Burden of oral cancer increasing on public sector hospitals, warn experts

Oral cancer at early stages is commonly associated with few symptoms, and when symptoms are present, they may be minor and nonspecific. Even advanced-stage cancers at initial presentation may have few, minimal, or nonspecific symptoms. Symptoms may come and go. Persistent doesn't always mean constant. For example, you may have a sore throat for a week that goes away for a few days and then returns. If you experience intermittent or constant symptoms for two weeks or longer, you should make an appointment to see a dental surgeon.

These facts came to light in discussions with Prof Shahjehan Katpar, consultant oral & maxillofacial surgeon and head of the Department of Dental Faculty at the prestigious Dow University of Health Sciences, Karachi, at an ‘Oral Cancer Awareness Seminar’ organised on Saturday by M. Hashim Memorial Trust & Neurospinal & Cancer Care Postgraduate Institute.

Oral cancer, according to Prof Shahjehan, is one of the deadliest and commonest cancers seen in Karachi, while the rate of oral cancers has grown beyond four per cent in the country; it stands at an alarming 30 per cent in Karachi.

Though chalia does induce a mild sense of excitement, several brands of chalia and saunf supari (paan masala), gutka and mainpuri were found to be laced with narcotics, including nicotine, he points out, adding that most of the chalia being sold in the market is of very cheap quality and has fungus, making it harmful for human consumption. The colours added to the chalia and gutka have also proved to be harmful and has very high carcinogenic potential.

“Regular consumption of gutka and other concoctions changes the colour of the inner lining of the cheek from its natural pink to white. It is the first sign of oral sub-mucous fibrosis (OSF), which develops into a blister and eventually into big, painful non-healing mouth ulcers.”

Prof added that during the onset of OSF, patients also experience burning and irritation while eating. The disease causes the weakening of teeth and reduces appetite.

“While the burden of oral cancer is increasing on public sector hospitals, which have limited resources, no preventive measures are being taken to check or control the widespread use of chalia, manpuri and gutka, especially among youngsters, as they were are the rise with an alarming pace. It means that the disease is having a huge impact on society in terms of contributing to the health burden, loss of productivity as well as affecting individual families. This is a grave situation. If preventive measures are not taken today, oral cancer may take the form of an epidemic in coming years,” warned Prof Shahjehan.

“Almost 30 to 50 per cent of cancers can be cured if treated at early stages, for which timely diagnosis is crucial. A sore in the mouth that lasts for more than two weeks, persistent pain, numbness, bleeding, or swelling in the mouth, a lump or thickening in the cheek, gums, lips, or elsewhere in the mouth, white or red patch on the gums, tongue, tonsil, or elsewhere in the mouth, persistent sore throat, swelling and/or difficulty moving the jaw, and loose teeth are few of the symptoms of oral cancer,” he explained.

“While many of these symptoms may not be related to oral cancer, if you’re at higher risk and you experience any of these issues for more than two weeks, discuss them with your dental surgeon as your first priority,” he said. “Many oral cancer surgery patients are often concerned about disfigurement; but recent advances in reconstructive surgery help patients restore their appearance, sometimes with little or no sign of change,” Prof Shahjehan said.

Dr Lubna Saleem, consultant medical oncologist and assistant professor at the Cancer Foundation Hospital, shared her concern regarding oral cancer and its modern treatment options.

The burden of oral cancer patients has dramatically increased, but treatment facilities are limited in our country. The situation is resulting in a loss of quality treatment, long waiting lists, and delays in surgery as well as affecting the timely treatment of other patients.

“Oral cancer is typically treated by a team of professionals, including oral and maxillofacial surgeons who treat cancer and other diseases of the mouth, including the jaws and teeth, otolaryngologist, a surgeon who treats head and neck cancer and other diseases, radiation oncologist, who treats cancer with radiation therapy and the most important is a medical oncologist, who uses anti-cancer therapies such as chemotherapy, targeted therapy or immunotherapy to treat this complex disease,” she said.

Chemotherapy may be used to treat oral cancer patients whose disease has spread. It may be given alone or in combination with other treatments. Patients may undergo chemotherapy before or after surgery for oral cancer. When chemotherapy is given before surgery, the goal is often to shrink the cancer for easier removal. When given after surgery, chemotherapy can help kill any errant cancer cells that are left behind, reducing the chance of a recurrence.

“Immunotherapy drugs harness the power of your immune system to find and destroy cancer cells. They target specific proteins on the surface of cancer cells, killing them or preventing them from growing. Some immunotherapy drugs are being studied to see whether they have a role in the treatment of oral cancer, including the checkpoint inhibitors. These drugs may also be used when chemotherapy stops working in patients whose oral cancer has returned or spread to other parts of the body,” she elaborated.

Guest speaker Dr Muhammad Nauman Zahir, consultant medical oncologist and associate professor at Ziauddin University Hospital, said the most striking issue in appropriate and timely treatment is patients and their caregivers’ attitude towards biopsy as they are afraid to undergo biopsy although it can confirm diagnosis. Cancer is not spread by biopsy. People should get it if advised and procedure handled by a qualified doctor,” he added.

“A biopsy is the only way to know for sure that oral cavity or oropharyngeal cancer is present. The biopsy results help your healthcare provider determine whether the cells are cancerous. If the cells are cancerous, the results can tell your care provider where the cancer originated — the type of cancer. A biopsy also helps your care provider determine how aggressive your cancer is — the cancer's grade,” he further explained.

“One potential target in oral cancer is the epidermal growth factor receptor (EGFR). Studies have shown that many oral tumor cells contain too many copies of EGFR. This excess hormone allows the cancer cells to grow faster and to become resistant to radiation and/or chemotherapy. Treating oral cancer with a drug that targets EGFR may help kill cancer cells without harming normal tissues,” he said while discussing a recent novel therapy for oral cancers.

“Your medical oncologist may recommend a targeted drug in combination with chemotherapy or radiation therapy to treat oral cancer. If the cancer has stopped responding to radiation and chemotherapy, targeted therapy may be used on its own to help control the disease,” said Dr Nauman Zahir.