Cancers caused by tobacco, expert says, is the Indian disease

Dimapur, May 13 (EMN): A visiting oncologist from Apollo Hospitals has said cancer of the mouth often begins as a small ulcer or lump on the tongue, cheek and gums. Historically, according to the medical practitioner, 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,” warned Dr. Kannan Subbiah, senior ENT/ Head and Neck “Onco surgeon” at Apollo Hospitals of Chennai during a meet with the press in Dimapur.

35% of the total cancers in India are from the head and neck region as compared to 5-8% in the western world. India accounts for more than one-fourth of world’s head and neck cancer burden hence aptly being named as an “Indian Cancer,” he said.

The most common etiological factors for head neck cancers, the surgeon stated in a handout to the press on Saturday, are tobacco (smoking and smokeless) and alcohol. Smokeless tobacco -gutka, pan etc. are the major etiological factors in India and Southeast Asia.

Betel nut (contains areca nut) chewing causes oral submucosal fibrosis which leads to oral cancer. Areca nut is classified as group 1 carcinogen by World Health Organisation (WHO).These agents when taken together act synergistically and increase the person’s cancer risk by 8-10 times. These cancer causing agents (carcinogens) account for 90% of oral cancers and 80% of laryngeal cancers seen in our population.

On stopping these habits the chance of getting cancer decreases (it usually takes 10-15 years to return to normal state). In the western population, HPV (which spreads by faulty sexual habits) is a major cause of oropharyngeal and oral cancer and there is a slow but steady rise seen in India too.

Symptoms of head and neck cancers

Oral ulcer- not healing for 3 weeks
Change of voice / hoarseness
Difficulty in swallowing-dysphagia
Neck swelling
Unusual bleeding, pain or numbness in the mouth
Difficulty in opening mouth
Persistent facial, neck or ear pain
Loose teeth or ill-fitting dentures

Initially, chronic irritation produces a white patch (leukoplakia, 3-16% risk of transformation to cancer) or a red patch (Erythroplakia, 30-50% risk of transformation to frank cancer) 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 the early stages. Later, it produces excessive scarring the mouth that prevents the patient from opening the mouth. These patients are prone to develop oral cancers at multiple areas,” the surgeon said.

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”, stated Dr Kannan.

Cancer in these locations usually affects breathing, swallowing and speech, he stated. 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.

According to the doctor, the choice of treatment depends mainly on general health, where in the mouth the cancer began, the size of the tumour 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, he stated.

On the various treatments available, Dr Kannan said that the early-stage cancers are treated by single modality mostly surgery. Advanced stage cancers are treated by multimodality treatment – surgery followed by radiotherapy with or without chemotherapy, he stated.

“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.”

“When found early, oral cancers have on 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,” he stated.

Chances of developing second cancer

According to the surgeon, patients who survive the diseases, 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,” he said.

With the following message for the people of Nagaland, Dr Kannan has appealed for spreading the information for prevention of cancer:

1) 90% of oral cancers can be prevented on quitting tobacco, alcohol, betel nut and faulty sexual habits (oral sex).

2) Early cessation is important because risk gradually decreases and reach normalcy after 10-15 years

3) Early diagnosis has better cure rates

4) Surgical treatment targets on improved survival with good cosmetic and functional outcome.

5) Post treatment regular follow-up is needed to diagnose second primary.

For further information, one may contact Dr. Kannan at the phone number 9840251498 or Mr. Hemakumar at 9940052025.