Sangeeta Darvekar Charitable Trust , a registered trust with registration no E/3092/Thane dated 30/4/03 presents an awareness program on Oral Cancer and named it Oral Cancer Awareness.org
As a social obligation we started a charitable organization namely Sangeeta Darvekar Charitable Trust and as a dentist I used to see a lot of patients with complications arising out of habits like gutka eating, keeping tobacco Quid in mouth and smoking. So we thought of this awareness campaign.
So we started an Awareness program and called it “Oral cancer awareness.org” as we have a website with the same name. Dr Suwas Darvekar is the force behind this campaign. He is helped by Mr. Vincent Nazareth of ‘ Crusade Against Tobacco’
This program won’t have been possible without the help from TATA MEMORIAL HOSPITAL.
Oral cancer is the most common cancer in India and according to Dr Geoff Craig “People are dying of oral cancer because of ignorance”.
So Sangeeta Darvekar Charitable Trust thought of a mass awareness program about oral cancer, its causes, its treatment and resultant problems and the way of preventing this cancer.
So we approached Dr Surendra Shastri head of preventive oncology at TATA MEMORIAL HOSPITAL and he gave us a stunning information that ”There are about 7,00,000 new cases of cancers diagnosed every year in India out of which tobacco related cancers are about 3,00,000, cancer of uteri are 1,00,000 and 80,000 breast cancer. Cost of treatment of oral cancer is about 3.5 lakh. This can be completely prevented by simple changes in lifestyle and regular screening and even have health benefits that reach beyond cancer. About 2000 deaths a day in India is tobacco related.”
On receiving this stunning news we thought of enquiring for the reason of such high incidence of oral cancer. We found that the reason for such high prevalence of oral cancer in India was primarily because of the most common form of tobacco consumption is keeping the tobacco in mouth. Be it in the form of Gutka,tobacco Quid and Mava,betel leaf with tobacco(Pan), snuff or misri and so on.
Tobacco when kept in mouth leaches out carcinogens, which act on oral mucosa causing neoplastic changes. Habit of smoking is also equally dangerous .
Tobacco contains potent carcinogens including Nitrosamines (nicotine), polycyclic aromatic hydrocarbons, Nitrosodiethanolamine, Nitrosoproline, and polonium. Tobacco smoke contains carbon monoxide, Thiocyanate, hydrogen cyanide, nicotine and metabolites of these constituents.
Tobacco in India most commonly consumed in the form of gutka, quid pan or smoking in the form of bidi of cigarette.
Gutka is a flavored tobacco mixture with betel nut lime, and harmful additives like magnesium carbonate. It is extremely addictive and is apparently targeted at youngsters. Quid is the mixture of tobacco and lime and extensively consumed in India.
According to the B.B.C ‘4 in 10 of all cancers in India are oral cancers’. And this because of extensive use of tobacco and betel quid.
Precancerous lesions There are three most common precancerous lesions seen in the mouth and they are 1. Oral leucoplakia It is characterized by white patch on the buccal mucosa or any place in the mouth and is adjacent to the place where the tobacco quid is kept. The less likely place is floor of the mouth and tongue although 93% of leucoplakia at this sites turn malignant.
2. Erythroplakia This is characterized by red velvety patch which is not associated with any trauma or inflammation. It may present with or without leucoplakia. This lesion is easily missed out but is considered to have great malignancy potential.
3. Oral sub mucous fibrosis . This condition is characterized by limited opening of mouth and burning sensation on eating of spicy food. This is a progressive lesion in which the opening of the mouth becomes progressively limited, and later on even normal eating becomes difficult. It occurs almost exclusively in Indians and Indian communities living abroad.
Professor Newell Johnson an expert oral surgeon said, ”we know this condition, oral sub mucous fibrosis has highest rate of transferring to malignancy of any of the so called pre-malignant lesions in the mouth. It is a very serious condition.”
The next stage after the precancerous lesion is the Cancerous lesions.
The most common form of cancer is Squamous cell carcinoma.
It normally starts from any of the precancerous lesion in the mouth.
