As per the Globocan 2022 data, oral cavity is the most common site of cancer in males in India and India has the highest incidence of oral cancer globally. The developing countries of South and Southeast Asia are the major contributors to the global oral cancer burden.Oral cavity includes lip, tongue, buccal mucosa, palate and floor of mouth.
Risk factors:
Smoking, alcohol use, pan chewing, human papilloma virus (HPV) infection, poor oral hygiene.
The use of ‘Smokeless tobacco’ is widespread in Northern states and refer to the use of tobacco other than for smoking like chewing and sniffing. These are known in different names (khaini, gutka, zarda) in different parts of the country.
Another notable risk factor for oral cancer is a sharp tooth which causes constant irritation and injury to the tongue or cheek (buccal mucosa) which can later evolve into cancer. This can be prevented by dental procedures like smoothening the sharp tooth in order to prevent injury. This is quite often seen in those who do not have any unhealthy habits.
Betel nut chewing is common in many parts of our country. It is a mixture of betel leaf, areca nut and lime. Areca nut contain arecoline which is a carcinogen. Prolonged use can cause oral cancer.
Premalignant lesions:
Leukoplakia, erythroplakia and oral submucous fibrosis constitute the premalignant lesions of oral cavity. These are seen as whitish, reddish patches and band like thickening in the oral mucosa respectively. Patients having these lesions needs close monitoring to rule out development of oral cancer.
Clinical presentation:
- Persistent non healing ulcer
- Persistent pain
- Difficulty in swallowing or chewing
- Bleeding from mouth
- Loosening of teeth
- Neck swellings
Diagnosis and treatment:
Biopsy is needed for diagnosis.
Treatment depends on the stage and site of the tumour. Surgery alone is needed for early stage tumours. Surgery and radiation (+/- chemotherapy) is recommended for locally advanced tumours.
Oral cancer screening:
Oral cancer screening involves examination of mouth with the help of physician or dentist for signs of cancer or precancerous conditions with the aim of early detection. Apart from oral examination, there are screening tools like VELscope, Orascoptic DK which help in identifying and sampling abnormal areas.Oral cavity cancers are closely associated with smoking, alcoholism and betel nut chewing. Quitting these habits and maintaining good oral hygiene can decrease the incidence and mortality from this cancer. April is Head and neck cancer awareness month!!!!