Oral cancer or mouth cancer, a type of head and neck cancer, is any cancerous tissue growth located in the oral cavity. The Case Study was conducted in 2014 as a part of an Investigatory Project Work on the Number Of Oral Cancel in the District of Balasore of Odisha in that Year

1. A CASE STUDY
 After a long search our team member went to a small village named Dhusuri at Bhadrak to
meet a person who is suffering from mouth cancer for the last 20 years.
 We reached at our destination through the dusty roads of the village and met
Mr. Golakchandra Jena , a poor teacher in a govt. school of that village.
 Then the interview started. We had taken our preplanned questions & materials with us.
 We asked him many questions on his life history, about tobacco chewing & gutkas .
 He narrated us the whole story with a great patience.
 He first of all told that he was just only 18 when he started taking Gutkas in a small
amount. But slowly & slowly this nature turned into a habit and at around 22 he used to
take 20 – 22 packed of gutkas a day. He first thought taking all these gave him proper
and strength and will power to his mind to do more work .
 Slowly & slowly all these things became a part of his life and after 6years he started
having severe throat itching and swallowing problems . He then consulted the doctor & he
was replied by the doctor that it was a serious case of mouth cancer on the right side of
his check & he had to operate it as soon as possible or else it will kill his life.
 There begin the wheel of hell and he started his check up starting from Cuttack to BBSR
to Bangalore to Gujarat. And finally got operated in “Gujarat cancer & Research
Institute”, Ahmadabad, Gujarat. In 2002 his operation was successful & then returned
home.
 But all his wealth & strength went in a vain when he came to knew that he was suffering
from mouth cancer in left cheek also. He became mad but what to do, he had no other
choice. Though he had left all his bad habits since a long time ago but its impacts are still
prevailing. Now again he is continuing his treatment of his left cheek in Apollo at BBSR.
 He got really disappointed when he listened that there is no such facilities available in
every district of Odisha. For all these reasons, poor person has to suffer a lot. They are
not getting proper medicinal care. They have to move distant places for treatment.
 He now is not able to feed his own family and is crying for his fate.
At last he advised our generation not to opt any kind of bad habits which will put
them in a trap forever their life.

2. A STUDY ON BaLASORE
The team visited the District Hospital, Balasore and consulted with ADMO, Balasore ,
regarding the treatment facilities available in the hospital. It was said that, there is no proper
treatment facility available for the tobacco addicted people and resultant mouth cancer
patients. If any patient reported, they are referred to Govt. cancer hospital at Cuttack.
Further the team collected the list of people who sufferered from mouth cancer in the
year 2014 and visited the doctor & consulted with her about the above mentioned topic. She
appreciated us for our work and dedication towards the welfare of the society.
Months Total no. of
case
Total no. of
male
Total no. of
female
January 0 0 0
February 0 0 0
March 0 0 0
April 12 10 2
May 0 0 0
June 0 0 0
July 0 0 0
August 0 0 0
September 0 0 0
October 0 0 0
November 0 0 0
December 0 0 0

