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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.