As per NCBI, 20 per 100,000 populations are affected by oral cancer in India, which is about 30% of all types of cancers. Deaths due to oral cancer are again very high, over 5 people every hour, every day. Men are mostly affected by this type of cancer than women mainly due to their tobacco consumption habits.
Oral cancer is a cancerous growth in the mouth. Here the cells of certain areas of the mouth start to multiply in an uninhibited manner. This growth may eventually lead to tumor formation. The most common areas of oral cancer formation are:
- Inner sides of the cheeks
- Under the tongue
- The lining of the mouth
- The floor of the mouth
- On the tongue
Four stage classification of oral cancer is generally followed:
- Stage 1: Tumor is smaller than equal to 2 centimeters and the lymph nodes are not involved.
- Stage 2: Tumor is about 2 to 4 centimeters and the lymph nodes are still not involved.
- Stage 3: Either tumor is larger than 4 cm without the involvement of lymph nodes, or it is of any size but has involved one lymph node. None of the other body parts is involved as yet.
- Stage 4: The size of the tumors is irrelevant here but the nearby tissues, the lymph nodes, or other parts of the body are involved.
Apart from staging, other factors are also considered while management approach is being designed, this includes:
- Type of the tumor
- Location of the tumor
- Age of the person
- General health status
Stage-wise Management Plan:
Stage 1 and 2
These early-stage cancers are usually addressed through surgical management. Here, the cancer growth and the involved lymph node if any are removed through a surgical approach. Any other infected tissue is taken out too.
Reconstruction procedures are used in oral cancer stages when significant cancerous tissue is removed due to the spread of cancer.
Such advanced stage tumors are addressed through radiation therapy. Radiation therapy is mostly used in conjugation with another therapy like surgical oncology after the tumor is removed to limit the spread and regrowth of the same tumor.
Brachytherapy and external beam radiations are the most commonly used radiation therapy techniques to address oral cancer.
These tumors can only be addressed through chemotherapy. Drug usage in oral cancer management has evolved from standard chemotherapeutic drugs to precision medicine, Chemo ID to immunotherapy, and targeted therapy.
Targeted therapy can even be used in early-stage oral cancer management only after the other therapies fail to produce the desired results. For example, a targeted drug like Cetuximab (Erbitux) is used to treat various locations of oral cancer. It deactivates the protein found in cancer cells thus controlling cancer growth.
Immunotherapy is also recommended in stage 4 cancers which act by binding on oral cancer cells and making then visible to the body’s immune system thus addressing the tumor.
We have specified a general outline of the stage-wise management of oral cancer. You should know that people are different, so are their tumors, therefore each tumor requires a specific management protocol designed for that person, that tumor.
Dr. Anshuman Kumar | Director & Clinical Lead – Oncology, Surgical Oncology | Dharamshila Narayana Superspeciality Hospital, Delhi