Common sites of oral cancer The most common sites of the oral cancer is the tongue and the floor of the mouth. The other common sites are buccal vestibule, buccal mucosa, gingiva and rarely hard and soft palate. Cancer of bucco-pharyngeal mucosa is common in smokers.
Diagnosis Initially oral cancer may be asymptomatic but a check up of a small ulcerative lesion from a professional is recommended. But patients normally presents when pain and discomfort is predominant and then the prognosis becomes poor. Diagnosis is established by many ways like applying dyes like toluidine blue which may give false positive results in inflammatory lesion but never false negative, using X rays and scans to see the extension of the lesion and the bony involvement and the most confirmatory test is biopsy of the lesion and its histo-pathological examination
It may start as a small ulcer, usually on the lateral border of the anterior two third of the tongue. It may have varied presentation like a small papillary exophytic lesion, a flat nodule, ulceration within a pre existing fissure or may occur in the absence of frank ulceration in an atrophic tongue. Once ulceration has occurred, the lesion becomes painful, making speech and swallowing difficult. Tongue cancer rapidly extends to involve the floor of the mouth and lower alveolus, which makes treatment difficult. Carcinoma of the Tongue
Cancer of Tongue following tobacco consumption
The lesion is usually painless in early stages and only when it becomes ulcerated and secondarily infected or invades adjacent nerve, pain is the noticeable feature. The tumor is usually at the level of the occlusal plane or below it. They may be proliferative warty exophytic growth with little fixation or deeply ulcerative invasive lesion. The proliferative lesion though it looks dangerous is easily treatable and long-term prognosis is good as the metastasis to the local lymph nodes is relatively late. Whereas the ulcerative lesion is not so easily noticeable in the early stages but is more dangerous because of their invasive nature and the metastasis to the local lymph nodes is very early Cancer of Gingiva and Buccal mucosa
CANCER LESION COMING OUTSIDE THE MOUTH Cancer Of Cheek after tobacco quid habit
SAME PATIENT WITH THE CANCER LESION COMING EXTRA ORALLY
Cancer of buccal mucosa after tobacco habit going extra-orally
CANCER STARTING FROM BUCCAL VESTIBULE FOLLOWING HABIT OF PAN WITH TOBACCO
Cancer of Buccal mucosa invading extra-oral tissues following tobacco quid habit
Cancer of labial mucosa invading extra-oral tissues following tobacco quid habit
Carcinoma of the lip usually starts at the vermilion border of the lower lip. 95% of lip cancer affects the lower lip. It is in the form of a nodule, which ulcerates and forms a small scab, which fail to heal completely. It is often misdiagnosed as a cold sore. Eventually the margins of the lesions become proliferative and an extensive exophytic lesion with central ulceration develops. Carcinoma of the lip
Alveolar carcinoma is common in mandible that maxilla. The lesion is warty nodular and proliferative, although it may rarely present as erosive lesion. Unfortunately it mimics apical or periodontal disease and their diagnosis is often delayed. Often the neoplastic nature is recognized when socket fails to heal following dental extraction for a supposedly periodontal abscess. Alveolar carcinoma
This cancer is extremely malignant and even if there is slight delay it spreads to lymph nodes of the neck. Once it spreads the prognosis becomes poor and death is inevitable and is because of erosion of major blood vessels and erosion of the base of the skull, Cachexia and secondary infection of the respiratory tract.
The American joint committee on cancer has developed the Tumor (T), Node (N), and Metastasis (M) system of cancer classification. The TNM classification is basically a clinical description of the disease, but can also involve imaging in classification. T is the size of the tumor and T1 is <2 cm, T2 is >2 but < 4 cm, T3 is >4 cm and T4 is >4 cm with invasion of adjacent structures. N0 is no lymph node N1 is single ipsilateral node < 3 cm N2a single ipsilateral node > 3 cm but < 6 cm N2b multiple ipsilateral node < 6 cm. N2c bilateral or contra lateral nodes < 6 cm N3a ipsilateral node > 6 cm N3b bilateral nodes > 6 cm M0 is no metastasis and M1 is metastasis present. Staging Stage I T1 N0 M0 Stage II T2 N0 M0 Stage III T3 N0 M0; any T1 T2 T3, N1 M0 Stage IV T4 ANY N, M0; any T, N2 or N3; ANY T OR N WITH M1 Cancer classification and Staging
Treatment available Treatment is surgery, and in advanced cases surgery followed by radiation therapy is performed. But even that is not always successful as more than 70% of the cases after treatment leads to relapse and the result is death.
