oral cancer

Never ignore these early symptoms of oral cancer

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Tobacco – The Silent Killer:

Tobacco kills up to half of its users. There are various forms in which tobacco is used like cigarettes, E-cigarettes, pipes, cigars, and chewing (smokeless) tobacco. Tobacco use and heavy alcohol consumption are the main risk factors for oral cancer in developing countries.

Dr. Vipin Goel, Senior Consultant, Surgical Oncology, CARE Hospitals, Banjara Hills, Hyderabad says, “In India over 80% of the cases are attributable to the use of tobacco and alcohol consumption. More teens and young adults are using tobacco for various reasons. If the present trend continues, the condition will further worsen with more and more cases of oral cancers in the near future amongst youngsters.”

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02/7Difficulty in swallowing:

Oral cancer can also be associated with difficulty in chewing, swallowing, speaking, or moving of tongue. You might have a food-in-throat sensation. Another factor contributing to difficulty swallowing is a narrowing of the food stream (Oesophagus).

03/7Ulcers, white and red patch:

The most common presentation for oral cancer is an ulcer that does not heal. A white or reddish patch on the inside of your mouth. The patches are not associated with cancer if you have antifungal medication and they disappear.

04/7Missing teeth:

Dr. Goel says, “Tooth loss has also been reported to be associated with a higher risk of oral cancer. Cigarette use, alcohol intake, and poor oral hygiene are the culprits in bad teeth condition.”

Your teeth’s enamel is more likely to discolour and thin over time if you smoke or use chewing tobacco products. Nicotine and tobacco are both exposed to your teeth when you smoke. As a result, it’s likely that you’ll have stained, yellow teeth and unpleasant breath. This can also lead to tooth loss.

05/7Pain while opening your mouth:

This is another symptom of oral cancer. Mouth cancer can make chewing and swallowing food painful or give you a burning sensation. Oral lumps that are persistent and unexplained do not go away. Neck lymph nodes that have chronic, inexplicable tumors that do not go away can also signal oral cancer.

If you do notice any of these symptoms, approach your healthcare professional as soon as possible.

06/7How to diagnose oral cancer:

Dr. Goel says, “For diagnosis, we do a biopsy and imaging (CT scan/MRI scan) to determine the extent of cancer. The kind, location, and stage of cancer at diagnosis will all affect how oral cancer is treated. One may have just one type of treatment, or one may undergo a combination of cancer treatments (Surgery, chemotherapy, and radiation) depending on the stage.”

07/7The takeaway:

As Treatment is very painful, costly, and has no guarantee of cure, we have to think about how we can prevent this epidemic of oral cancers. To deal with this “Silent Killer” The best way is to avoid the use of tobacco in any form. Without tobacco, we live longer, experience better health, have more energy, and have a lower risk of developing cardiovascular, pulmonary, and other ailments. Quit now as prevention is better than cure.

Broccoli Extract Can Rid Your Body of Cancer-Causing Chemicals and Fight Oral Cancer

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It’s no surprise that cruciferous vegetables – such as broccoli, cabbage, and garden cress – are good for our health. Now, a new study demonstrates how broccoli sprout extract activates a gene that detoxifies carcinogens in the body, serving to prevent cancer recurrence in people who have encountered head and neck cancer.

The study, published in the journal Cancer Prevention Research, was led by Dr. Julie Bauman, co-director of the University of Pittsburgh Medical Center (UPMC) Cancer Center in Pennsylvania.

According to the Centers for Disease Control and Prevention (CDC), each year in the United States, over 30,000 new cases of oral cancer are diagnosed, and there are over 8,000 deaths due to oral cancer. The survival rate for such cancers is quite low, with a 5-year survival rate of about 50 percent.

“With head and neck cancer, we often clear patients of cancer only to see it come back with deadly consequences a few years later,” says Dr. Bauman.

Methods of treating oral cancers include surgery, radiation, and chemotherapy, but they can be disfiguring and costly. Repeated exposure to carcinogens is the greatest risk factor for head and neck cancer. Cruciferous vegetables have a high concentration of sulforaphane; previous research has shown it can protect people against environmental carcinogens.

 Dr. Bauman notes that previous attempts to develop drugs to reduce the risk of head and neck cancer recurrence “have been inefficient, intolerable in patients and expensive. That led us to ‘green chemoprevention’ – the cost-effective development of treatments based upon whole plants or their extracts.”

