Oral cancer: The unseen killer

Cancer is a big challenge that is faced by humankind throughout the globe. Several people die with cancers per day, is far more than the covid-19. If we take our country, Sri Lanka, the two most common cancers are oral and breast cancer.

Out of those two cancers, oral cancer is the most common cancer among Sri Lankan males. Every day three or four people die of this deadly disease. Every year about three thousand new cases reported. Along with its fatality, its highly debilitating, disfiguring, and people who are fortunate enough to survive also live a miserable life.

As we all know, our face and mouth are the gateways to many important functions and aesthetics. The structures there, help us in eating, talking, breathing, express our feelings, and keep in the good look. But this menacing disease will destroy them all and carries the victim to an untimely death.

Now, let’s see, is there any way that, we can protect ourselves from this deadly disease?. For that, it is wise to avoid causative factors and identify the oral features that will lead to cancer.

According to scientific evidence, the main causative factors are betel chewing, smoking, and alcohol, some viruses and heredity also play very minor roles. In our country, the leading cause is undoubted “betel chewing”

It is scientifically proven that all four ingredients, that are betel leaf, tobacco, areca nut, and lime are contributory for the causation of oral cancer. Apart from that, products are coming from abroad (specially south Indian sub-continent) like “Babul. Mawa” etc. which are many times more dangerous and highly carcinogenic, and unfortunately has a big effect on the younger generation.  Alcohol and smoking have synergistic action that is they help each other in causing oral cancer especially in tongue and floor of the mouth.

Identifying early lesions is a very important aspect in managing oral cancer. If the disease can be identified at very early stages, the five-year survival rate is about eighty per cent. In other words, if we take a hundred patients with early disease and treat them, about eighty of them will be able to live for the next five years. The terrifying fact is that in advanced disease, the five-year survival rate is less than twenty per cent. Which means out of a hundred patients, less than twenty will be able to live for the next five years even if they get treatment.

This mere fact emphasizes the importance of identifying the disease at an early stage within the community.

Following are some of the early lesions that are suggestive of oral cancer.

·         Non-healing ulcer

·         White patch(Leukoplakia)

·         Red patch (Erythroplakia)

·         White and red mixed patch (Erythroleukoplakia)

·         Growth or lump

·         Unexplained facial pain

·      An Unexplained loosening of teeth

·         Difficulty in mouth opening

 It is very important to learn how to do a “self-mouth examination” properly. If one has of the above conditions or any other suspicious oral  lesions It is very important to meet your Dental surgeon or medical doctor and get the necessary referral done for specialist care.

The mainstay of treatment for oral cancer is surgery, which is done by Oral and Maxillofacial The surgeon or an Onco surgeon. Radiotherapy and Chemotherapy are the two other treatment modalities carried out by Oncologists in the management of oral cancer.

Although, Oral Cancer is the number one cancer among Sri Lankan men, with very high mortality and morbidity, it is pathetic to say that not much attention is geared towards the management of this preventable disease. One can doubt that because it is a“poor man’s disease”. Those who are affected mainly from oral cancers are farmers, manual workers, Daily wagers and another economically deprived segment of our society. But it is very important to note that, they are the breadwinners for this country, who produce food, and they deserve necessary attention.

Educating the community about hazardous habits, picking up patients with early lesions and directing them for treatment will greatly improve oral cancer prevention and management.

Although, Oral and Maxillofacial Surgeons, Onco Surgeons and Oncologists are working hard throughout the country and do an immense service in far corners of the island to cure the patients, the specialists who are responsible for preventing oral cancer at the community level are mainly confined to Colombo, failing to carry out the effective mode of community programmes in remote areas, which is reflected in continuously increasing number of patients coming to hospitals with advanced oral cancers.

The service of the Dental Surgeons who are having the expertise in identifying the early lesions of oral cancer at the community level also not utilized properly.

In conclusion, Oral cancer is a deadly disease, which causes dramatic damage to the society, economy and to the country as a whole, but not addressed properly.it is the duty of us as the health care providers to save our fellow citizens from this preventable disease.

Dr Buddhika Dassanayake

Consultant Oral and Maxillofacial Surgeon

Provincial General Hospital

Badulla.