4. DATA OF ODISHA
Age Group Male Female Total
30-49 33 11 44
50-60 34 36 70
70-89 15 7 22

5. Oral Cancer
Oral cancer or mouth cancer, a type of head and neck cancer, is any cancerous tissue growth
located in the oral cavity.
It may arise as a primary lesion originating in any of
the tissues in the mouth, by metastasis from a distant site of
origin, or by extension from a neighboring anatomic structure,
such as the nasal cavity. Alternatively, the oral cancers may
originate in any of the tissues of the mouth, and may be of
varied histologic types: teratoma, adenocarcinoma derived from a major or minor salivary
gland,lymphoma from tonsillar or other lymphoid tissue, or melanoma from the pigment-producing
cells of the oral mucosa. There are several types of oral cancers, but around 90% are squamous
cell carcinomas, originating in the tissues that line the mouth and lips. Oral or mouth cancer most
commonly involves the tongue. It may also occur on the floor of the mouth, cheek
lining, gingiva(gums), lips, or palate (roof of the mouth). Most oral cancers look very similar under
the microscope and are called squamous cell carcinoma, but less commonly other types of oral
cancer occur, such as Kaposi's sarcoma.
Signs and Symptoms:
Skin lesion, lump, or ulcer that do not resolve in 14 days located:
 On the tongue, lip, or other mouth areas
 Usually small
 Most often pale colored, may be dark or discolored
 Early sign may be a white patch (leukoplakia) or a red patch
(erythroplakia) on the soft tissues of the mouth
 Usually painless initially
 May develop a burning sensation or pain when the tumor is
advanced
 Behind the wisdom tooth
 Even behind the ear
Additional symptoms that may be associated with this disease:
 Tongue problems (moving it)
 Swallowing difficulty
 Mouth sores
 Pain and paraesthesia are late symptoms.

6. Causes
Oncogenes are activated as a result of mutation of the DNA. Risk factors that predispose a
person to oral cancer have been identified in epidemiological (epidemiology) studies. India being
member of International Cancer Genome Consortium is leading efforts to map oral cancer's
complete genome.
It is important to note that around 75 percent of oral cancers are
linked to modifiable behaviors such as tobacco use and excessive
alcohol consumption. Other factors include poor oral hygiene, irritation
caused by ill-fitting dentures and other rough surfaces on the teeth,
poor nutrition, and some chronic infections caused by bacteria or
viruses. If oral cancer is diagnosed in its earliest stages, treatment is
generally very effective.
In many Asian cultures chewing betel, paan and Areca is known to be a strong risk factor for
developing oral cancer. In India where such practices are common, oral cancer represents up to
40% of all cancers, compared to just 4% in the UK.
Tobacco
Tobacco is a plant within the genus Nicotiana of the Solanaceae (nightshade) family. While there
are more than 70 species of tobacco, the chief commercial crop is N. tabacum. The more potent
species N. rustica is also widely used around the world.
Dried tobacco leaves are mainly smoked in cigarettes, cigars, pipe tobacco and flavored shisha
tobacco. They are also consumed as snuff, chewing tobacco and dipping tobacco.
Tobacco contains the alkaloid nicotine, a stimulant. Tobacco use is a risk factor for many
diseases, especially those affecting the heart, liver and lungs, and several cancers. In 2008,
the World Health Organization (WHO) named tobacco as the world's single greatest cause of
preventable death.
Biology
There are many species of tobacco in the genus of herbs Nicotiana. It is part of the
nightshade family (Solanaceae) indigenous to Northand South America, Australia,
South West Africa and the South Pacific.
Many plants contain nicotine, a powerful neurotoxin to insects. However,
tobaccos contain a higher concentration of nicotine than most other
plants. Unlike many other Solanaceae, they do not contain tropane
alkaloids, which are often poisonous to humans and other animals.
Despite containing enough nicotine and other compounds such
as germacrene and anabasine and other piperidine alkaloids (varying between species) to deter
most herbivores a number of such animals have evolved the ability to feed on Nicotiana species
without being harmed. Nonetheless, tobacco is unpalatable to many species, and accordingly some
tobacco plants (chiefly tree tobacco, N. glauca) have become established as invasive weeds in
some places.
NICOTINE