Lab, mice, and human studies have been successful

cauli-sprout-close

To further investigate, Dr. Bauman and colleagues first treated human head and neck cancer cells with different doses of sulforaphane, as well as a control. They then compared them with healthy throat and mouth cells.

Results showed that the sulforaphane encouraged both cell types to increase levels of a protein that turns on specific genes that induce carcinogen detoxification, protecting cells from cancer. Next, in a small preclinical trial, for several days, 10 healthy volunteers drank or swished juice mixed with broccoli sprout extract.

Not only did the study subjects have no significant problems tolerating the extract, but the lining of their mouths also showed that the same protective genetic pathway was activated in their mouths. The researchers say this means the sulforaphane was absorbed and focused on at-risk tissue.

In a further experiment, the researchers used mice to see how the extract worked in those predisposed to head and neck cancer. Results showed that the mice that received the extract developed fewer tumors, compared with those that did not.

In light of the successful studies, Dr. Bauman and her colleagues have initiated a larger clinical trial in humans who have previously been cured of head and neck cancer. The participants are currently taking capsules with broccoli seed powder.

The researchers write:


”Together, our findings demonstrate preclinical chemopreventive activity of sulforaphane against carcinogen-induced oral cancer, and support further mechanistic and clinical investigation of sulforaphane as a chemopreventive agent against tobacco-related HNSCC [head and neck squamous cell carcinoma].”

Watch the video discusion. URL:https://youtu.be/QTA-BMAYaxQ

 

ASCO: Elective Neck Dissection New Tx Standard in Oral Cancer

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Early lymph node removal boosts survival in early-stage squamous cell disease

  •  An open question about the surgical management of early-stage squamous cell oral cancers has a clear-cut answer, researchers said here. They advocated for elective neck dissection in patients with early disease.

It is always better to take out lymph nodes in the neck at the same time as the primary surgery rather than waiting for them to relapse, according to Anil D’Cruz, MBBS, of the Tata Memorial Centre in Mumbai, India, and colleagues.

In a 10-year randomized trial, elective neck dissection at the same time as the tumor surgery improved overall survival (OS) and reduced recurrence compared with a wait and watch approach, D’Cruz told reporters at the American Society of Clinical Oncology annual meeting.

Immediate neck dissection in early stage oral cancers “should be standard of care,” D’Cruz said.

Indeed, the study “will change practice tomorrow,” commented ASCO expert Jyoti Patel, MD, of Northwestern University in Chicago.

“This one-and-done approach might add an hour or so to operative time,” she toldMedPage Today, “but really decreases the need for close surveillance.”

Even very close surveillance can miss the first signs of relapse, which means patients present after relapse with extensive disease. “So every patient with an early oral cancer should now have elective neck surgery,” she said.

How to treat early-stage node-negative oral cancers has “been a matter of considerable debate for more than 5 decades,” D’Cruz said, and is important in both developed and developing countries.

The tumors are seen “everywhere there is high incidence of excessive consumption of tobacco and alcohol.”

The management of the initial tumor is an “often straightforward” surgery through a small incision. “Controversy surrounds the management of the neck,” he said.

Leaving the lymph nodes in the neck alone — the wait and watch approach — has not been seen to have a survival disadvantage, but can entail additional surgery, with the attendant risks, he said.

The other school of thought is to dissect out the lymph nodes at the time of the original surgery, an approach that has the advantages of being a single-stage procedure and yielding better cancer control.

To try to settle the question, he and colleagues enrolled 500 patients with lateralized T1 or T2, node-negative squamous carcinoma of oral cavity, which was treated with peroral excision.

Patients were randomly assigned to elective neck dissection or watch and wait with therapeutic neck dissection at the time of relapse, he said.

The researchers found immediate neck dissection improved OS by 12.5%, compared with a watch and wait approach, and cut the risk of death by 36%.

The elective dissection also reduced the risk of recurrence by 55% compared with watch and wait.

There were eight excess deaths for every 15 excess recurrences in the watch and wait/therapeutic neck dissection arm, the authors reported.

While tobacco use has been falling in the U.S., Patel noted that “over 42 million Americans still smoke so we are still at high risk for developing oral cancers … cancers of the cheek, the lip, the tongue.”

She drew a contrast between the cancers in the study and those associated with human papillomavirus, such as the disease that affected actor Michael Douglas.

“HPV cancers are different,” Patel said. “They typically present with more bulky locally advanced disease.”