The treatment is successful only if the lesion is diagnosed early, but sadly many times, it is ignored and the patient reports when the lesion has spread so much that the treatment is impossible or even if done the long term prognosis is poor.
The cost of the treatment is 3.5 lakh and in spite of this cost there is no guarantee of sure cure.
Differences in genetics have not been identified in relation to risk and survival.
Commando operation is resection of half of the mandible with floor of the mouth and block desection of the neck to remove the entire lymphatic drainage of the neck together with sterno-cleido mastoid muscle and internal jugular vein. In the following photographs you will see what a commando operation looks like.
This is a patient who has undergone a commando operation for oral cancer
This is a patient who has undergone a commando operation for oral cancer
This is a patient who has undergone an operation of his palate, nose and right eye for cancer of palate extending to nose and right eye.
This is a patient who has undergone a commando operation for oral cancer
This is a patient who has undergone a commando operation for oral cancer. Because of the operation he has lost control on his left side of the mouth and hence saliva is seen drooling from left side of the mouth.
<ul><li>Frequently Asked Question </li></ul><ul><ul><li>How do I prevent oral cancer ? </li></ul></ul><ul><ul><li>Why is that not all people consuming tobacco have oral cancer ? </li></ul></ul><ul><ul><li>Who is more susceptible to oral cancer ? </li></ul></ul><ul><ul><li>I have a precancerous lesion in my mouth, would I get cancer ? </li></ul></ul><ul><ul><li>How is the diagnosis established ? </li></ul></ul><ul><ul><li>What is the treatment available ? </li></ul></ul><ul><ul><li>what is the approximate cost ? </li></ul></ul><ul><ul><li>I Occasionally chew tobacco/smoke, and keep tobacco only for very short time. Am I susceptible for cancer ? </li></ul></ul><ul><ul><li>My friend has been told that he has oral cancer, but he does not believe it. what to do? </li></ul></ul><ul><ul><li>My dentist has recommended the biopsy of the premalignant lesion. What should I do? </li></ul></ul><ul><ul><li>I have oral cancer and I am taking ayurvedic medicine. Will that help? </li></ul></ul><ul><ul><li>My Friend had cancer after tooth extraction. Was the doctor negligent? </li></ul></ul><ul><li> </li></ul>
How do I prevent oral cancer ? Stopping all the habits of tobacco consumption. Stopping means complete stop to the habit. Reducing the consumption of tobacco does not reduce your risk of cancer. But stopping certainly reduces the risk. Is tobacco the only cause of oral cancer ? Tobacco is the major cause of oral cancer but certainly not the only cause. Their are other causes like poor oral hygiene, chronic trauma from sharp tooth or an ill fitting dentures. Their are other agents like some viruses which are thought to cause or expedite the effect of tobacco in causing oral cancer. Why is that not all people consuming tobacco have oral cancer ? Their are many factors like genetic make of the person, his diet and many unknown factors that increases or decreases the susceptibility of person of having oral cancer. But one thing is certain that tobacco consumption increases your susceptibility by almost 8 times. That means a person consuming tobacco is more prone to have oral cancer or other tobacco related problems. Who is more susceptible to oral cancer ? Anybody consuming tobacco is susceptible to oral cancer. Differences in genetics have not been identified in relation to risk and survival. That means a Caucasian or a mongoloid, Black race all are equally prone to oral cancer if they consume tobacco.
