sensation in the mouth in early stages. Later, it produces excessive scarring in the mouth that prevents the patient from opening the mouth. These patients are prone to develop oral cancers at multiple areas.
Once the presence of cancer is confirmed, the stage (extent) of the disease needs to be assessed to plan the best treatment. The stage is based on the size of the tumor, whether the cancer has spread and, if so, to what parts of the body. Endoscopy, CT scan and MRI give useful information to stage and plan the treatment better. PET scan can pick up disease from any part of the body with certain limitations.
Cancer in these locations usually affects breathing, swallowing and speech. The aim of the treatment is to cure the patient and also to preserve and restore these vital functions. Cosmetic concerns such as facial symmetry and facial contours are also important to ensure good quality of life after cancer treatment.
The choice of treatment depends mainly on general health, where in the mouth the cancer began, the size of the tumor, and whether the cancer has spread. Treatment of oral cancers is ideally a multidisciplinary approach involving the efforts of surgeons, radiation oncologists, chemotherapy oncologists, dental practitioners, nutritionists, and rehabilitation and restorative specialists. The actual curative treatment modalities are usually surgery and radiation, with chemotherapy added to decrease the possibility of metastasis, to sensitize the malignant cells to radiation, or for those patients who have confirmed distant metastasis of the disease. Some patients have a combination of treatments.
Surgery is the main form of treatment for head and neck cancers. Numerous surgical approaches have been developed that permit preservation of organ function and facial appearance to a far greater degree than was possible in the past. Patients are usually worried about changes in the facial appearance following cancer surgery. That was the scenario in the past. Currently, when surgery is extensive, immediate reconstruction of complex defects is done by transfer of appropriate tissue from distant sites (like the forearm, thigh, leg etc.) along with their blood supply which is then reestablished using microvascular technique. With this we can bring the facial appearance as well as the functions of mouth as close to normal as possible.
You may want to ask the doctor these questions before treatment begins:
What is the stage of the disease? Has the cancer spread? If so, where?
What are the treatment choices? Which is recommended?
What are the expected benefits of each kind of treatment?
What are the risks and side effects of each treatment?
When found early, oral cancers have an 80 to 90 % survival rate. Unfortunately at this time, majority are found as late stage cancers, and this accounts for the very high death rate of about 45% at five years from diagnosis.
Patients, who survive the disease, have up to a 20 times higher risk of developing a second cancer. This heightened risk factor can last for 5 to 10 years after the first occurrence. Therefore follow-up care after treatment is very important. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained in the body after treatment. The doctor monitors the recovery and checks for recurrence of cancer.