7. Etymology
The English word tobacco originates from the Spanish and Portuguese word tabaco. The precise
origin of the Spanish/Portuguese word is disputed but it generally thought to have originated, at
least in part, from Taino, the Arawakan language of the Caribbean. In Taino, it was said to refer
either to a roll of tobacco leaves (according to Bartolomé de las Casas, 1552), or to the tabago, a
kind of Y-shaped pipe for sniffing tobacco smoke also known as snuff (according to Oviedo; with
the leaves themselves being referred to as cohiba).
However, similar words in Spanish, Portuguese and Italian were commonly used from 1410 to
define medicinal herbs which are believed to have originated from the Arabic tabbaq, a word
reportedly dating to the 9th century, as the name of various herbs.
Types of tobacco
There are a number of types of tobacco including, but are not limited to:
Aromatic fire-cured
Brightleaf tobacco
Burley tobacco
Cavendish
Criollo tobacco
Dokha
Turkish tobacco.
Perique
Shade tobacco
White burley
Wild tobacco
Y1
Consumption
Tobacco is consumed in many forms and through a number of different methods. Below are
examples including, but not limited to, such forms and usage.
Beedi
Chewing tobacco
Cigars
Cigarettes
Creamy snuffs
Dipping tobaccos
Gutka
Hookah
Kreteks
Roll-Your-Own
Pipe smoking
Snuff

8. Diagnosis
An examination of the mouth by the health care provider or
dentist shows a visible and/or palpable (can be felt) lesion of the
lip, tongue, or other mouth area. The lateral/ventral sides of the
tongue are the most common sites for intraoral SCC. As
the tumor enlarges, it may become an ulcer and bleed.
Speech/talking difficulties, chewing problems, or swallowing
difficulties may develop. A feeding tube is often necessary to
maintain adequate nutrition. This can sometimes become
permanent as eating difficulties can include the inability to swallow even a sip of water. The
doctor can order some special investigations which may include a chest x-ray, CT or MRI scans,
and tissue biopsy.
There are a variety of screening devices that may assist dentists in detecting oral cancer,
including the Velscope, Vizilite Plus and theidentafi 3000. There is no evidence that routine use
of these devices in general dental practice saves lives. However,
there are compelling reasons to be concerned about the risk of
harm this device may cause if routinely used in general practice.
Such harms include false positives, unnecessary surgical biopsies
and a financial burden on the patient. While a dentist, physician or
other health professional may suspect a particular lesion is
malignant, there is no way to tell by looking alone - since benign
and malignant lesions may look identical to the eye. A non-invasive
brush biopsy (BrushTest) can be performed to rule out the
presence of dysplasia (pre-cancer) and cancer on areas of the mouth that exhibit an unexplained
color variation or lesion. The only definitive method for determining if cancerous or
precancerous cells are present is through biopsy and microscopic evaluation of the cells in the
removed sample. A tissue biopsy, whether of the tongue or other oral tissues and microscopic
examination of the lesion confirm the diagnosis of oral cancer or precancer. There are six
common species of bacteria found at significantly higher levels in the saliva of patients with oral
squamous cell carcinoma (OSCC) than in saliva of oral-free cancer individuals. Three of the six, C.
gingivalis, P. melaninogenica, and S. mitis, can be used as a diagnostic tool to predict more than
80% of oral cancers.

9. Management
Surgical excision (removal) of the tumor is usually recommended if the tumor is small enough,
and if surgery is likely to result in a functionally satisfactory result. Radiation therapy with or
without chemotherapy is often used in conjunction with surgery, or as the definitive radical
treatment, especially if the tumor is inoperable. Surgeries for oral cancers include
 Maxillectomy (can be done with or without orbital exenteration)
 Mandibulectomy (removal of the mandible or lower jaw or
part of it)
 Glossectomy (tongue removal, can be total, hemi or
partial)
 Radical neck dissection
 Moh's procedure or CCPDMA
 Combinational e.g. glossectomy and laryngectomy done
together.
 Feeding tube to sustain nutrition.
Owing to the vital nature of the structures in the head and neck area, surgery for larger cancers
is technically demanding. Reconstructive surgery may be required to give an acceptable cosmetic
and functional result. Bone grafts and surgical flaps such as the radial forearm flap are used to
help rebuild the structures removed during excision of the cancer. An oral prosthesis may also
be required. Most oral cancer patients depend on a feeding tube for their hydration and
nutrition. Some will also get a port for the chemo to be delivered. Many oral cancer patients are
disfigured and suffer from many long term after effects. The after effects often include
fatigue, speech problems, trouble maintaining weight, thyroid issues, swallowing difficulties,
inability to swallow, memory loss, weakness, dizziness, high frequency hearing loss and sinus
damage.
Following treatment, rehabilitation may be necessary to improve movement, chewing, swallowing,
and speech. Speech and language pathologists may be involved at this stage.
Chemotherapy is useful in oral cancers when used in combination with other treatment modalities
such as radiation therapy. It is not used alone as a monotherapy. When cure is unlikely it can also
be used to extend life and can be considered palliative but not curative care. Biological agents,
such as Cetuximab have recently been shown to be effective in the treatment of squamous cell
head and neck cancers, and are likely to have an increasing role in the future management of this
condition when used in conjunction with other established treatment modalities.
Treatment of oral cancer will usually be by a multidisciplinary team, with treatment professionals
from the realms of radiation, surgery, chemotherapy, nutrition, dental professionals, and even
psychology all possibly involved with diagnosis, treatment, rehabilitation, and patient care.
Prognosis
Postoperative disfigurement of the face, head and neck
 Complications of radiation therapy, including dry mouth
and difficulty swallowing
 Other metastasis (spread) of the cancer

