CHEARS

With close to over 1 lakh cases every year and 5 people dying due to oral cancer every sixty minutes, it is utterly important to inform commoners on the How-to of oral carcinoma.

This article will take you(reader) through the intraoral as well as extraoral indicators that you should not be ignoring.

Ready?

Without jumping right into the details, let us first figure out the statistics from public health communities to better understand the risk group.

Oral and oropharyngeal carcinoma is the 6th most common type of cancer globally. However, the data suggest it is the third most common type of cancerous pathology in India. Risk groups overall include males more than females majorly from underdeveloped social backgrounds and unstable economy. Incidence rates have been found to increase with the age of population. People from middle and old-age group seems to be at risk because of compromised immunity than young age group.

How does oral cancer advance? What are the changes one can anticipate?

Any malignancy origins from a genetic level. It then advances to epithelium (in case of carcinoma). If not intervened at early stages, it enters the invasive phase and starts spreading to other organs or tissues through systemic circulation(metastasis).

1. What happens to the genes in the beginning? Alteration within genes starts with mutation- meaning changes in chromosomal patterns.

After the genetic alterations, dysplastic changes of cells occur.

1. Once there is a mutation in genes, they send signals to the targeted cells to proliferate even after they have finished their complete cell cycle. This means perfectly normal cells begin to proliferate further. This is called dysplasia. Usually, it is hard to track cancer at this stage. Clinicians require vigorous and detailed inspection to rule out cancerous changes since these alterations are not visible.

2. If cancer at this stage not identified, it starts becoming visible with proliferation of epithelial/surface cells. At this stage, one starts seeing visible physical manifestations. However, cancer still remains confined to the area.

3. Metastasis- This is the advanced stage of malignancy where cancer starts spreading to other organs through lymphatic system or blood circulation.

One can identify the changes well in advance for early detection and take necessary precautions.

• Red or white patches in the oral cavity. Patches could be found on frequently on cheek mucosa, floor of the mouth and vestibules in individual at risk.

• Ulcer that is not healing for more than two weeks

• Ulceration that subsides and erupts at the same place

It is best to visit your dentist or physician if skeptical changes occur.

Now that you know about what to look for as signs in your oral cavity, this article will further guide you with various lesions or appearances that appear well before cancer could be clinically diagnosed.

Precancerous lesions and conditions

Premalignant lesions are oral pathologies with the highest chances of getting converted into cancer.

lesions/appearances one should be careful of

Precancerous lesions and conditions include:

• Leukoplakia- white or grey keratotic patches on the mucosa

• Erythroplakia- red areas in the mouth

• Oral submucous fibrosis- reduced mouth opening

• Oral lichen planus- white or grey lace-like strides formation on mucosa, non-healing ulcers

• Oral thrush- fungal infection in oral cavity, thickened white plaques seen on oral mucosa

• Smoker’s palate- changes appearing on the roof of the mouth, cracks formation, red spots due to inflamed salivary duct openings spread on white or grey cracky area.

• Tobacco pouch keratosis- white, wrinkly pouch-like formation in the area where tobacco is kept for prolonged periods

All of this premalignancy have few risk factors in common- tobacco smoking, chewable tobacco, increased alcohol intake, areca nut or betel chewing, immunocompromised individuals with Human papillomavirus or HIV-AIDS, combined with a low nutritionally dense diet and poor oral hygiene. Another potential risk factor is stress.

Advanced indicators for head and neck cancer

• Painful swelling in floor of the mouth(beneath the tongue)

• Difficulty in opening mouth (trismus)

• Painful swallowing

• Bleeding that does not stop

• Loosening of tooth in particular site for no apparent reason

Tips to prevent and intervene at the earliest possible

Lifestyle changes constitute the first step of primary level of prevention. Clinician can identify patients at risk by History taking. Once identified, this group should be advised:

• To stop smoking cigars, cigarettes and other tobacco products

• For tobacco cessation

• Maintain oral hygiene

• Consumption of green vegetables and fruits

• Reduce alcohol consumption

• To optimize Vitamin A and Folic acid intake

How can clinicians identify individuals at risk?

Patient’s case history tells us secrets that patient might be hiding or facts which are unknown to patient itself. Clinician can identify potential risk of cancer by their nutritional history, habits, medical history as well as family history. If patient has former history of surgical intervention for cancer, there are very high chances of them redeveloping it.

Upon recognizing positive link, clinician should prepare patient for oral screening. If screening patient further reinforces the link to potentiality of malignancy, clinician can go ahead with few non-invasive tests to rule out diagnosis.

Who should you contact if you or someone you know is at the risk of oral cancer?

This requires an inter-disciplinary approach for treatment. However, Your dentist knows your oral cavity better. Dentists and oral surgeons are trained to identify potential signs. Not just that, they can perform swab tests, dye tests and oral biopsy when required. Other than dentists, ENT surgeons, general surgeons, head and neck specialists know well when carcinoma is metastasizing. These are few professionals one can reach out to if and when needed for primary diagnosis.