Did you know even non-tobacco users can get oral cancer? This doctor busts more myths!

Q. What parts of our mouth are prone to oral cancer?

A. Oral cancer can affect any part of the mouth. It can affect the tongue, the inner lining of the cheek, the upper or lower jaw bones, what’s called the floor of the mouth, which is under the tongue, and it can affect the lips. So virtually any part of the mouth can be affected by oral cancer.

Q. What is the incidence of oral cancer in India, especially in South India?

A. Oral cancer is one of the commonest cancers in India, with more than 2 lakh new cases every year. India is considered the oral cancer capital of the world. It’s all over the country. The reason is tobacco prevalence, one in three adults use tobacco, but a significant portion of patients also don’t use tobacco.

Q. What are the symptoms of oral cancer?

A. One must not ignore any of these symptoms for more than two weeks.

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  Lumps and bumps on the tongue. (Creative Commons)

  An ulcer or a non-healing kind of wound anywhere in the mouth, which could be on the lips, cheek, or jawbone.

• White or red patches in the mouth that do not go away when you rub them, lasting for more than two weeks.
• Lumps and bumps in the tongue, on the jawbone, or on the hard palate.
• Difficulty opening the mouth.
• Swellings in the jawbone.
• Blood in saliva.
• Lumps in the neck, typically enlarged lymph nodes.

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Q. Are the symptoms of oral cancer always painful?

A. Many of them are not. So usually they’re painful only when they’re advanced, which is why patients delay seeking treatment. Other things like toothaches and infections are often very painful. So patients seek treatment immediately, but these are often quite innocuous and they don’t create many symptoms. So till they get much bigger and involve larger areas, they’re totally painless, which is why we have to be aware of them and identify the symptoms early.

Q. What are the common myths surrounding oral cancer?

A. These are the five most common myths:

Myth 1: Tobacco and alcohol use is a very important factor in causing oral cancer

It’s not only tobacco and alcohol users who get oral cancer. For reasons unknown to us, about 10 to 15 percent of patients have no history of tobacco and alcohol, either smoked or chewed tobacco. These which are considered as risk factors may not even be there in a person but they can develop oral cancer.

You can have chronic trauma from a sharp tooth or an ill-fitting denture. Sometimes, you can be at a slightly higher risk if you have HIV or if you are on transplant medication. This is a sizable portion. So it’s important to be able to identify the symptoms that we listed out whether or not you use tobacco or consume alcohol.

Myth 2: It occurs only in people above 65 years of age

In Southeast Asia, especially in India, oral cancer appears 10 years earlier. So the average age at which oral cancer appears in the West — Caucasian populations primarily — is 65 years of age. In India, it’s 10 years younger, so 55 is the median age. We don’t know the exact reason. It could be due to the fact that we are putting multiple carcinogens together or we could even have some genetic predisposition to develop oral cancer early. It is still being studied.

When we were in college, we were taught that people above 65-70 years are susceptible to oral cancer but it’s not so anymore. We are operating on patients every day who are under 55 years of age.

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Myth 3: Only men get oral cancer

Funnily enough, when you look at tobacco use in India, men and women both use a lot of tobacco. So one in three adult men, one in three adult women, both in urban and rural areas, use some form of tobacco, either smoked or chewed. We see plenty of women with oral cancer, some of them are tobacco-related, some are not. And for some reason, there’s an increasing epidemiological trend of younger women without any tobacco and alcohol history.

Myth 4: Oral cancer is not treatable

One thing I really want to put on record is that oral cancer is very treatable. We have data that we put out from our group, other groups in India, all over the country — we have excellent cure rates. Even advanced oral cancer has better cure rates than many other cancers. Once diagnosed we identify the extent of the disease and treat them accordingly, usually with surgery or sometimes surgery along with radiotherapy. It depends on the stage.

Myth 5: There is going to be a lot of deformity post-surgery

It not true that patients have to be left deformed. Each patient is treated differently and the treatment options have exploded. The way we treat patients has fundamentally remained the same. But when we look at reconstruction and we look at rehabilitation, we are able to do a lot now than before. So very often if we have to remove multiple teeth, we can reconstruct and give the patient a full set of teeth at the same time. They wake up from surgery with a full set of teeth, no scars on the face, no deformity, and good symmetry between both sides of the face.

Unfortunately, this wasn’t available 20 years ago. With the expansion in technology, with the expansion in expertise and techniques, we are able to do this even for patients who are not very economically well-off. The cost of all of this has come down considerably. The expertise is available now.

Oftentimes, patients with oral cancer don’t seek treatment because they are afraid of deformity and dysfunction. That’s not the case anymore. Even if you come in with advanced disease, you’re treated appropriately, your rehabilitation and reconstruction are planned appropriately. By the time you go home from the hospital, you will be eating, talking, and appearing normal.

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Q. How soon should someone seek treatment after noticing symptoms of oral cancer?

A. You lose nothing by getting an evaluation. It may not be cancer in the majority of patients. But just know that your cure rate in stage one is 85 to 90 percent, while for stage four it is about 50 percent. So a few months can cut your survival into half.

Q. What about the recurrence of oral cancer post-surgery?

An issue we see in some cancers is that sometimes it recurs. Whatever we do, some of them recur but the vast majority don’t.

If we treat patients appropriately, which means that we stage them properly and we complete the treatment in one shot, the vast majority of patients are cured.

We’ve gone beyond the point where we write off anybody with a recurrent cancer saying, “I’m sorry, the disease has come back and there’s nothing you can do.”