What is cancer? What is different about oral cancer?

Oral cavity is the place through which is food is taken in , speech comes out , the jaw which surrounds the mouth forms the face so the effect of cancer on life is devastating. Oral cancer when it occurs in the floor mouth can invade the tongue, the jaw bone. Even what occurs inside the cheek can invade the jaw bone. Upper jaw cancer can invade even the eye. Most oral cancers are painless. This makes the people to ignore the early cancer. So they seek treatment late when the cancer has become big or even has spread to the lymph nodes and distant places. . There is no effective cure for cancer. Surgery is mutilating unless mouth cancer is detected when it is very small and removed with wide margins. Radiotherapy and chemotherapy have severe side effects but are not fully effective recurrences are common Overall 5 year survival rate except for lips is less than 50%. Mouth cancer has the highest prevalence in Sri Lanka. It is no 1 cancer in Sri Lanka among males. 6th most common cancer among females. When the world is looked at it is about the 6th -11th most common cancer. But more than 95 % mouth cancers can be prevented because we know what causes them. Only about 5% of mouth cancers occur because of heredity and for unknown reasons. So what are the 95% of mouth cancers in Sri Lanka due to? They are due to totally unnecessary habits prevalent among all communities in Sri Lanka. The number one cause in Sri Lanka is tobacco. Tobacco can be chewed as in betel quid or can be smoked in beedi, cigars, pipe or cigarettes. Or it can be used as snuff. Second commonest cause in Sri Lanka is areca nut. Raw arecanut, dried arecanut, flavored arecanut (Babul). Third commonest cause is alcohol consumption which is fortunately rare if not absent among Muslims. When smoking habit and alcohol consumption are in one patient his risk for oral cancer is quadrupled or more. Most oral cancers develop through a pre cancer stage which is also usually painless, except a condition called OSMF Fortunately every pre cancer state does not become cancer. Mouth is an easy place to examine. So the pre cancer and even early cancer can be easily detected. What are the features of pre cancer and early cancer? A white patch that cannot be rubbed away. All white patch is not pre cancer A red patch that lasts for more than few days. All red patches are not pr cancer. Burning sensation in mouth with or without difficulty in opening the mouth. All burning sensation and all difficulty in opening the mouth is not pre cancer An ulcer that does not heal within 2-3 weeks. To whom must you show these? Show to a doctor or preferably a dental surgeon. What will he /she do? If possible he/ she will take a small part of the tissue (biopsy) after making it numb for tissue analysis. Otherwise you may be referred to a bigger hospital to see a specialist who will arrange a biopsy. What may be the outcome of this test? 1. May be it is totally harmless change. 2. It may have some features which may be a step towards cancer but it is still not serious reason for worry. But it must be kept under observation. 3. It may have more features which that can indicate a potential for cancer but not cancer yet. This also must be kept under observation. 4. Observation frequency may be every 2-4 months. It may have to be for the rest of patients life. 5. It may be cancer but very early stage. You will be advised to have surgery or radiotherapy. TAKE HOME MESSAGE FOR YOU: Eat plenty of vegetables and fruits. At least 5 different vegetables or fruits per day is recommended by International Cancer Association. They have substances that can prevent cancer. Check your mouth for the suspicious lesions. If you are in doubt see a dental/medical doctor.