Oral cancer by Dr Amol Dumbre

ORAL CANCER – A SILENT KILLER

Dr. Amol Dumbre Patil DNB

Consultant Oncosurgeon

Ruby Hall Clinic,Pune

KEM Hospital ,Pune

CANCER

CANCER

CANCER PREVENTION

Healthy lifestyle

Avoid tobacco: any form

Alcohol

Diet

Exercise

Mental stress

Treatment of infections

Screening

CANCER CURE

Early diagnosis

Prompt, aggressive and correct treatment

No pain…….No gain

Regular follow-up

FIRST CHANCE IS THE BEST CHANCE

EARLY DIAGNOSIS

Screening

Identify symptoms

Seek expert help

Good quality diagnostic tests

Tumor markers, CT, MRI, PET Scan

Good pathologist with good lab

Immunohistochemistry (IHC)

SCREENING

Finds cancer when asymptomatic

Size very small, may not be palpable

Cancer found is usually curable

Simple tests

Can be used in

Breast cancer

Cervical cancer

Colon cacner

Oral cancer

Finds cancer early in persons who would otherwise surely get it later in

advanced, incurable stage.

SURGERY

CHEMOTHERAPYRADIOTHERAPY

TREATMENT

ORAL CANCER

Magnitude of problem

Prvention-primary and secondory

Oral examination

Premalignat lesions

Cancerious lesions

Treatment

INCIDENCE AND SURVIVAL

OF ORAL OR PHARYNGEAL CANCER

30,000 new cases diagnosed yearly

8,000 deaths each year

5 year survival rate: 50%

USA

New cases of cancers in India per year- about

7,00,000

Tobacco related cancers - about 3,00,000

Cancer of uteri - 1,00,000

breast cancer – 80,000

(TMH-preventive oncology department)

ORAL CANCER

MORBIDITY & MORTALITY

Most common cause of cancer death in most

parts of Asia

5 year survival (20 -50 %)

50,000 deaths in India annually. Primarily due to

late presentation (60-80%)

Tata Memorial Hospital Of 2275 cases- Only 9%

in Stage I & II

BATTLE AGAINST ORAL CANCER !

• Prevention

• Improved treatment ( no significant change in

last 50 years)

ORAL CANCER – PREVENTION

Primary Prevention

Secondary Prevention – Early detection

PRIMARY PREVENTION

Cancer prevention- Addressing the etiologic

agents

Ban tobacco

Behavioral modifications

Educate the people

TOBACCO BAN – IMPLICATIONS

India 3rd largest producer of tobacco

900,000 employed in growing and curing

industry and 3.4 million in manufacturing 97.7

million dollar trade surplus

Smokeless tobacco $ 1 billion annually = 0.2 %

of the gross national product

“only industry that has had a constant growth

for last few decades

SECONDARY PREVENTION

Early detection of premalignant and malignant

lesions

Screening

EARLY DETECTION SAVES LIVES

5-year survival for localized disease is 76%

5-year survival for metastatic disease is 19%

EARLY DETECTION

Increase survival

Decreases morbidity

Decreases cost of treatment

EARLY DETECTION IS OFTEN POSSIBLE

Tissue changes in the mouth that may signal

cancer can often be seen and felt easily.

EXAMINATION OVERVIEW

Head and neck exam should be a routine part of

dental and medical check-ups.

Take a history of alcohol and tobacco use.

Follow up on suspicious signs.

TOOLS AND TIME

Proper lighting

Dental mouth mirror

Gauze squares

Gloves

5 minutes

EXTRAORAL EXAMINATION

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: LIPS

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: LABIAL MUCOSA

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: LABIAL MUCOSA

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: BUCCAL MUCOSA

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: BUCCAL MUCOSA

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: GINGIVA

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: DORSUM OF

THE TONGUE

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: LEFT MARGIN OF THE TONGUE

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: RIGHT MARGIN OF THE TONGUE

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: VENTRAL SURFACE OF THE

TONGUE

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: HARD PALATE

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION: OROPHARYNX

PERIORAL AND INTRAORAL SOFT

TISSUE EXAMINATION

PREMALIGNAT CONDITIONS

Leukoplakia

Erythroplakia

Oral submucous fibrosis

PREMALIGNANT CONDITIONS-

LEUKOPLAKIA

ERYTHROPLAKIA

ORAL SUBMUCOUS FIBROSIS

MALIGNANT CONDITIONS

TREATMENT

Surgery

Radiation

Chemotherapy

HEMIMANDIBULECTOMY

LIP WIDE EXCISION AND

RECONSTRUCTION

BUCCAL MUCOSA WIDE EXCISION

COMONDO OPERATION

There is still much to be done. Oral cancer remains

a major health problem in India, and only dedicated,

sustained efforts towards early detection and

prevention will reduce the burden of this disease.

THANKS…

INTRODUCTION

Oral Cancer is the sixth leading cause of cancer worldwide

The survival rate was 52%.

Oral cancer generally are socially derived diseases.

Tobacco and alcohol are synergistic effect

Treatment of early oral cancer is surgery. Locally advanced T3/4 are best treated with combined surgery and Radiotherapy.

High risk of second primary cancer. (Field cancerization)

THE ABILITY TO CONTROL ORAL CANCER

WILL BE DEPEND ON:PREVENTION

EARLY DIAGNOSIS

CONTINUING EDUCATIONAL CAMPAIGNS

"THERE ARE ABOUT 7,00,000 NEW CASES OF

CANCERS IN INDIA OUT OF WHICH TOBACCO

RELATED CANCERS ARE ABOUT 3,00,000, CANCER

OF UTERI ARE 1,00,000 AND 80,000 BREAST

CANCER. COST OF TREATMENT OF ORAL CANCER

IS ABOUT 3.5 LAKH. THIS CAN BE COMPLETELY

PREVENTED BY SIMPLE CHANGES IN LIFESTYLE AND

REGULAR SCREENING AND EVEN HAVE HEALTH

BENEFITS THAT REACH BEYOND CANCER. ABOUT

2000 DEATHS A DAY IN INDIA IS TOBACCO

RELATED."

Despite the fact that the oral cavity is

accessible for visual examination, and that

oral cancers and premalignant lesions

have well-defined clinical diagnostic

features, oral cancers are typically

detected in their advanced stages. In fact,

in India, 60-80% of patients present with

advanced disease as compared to 40% in

developed countries. Consistent with

patients presenting for medical care with

more advanced disease in India compared

with developed countries, overall survival is

also reduced. Early detection would not

only improve the cure rate, but it would

also lower the cost and morbidity

associated with treatment.

In this randomized, controlled trial of

almost 192,000 people, carried out over an

eight-year period, there was a significant

reduction in mortality in the intervention

arm (29.9 cases per 100,000) versus the

control arm (45.4 cases per 100,000), due

to detection of oral cancer at an early

stage.