I have a precancerous lesion in my mouth, would I get cancer ? It depends on whether you continue your habit or not. If you stop your habit then your chances of getting oral cancer decreases drastically. But it is always better to get your precancerous lesion checked by a Dentist. He will suggest you the best thing for you and may be he will take a biopsy sample of the lesion for histo-pathological check up. Or he may apply some specific Dyes to the lesion so that check its neoplastic potential. How is the diagnosis established ? Diagnosis is established by many ways like applying dyes like Toluidine blue which may give false positive results in inflammatory lesion but never false negative, using X rays and scans to see the extension of the lesion and the bony involvement and the most confirmatory test is biopsy of the lesion and its histo-pathological examination What is the treatment available ? Treatment is surgery, and in advanced cases surgery followed by radiation therapy is done. But even that is not always successful as 70% of the cases after treatment leads to relapse and the result is death. The treatment is successful only if the lesion is diagnosed early, but sadly many times, it is ignored and the patient reports when the lesion has spread so much that the treatment is impossible or even if done the long term prognosis is poor
What is the approximate cost ? Cost involved is approximately Rs 350,000/- . The cost may vary because of many things like the extent of the lesion, any metastasis and many other factors. I Occasionally chew tobacco/smoke, and keep tobacco only for very short time. Am I susceptible for cancer ? Tobacco has many chemicals which can cause cancer and lower intake doesn't mean less susceptibility. If a person is genetically more predisposed then even little consumption can trigger malignancy. My friend has been told that he has oral cancer, but he does not believe it. what to do? Cancer is very well treated with fewer complication in early stages. So if a doctor has said that your friend has cancer than don't neglect it. If you don't believe get it checked from an authority. Remember time is an essence here. Even if their is slight delay the prognosis rapidly goes from good to bad to worse. My dentist has recommended the biopsy of the premalignant lesion. What should I do? Biopsy is the only confirmatory test of whether you have oral cancer or not. If your Dentist has recommended a biopsy he has given you the right advise. Go ahead and do it at once without any delay.
I have oral cancer and I am taking ayurvedic medicine. Will that help? I am not an authority on ayurvedic medicine. But it has been generally noted that ayurvedic medicines don't work once you have oral cancer and you have to undergo surgery. So don't wait, get the surgery done at once. May be if the lesion has not progressed you will have a excellent prognosis. My Friend had cancer after tooth extraction. Was the doctor negligent? No! You can never have oral cancer with any dental procedure performed by your Dentist. The predominant sign of alveolar and gingival carcinoma is mobile tooth/teeth, and only after extraction when the socket doesn't heal and their is some growth, you find out that the tooth/teeth were mobile because of cancer. This is a case of misdiagnosis and not wrong treatment. This type of diagnosis can be missed even by the best of Dentist. Usually such cases give a history of tobacco consumption.
So friends if you want to save money, lead a healthy life style don’t want to suffer from cancer and its associated problems, stay away from tobacco in any form be it Gutka, tobacco Quid,pan,snuff,Mava Misri, Smoking and so on.
Wish you a healthy life without tobacco and oral cancer.
This is Dr Suwas Darvekar who has been the force behind this awareness campaign.
This presentation can be freely copied and shown without alteration to your friends, relatives and any audience. An awareness campaign is not possible with few individuals so we want maximum people to cooperate in this effort as this is one cancer which is completely preventable. Any one who needs a CD of this presentation can obtain by sending Rs 50/- only or copy it free of cost from www.oralcancerawareness.org Please remember no alteration is permissible in this presentation as it would lead to copyright infringement and therefore a punishable offence.
We want to convert this presentation into a Video and plan to add the interviews of leading doctors on oral cancer and interviews of the patients as to how they got this cancer. All the written matter in this presentation will be converted into dialogues with a professional Voice. The whole presentation will then be converted into a VCD of leading local languages initially and later on in all the vernacular languages and will be circulated throughout India and possibly world over. This requires strong financial capabilities which we are lacking. Therefore we request all the like minded peoples and organizations to help us for this noble cause.
You can contact us at Sangeeta Darvekar Charitable Trust 602/A, Sealand Tower, Jesal Park, Bhayandar East, Dist Thane 401105 Phones: 28149233, 28162440, 9869368937 Email: [email_address] Website: www.oralcancerawareness.org