10. CHINA
54%
INDIA
15%
BRAZIL
14%
UNITED STATES
6%
INDONESIA
4%
MALAWI
3%
ARGENTINA
2%
TANZANIA
0% ZIMBABWE
2%
CHINA INDIA BRAZIL
UNITED STATES INDONESIA MALAWI
ARGENTINA TANZANIA ZIMBABWE
 Significant weight loss
Global production
Production of tobacco leaf increased by 40% between 1971, during which 4.2 million tons of leaf
were produced, and 1997, during which 5.9 million tons of leaf were
produced. According to the Food and Agriculture organization of the
UN, tobacco leaf production was expected to hit 7.1 million tons by
2010. This number is a bit lower than the record high production of
1992, during which 7.5 million tons of leaf were produce. The
production growth was almost entirely due to increased productivity
by developing nations, where production increased by 128%.
Top Tobacco Producers, 2012
Country Production (tonnes)
China 3,200,000
India 875,000
Brazil 810,550
United States 345,837
Indonesia 226,700
Malawi 151,150
Argentina 148,000
Tanzania 120,000
Zimbabwe 115,000
World 7,490,661.35

11. Harmful effects of tobacco and smoking
According to the World Health Organization (WHO), tobacco is the single greatest cause of
preventable death globally. The WHO estimates that tobacco caused 5.4 million deaths in 2004
and 100 million deaths over the course of the 20th century. Similarly, the United States Centers
for Disease Control and Prevention describes tobacco use as "the single most important
preventable risk to human health in developed countries and an important cause of premature
death worldwide."
The harms caused by using tobacco include diseases
affecting the heart and lungs, with smoking being a major
risk factor for heart attacks, strokes, chronic
obstructive pulmonary disease (COPD), emphysema,
and cancer (particularly lung cancer, cancers of the larynx
and mouth, and pancreatic cancers).
The addictive alkaloid nicotine is a stimulant, and popularly
known as the most characteristic constituent of tobacco. Users
may develop tolerance and dependence. Harmful effects of tobacco consumption can
further derive from the thousands of different chemicals in the smoke,including polycyclic
aromatic hydrocarbons (such as benzopyrene), formaldehyde, cadmium, nickel, arsenic,tobacco-
specific nitrosamines (TSNAs), phenols, and many others.

12. INFERENCE
 Cancer treatments are costly & also not available at all govt. hospitals.
 No financial assistance from govt . is given overcome the financial burdens.
 Therefore there must be at least one cancer hospital in every district of a state. So
that the person may get proper facility at proper time in its own area.
 It is avoidable not to get addicted to any kind of the bad habits which will spoil the
future of the person & the nation too.
 Proper awareness programmers’ should be undertaken to eradicate cancer is future.
 Govt. must have to take strict norms on these things as soon as possible.