But “for all intents and purposes (early stage) oral cancers are caused by carcinogen exposure,” she said.

Asia’s deadly secret: The scourge of the betel nut

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It is used by almost a tenth of the world’s population. It gives people a buzz equivalent to six cups of coffee and is used variously as a symbol of love, marriage and a cure for indigestion and impotence.

But it is also leading tens of thousands to an early grave.

The culprit? The humble betel nut.

Found across Asia, these nuts are harvested from the Areca palm and are chewed for their warming glow and stimulating properties.

Such is its effectiveness, that alongside nicotine, alcohol and caffeine, betel nuts are believed to be one of the most popular mind-altering substances in the world.

Although used by women and children, the nuts are especially popular among working-age men, who chew to stay awake through long hours of driving, fishing or working on construction sites.

But the short-lived benefits come at a terrible cost.

High rates of oral cancer are destroying the lives of many who buy betel nuts, often decades after their first taste.

Now in Taiwan, where the nuts are affectionately known as ‘Taiwan’s chewing gum’, the government is taking action to curb this centuries-old habit and reduce the thousands of lives lost each year.

Dangerous combination

Betel chewer's teeth and lips
Regular betel nut chewers stand out from the crowd with their red-stained lips and teeth

The betel nut is a key part of many Asian cultures and can be consumed dried, fresh or wrapped up in a package known as a quid.

Although the exact preparation varies across countries and cultures, the quid is usually a mixture of slaked lime, a betel leaf and flavourings such as cardamom, cinnamon and tobacco.

Worryingly, the International Agency for Research on Cancer lists each ingredient, with the exception of cardamom and cinnamon, as a known carcinogen – or cancer-causing agent.

The slaked lime is seen as a particular problem as it causes hundreds of tiny abrasions to form in the mouth. This is thought to be a possible entry point for many of the cancer-causing chemicals.

“About half of the men here still don’t know that betel nuts can cause oral cancer,” says Prof Hahn Liang-jiunn, an oral cancer specialist at the National Taiwan University Hospital.

“[This is despite] Taiwan’s incidence or mortality rates for oral cancer ranking among the top two or three in the world.”

‘I started chewing because everyone else did’

Qui Zhen-huang with photo of oral cancer lesion
Qui Zhen-huang now warns others about the dangers of betel nuts.

Like most people, Qiu Zhen-huang, 54, was completely unaware of the risks.

A former gravel company worker, he chewed for ten years. Twenty years after quitting, he developed the disease.

“I started chewing betel nut because everyone at work did it,” says Mr Qiu.

“We shared it with each other to build good relations.”

Three years ago, a small hole developed in his left cheek and in just three months, the tumour grew to the size of a golf ball and completely changed his life.

“Whatever I ate flowed out. I had a gauze pad over it. It hurt,” he said.

“It affected me a lot. I was so ashamed I avoided going out.”

Each year, 5,400 Taiwanese men like Mr Qiu are diagnosed with oral cancer or pre-cancerous lesions and an estimated 80 to 90% of those also chew betel nuts.

An early symptom includes white or red lesions inside the mouth, but this can rapidly progress to grotesque flesh-eating tumours.

Unlike other cancers, these are difficult to hide, leaving sufferers physically and psychologically devastated.

“It’s miserable for them,” says Prof Hahn.

“Sometimes, even after surgery, they still can’t perform basic functions, including expressing emotions through their face because the lower jaw also has to be cut depending on the scale of the cancer.”

Tackling the scourge

Betel nut palms
The Taiwanese government is offering subsidies in return for cutting down betel nut palms

Luckily for Qiu Zhen-huang, his cancer was treated and his cheek reconstructed.

But the Taiwanese government is helping people detect the disease much sooner by providing around one million free screenings and funding programs to help people quit betel nuts for good.

In 2013, these measures helped cut the usage rate among men by nearly half.

The government is also trying to reduce the domestic supply of betel nuts by offering subsidies to farmers to cut down their trees and plant alternative crops.

Other countries such as India and Thailand have also launched campaigns to discourage betel nut chewing.

But there is still a way to go. At a recent presentation to elementary school children of fishing industry workers, nearly all raised their hands when asked whether their parents or relatives chewed betel nuts.

And as the cancer can take up to 20 years to appear, the current changes will have come too late for many people – a fact that Mr Qiu keeps close to his heart.

“I’m one of the luckier ones.”