Dr Deepak Sarin
Mouth cancer is the commonest cancer among men in India. Its incidence is rising in our country and is mainly attributable to the increasing use of Gutka. The use of Gutka is unique to our country and hence more than 75 percent of mouth cancers of the world occur in India. Gutka, which is a combination of betel nut and tobacco, is a very cheap and readily available stimulant. Compared to the traditional “paan” which may or may not contain tobacco and involves a long and often messy prepartion, Gutka offers a easier and more portable solution for people addicted to it. The cost is about 1 rupees and a large number of people take to it at a very young age. It is not unusual to see patient in their teens or twenties developing mouth cancer because of early addiction. Most of them did not believe the substance was either addictive or caused cancer when they started its abuse. For this reason the average age of a mouth cancer patient in India is 10 years lesser than in the world.
Apart from Gutka, smoking and regular alcohol consumption are major risk factors. More recently the Human Papilloma Virus (HPV) has been proven to be a causative factor for throat cancer. This is a sexually transmitted virus and oral infection by HPV occurs as a result of oral sex. The infection is generally asymptomatic but predisposes the person to develop a cancer later in life.
Mouth cancer most commonly develops in the cheek, jaw or tongue. In its early stages the cancer is just a small ulcer or growth which is PAINLESS. This is why it is ignored or overlooked. As the ulcer grows it may start causing some symptoms and leads to the diagnosis. By this time the cancer may have spread to glands in the neck or in other sites of the body and treatment results are not that good. In India the majority of patients are diagnosed in late stages. Another reason for late diagnosis is the reluctance for patient to undergo a biopsy. A biopsy is the process of removing a small portion, generally less than the size of a pea, of the growth. This piece is sent to the laboratory for an examination to confirm the growth as a cancer. A widely prevalent MYTH is that a biopsy will cause the cancer to grow faster. This is unproven and unscientific, as doing a biopsy will not change the natural speed of growth of the cancer. It is the best test to establish the diagnosis following which treatment can be initiated early.
The treatment in early stages is relatively easy and can be done by conventional surgery or more advanced techniques like laser surgery. However, in more advanced stages, large operations are required with complex reconstructions of major portions of the mouth. Today, using microvascular free flaps excellent funtinal and cosmetic reconstruction of the tongue, jaw and cheek can be done. Additionally radiotherapy or chemotherapy will be needed in advanced stages. However, in advanced stages the cost of the treatment will be substantially more and relapse of disease is also more frequent.
Our best approach to tackle this “epidemic” would come from prevention by banning the sale of gutka and tobacco products, and public education about its ill-effects. In patients who have unfortunately developed the disease, early diagnosis followed by appropriate treatment would offer the best solution. This would need awareness among the general population, dentists and general physicians who are often the first doctors consulted.
(This Article is provided in Public Interest & to educate the Public In General An Initiative By Deptt. Of Community Out Reach Programme- Medanta The Medicity Gurgaon)
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