Rise of Oral Cancer and Treatment facilities in India

Oral cancer is the most commonest cancer in the population of India today.  The statistics are quite shocking with 14 deaths per hour due to oral cancer in India which inhabits 40% of world smokers. It is commonly seen in rural population in both sexes. Tobacco abuse (chewing & smoking) is seen in all sections of society, with India statistically to have the highest incidence of oral cancer. Chewing or smoking of tobacco as specified earlier combined with unhealthy oral habits, nutritional status, financial status, access to medical care result in this cancer. This is one cancer, the causal reason for which is known but still India still tops the list of highest number of reported oral cancer cases.

This type of cancer is likely to affect men and women both and men are twice as likely to develop it.  The likeliness of people who abuse tobacco to have oral cancer is six times as compared to non- smokers. Oral cancer sees its inception in the history and heritage of India. This tradition has been passed along generations in this country.
The age group affected is 30 – 45 years and male and female both have been found to have equal incidence percentages. Majority of the patients belong to lower socio- economic strata (81%) with minimum nutritional status and low literacy rates. After the 30 – 45 age group population, 2nd highest incidence is seen in young population (18 – 30 yrs age group). The poor income groups are more pre-disposed to smoking bidis and chewing tobacco. This is primarily attributed to "Ghutka – chewing tobacco", this smokeless tobacco is available in sachets with government permission. These have carcinogenic ingredients and are kept by the chewer in the oral cavity for long before he/she chews it. This constant chewing cause injury to inner oral cavity lining, making it irreversibly injured and finally the cells become malignant causing oral cancer.
Due to ethnic reasons Indian women also chew this smokeless tobacco and after breast and cervix cancer, oral cancer incidence is at 3rd highest in Indian women.
All this clearly indicates the rise of oral cancer in India and the situation warrants public education for prevention of oral cancer is instituted. To begin a correct treatment a definitive diagnosis is done with the aid of various diagnostic tools.
Also before starting with the treatment to prevent the side – effects and post therapeutic complications other combined therapy is also done. This may specifically be addressing of oral health needs to decrease post treatment complications. Sometimes a condition called osteonecrosis is resulted due to radiation exposure and all such conditions can be avoided if a planned treatment regime is followed. The type of treatment given to the patient, whether it is a combined therapy or an individual treatment is dependent totally on the type of malignant tissue and the advancement of the oral cancer. If the cancer is detected and treated at an early stage there is less of disfigurement and as such consequently lesser reconstructive surgery. For advanced cancer which may have affected voluminous cells due to removal of malignant cells a surgical reconstruction may be required of parts of oral cavity and sometimes even facial features. Also to limit the recurring of cancer the treatment may take away vital parts of anatomy in the face and neck. Therefore for help with functions like chewing food, speech orientation and dental structure interventions like adjunctive therapy – facial prosthesis, etc may be warranted.
Oral cancer is treated by maxillofacial surgeons who treat tumors of mouth, face, jaw and neck and much more.  Treatment facilities in India for oral cancer are minimal in rural areas. The primary step in treatment of oral cancer is staging which is done followed by biopsy which confirms the presence of cancer. Staging is done with help of diagnostic tests and in advanced health care setting most modern technology is available for the same.  A multimodal approach with maxillofacial surgeons, otolaryngologists (ear, nose, and throat doctors), medical oncologists, radiation oncologists, plastic surgeons, radiation therapy experts is required for a positive outcome. In most of the cases a surgery is necessary to take out the tumor in combination with radiotherapy. Due to the location of the cancer in the cavity and subject to the type of cancer often there are side effects of the treatment. Post operative healing is largely dependent on follow up and nutrition. There are excellent facilities in urban areas of India.  In rural areas the oral cancer state is quite depressing owing to lack of Oral Cancer awareness and is augmented by the lack of healthcare resources.