Mouth Cancer in India

Cancer is defined as the unregulated proliferation of cells that infiltrate and damage nearby tissues. Oral/Mouth Cancer typically begins with the appearance of a small, unfamiliar, and unexplained growth or lesion in various parts of the mouth, such as the lips, cheeks, sinuses, tongue, hard and soft palate, and the base of the mouth, extending into the oropharynx.

The specific type of Oral/Mouth Cancer you have is determined by the type of cells in which the Cancer originated.

• Squamous Cell Carcinoma: Squamous cell carcinoma is the most prevalent type, accounting for more than 90 percent of all oral/mouth cancers. While it typically develops on areas of the body exposed to sunlight, such as the face, ears, and neck, it can also occur in the oral cavity. 
• Oral Verrucous Carcinoma: This is a rare subtype of squamous cell carcinoma.
• Oral Melanoma: Melanoma originates in the pigment-producing cells that determine skin colour. In the head and neck region, it can manifest on the skin, inside the nasal passages, or within the oral cavity.

The treatment approach largely depends on the precise location of the Cancer within the mouth. Oral/Mouth Cancer depending upon the areas where the Cancer can originate include:

• Buccal Mucosa Cancer (Inner Cheek Cancer)
• Floor of Oral/Mouth Cancer
• Gum Cancer
• Hard Palate Cancer
• Lip Cancer
• Tongue Cancer

The primary factors that increase the risk of developing most Oral/Mouth Cancer are the use of tobacco and alcohol. Additional risk factors may encompass:

• Infection with human papillomavirus (HPV)
• Epstein-Barr virus (EBV) infection
• A family history of oral/mouth cancers
• Subpar oral hygiene and the presence of gum disease
• Sun exposure
• The habit of chewing the seed of the areca palm tree, commonly referred to as areca or betel nut

Why is Oral/Mouth Cancer Treatment needed?

Oral/Mouth Cancer treatment is essential for several reasons:

Life-threatening Condition: Oral/Mouth Cancer is a potentially life-threatening disease. If left untreated, it can spread to other parts of the body, leading to more severe health complications and a higher risk of death

Preventing Cancer Spread: Early treatment is crucial in preventing the cancer from advancing to a more advanced stage or metastasizing to other organs. Timely intervention can limit the extent of the disease

Quality of Life: Oral/mouth cancer can cause significant discomfort and pain, affecting a person's ability to eat, speak, and perform daily activities. Treatment aims to alleviate these symptoms and improve the patient's quality of life

Functional Restoration: Surgery and other treatments may be required to remove cancerous growths or affected tissues. These interventions can help restore normal mouth function and appearance

Survival Rates: The prognosis for oral/mouth cancer is generally better when detected and treated at an early stage. Early treatment increases the chances of a successful outcome and long-term survival

Psychological Well-being: Oral/mouth cancer diagnosis can be emotionally challenging. Treatment not only addresses the physical aspects of the disease but also provides emotional support and counselling to help patients cope with the psychological impact

Prevent Recurrence: Completing the prescribed treatment regimen is vital in reducing the risk of cancer recurrence. Post-treatment surveillance and follow-up care are also essential to monitor for any signs of recurrence

A pre-evaluation for oral/mouth cancer typically involves a comprehensive examination conducted by a healthcare professional, often a dentist or oral surgeon. Here are the core elements of this pre-evaluation for oral/mouth cancer:

• Review of Medical History: The healthcare provider initiates the process by delving into your medical background. They inquire about any prior medical conditions, family history of cancer, tobacco or alcohol use, and other relevant medical details. This inquiry aids in understanding your risk factors.
• Thorough Head and Neck Examination: The specialist pays particular attention to the head and neck area, meticulously inspecting for any irregularities. This examination includes the careful assessment of lymph nodes in your neck for any signs of swelling. Due to the deep location of the oropharynx, mirrors or specialized fiber-optic scopes may be employed to examine these areas. In some cases, numbing medicine may be applied to the back of the throat to facilitate the examination.
• Indirect Pharyngoscopy and Laryngoscopy: Small mirrors on extended handles are used to visualize the throat, the base of the tongue, and a portion of the larynx (voice box).
• Direct (Flexible) Pharyngoscopy and Laryngoscopy: A flexible fiber-optic scope, also known as an endoscope, is introduced through the mouth or nose to inspect areas that are not easily visible with mirrors.
• Pan Endoscopy: Given that tobacco and alcohol use are risk factors for oral and oropharyngeal cancers, as well as cancers of the oesophagus and lungs, there is a chance (up to 10%) of discovering multiple cancers simultaneously.To rule out additional cancers in the oesophagus or lungs, a pan endoscopy may be performed. This procedure is also beneficial when the origin of the cancer is unclear or when there are abnormalities in the lower neck lymph nodes.
• Biopsy: In a biopsy, a small tissue sample or cell sample is taken by the doctor for close examination in a laboratory to detect the presence of cancer cells.
• Exfoliative Cytology: This technique involves scraping the affected area and smearing the collected tissue onto a glass slide. The sample is then stained with a dye to facilitate clear visualization of cells. If any cells appear abnormal, the area can subsequently undergo biopsy.
• Fine Needle Aspiration (FNA) Biopsy: A very thin, hollow needle attached to a syringe is used to extract (aspirate) cells from a tumour or lump. These cells are later examined in the laboratory to ascertain the presence of cancer.
• Lab Tests on Biopsy Samples: All biopsy samples are sent to a laboratory, where a pathologist, a specialized doctor trained in cancer diagnosis, meticulously examines them. For throat cancers, the biopsy samples are often tested for the p16 protein to check for the presence of HPV infection.
• Imaging Tests: While not employed for oral cavity or oropharyngeal cancer diagnosis, imaging tests may be conducted for various reasons before and after a cancer diagnosis, including:
• Identifying suspicious areas that may be cancerous
• Determining the extent of cancer spread
• Monitoring the effectiveness of treatment
• Detecting Cancer recurrence after treatment
• Chest X-ray: An X-ray of the chest may be performed following the diagnosis of oral cavity or oropharyngeal cancer to assess whether the cancer has metastasized to the lungs. More frequently, however, CT or PET/CT scans of the lungs are conducted.
• Computed Tomography (CT or CAT Scan): CT scans employ X-rays to generate detailed cross-sectional images of the body. They help doctors determine tumor size and location, evaluate tumour invasion into adjacent tissues, assess lymph node involvement in the neck, or detect distant organ metastasis.
• Magnetic Resonance Imaging (MRI): MRI scans, similar to CT scans, provide detailed images of soft tissues in the body, utilizing radio waves and strong magnets instead of X-rays.
• Positron Emission Tomography (PET): PET scans involve the injection of slightly radioactive sugar (FDG) into the bloodstream, which accumulates mainly in cancer cells.
• Bone Scan: A bone scan entails injecting a small amount of low-level radioactive material into the bloodstream, which primarily accumulates in abnormal bone areas. It helps determine if cancer has spread to the bones.
• Barium Swallow: A barium swallow is utilized to visualize the lining of the upper digestive system, particularly the oesophagus, which connects the throat to the stomach.
• Ultrasound: Ultrasound employs sound waves and their echoes to create internal body images. A transducer, resembling a small microphone, emits sound waves and captures the echoes as they bounce off organs, which are then transformed into images on a screen.

Treatment for Oral/Mouth Cancer is determined by several factors, including the cancer's location and stage, your overall health, and your personal preferences. Various treatment modalities include:

Surgery: Surgical procedures for Oral/Mouth Cancer can include:

Tumour removal: This entails cutting away the tumor along with a margin of healthy surrounding tissue to ensure all cancer cells are removed. Minor surgery may suffice for smaller cancers, while larger tumours may require more extensive procedures, potentially involving the removal of jawbone or parts of the tongue.

Neck dissection: If cancer has spread to neck lymph nodes or there's a high risk of it, your surgeon may recommend removing lymph nodes and related tissue in the neck. This procedure helps eliminate any cancer cells that may have spread and determines if additional treatment is necessary.

Reconstructive surgery: After tumour removal, reconstructive surgery may be advised to restore mouth function for speaking and eating. This can involve grafting skin, muscle, or bone from other areas of your body, and dental implants might be used for tooth replacement.

Radiation Therapy: Radiation therapy employs high-energy beams, such as X-rays and protons, to destroy cancer cells. It can be administered externally from a machine or internally via radioactive seeds or wires placed near the cancer. Radiation therapy is often used after surgery or, in early-stage cases, as a standalone treatment. It may also be combined with chemotherapy, enhancing its effectiveness but potentially increasing side effects.

Chemotherapy: Chemotherapy employs chemicals to kill cancer cells and can be administered alone or in combination with other drugs or treatments. It may enhance the efficacy of radiation therapy.

Targeted Drug Therapy: Targeted drugs specifically target aspects of cancer cells that drive their growth. They can be used alone or alongside chemotherapy or radiation therapy. Cetuximab (Erbitux) is an example of a targeted therapy for certain oral/mouth cancer cases. It interferes with a protein found in cancer cells, inhibiting their growth. Side effects may include skin rash, itching, headache, diarrhoea, and infections.

Immunotherapy: Immunotherapy harnesses your immune system to combat cancer by disrupting the mechanisms that shield cancer cells from immune system attacks. Typically reserved for advanced and treatment-resistant Oral/Mouth Cancer, immunotherapy aims to overcome the immune evasion tactics of cancer cells.

Treatment for Oral/Mouth Cancer can effectively combat the disease, but it can also give rise to various complications, which can vary depending on the specific treatment modality and individual factors. Here are some typical complications associated with oral/mouth cancer treatment:

• Surgery: Surgical procedures carry inherent risks such as the potential for bleeding and infection. Surgery for oral/mouth cancer often has notable impacts on a person's appearance, as well as their ability to speak, eat, and swallow
• Radiation Therapy: Radiation therapy can result in dry mouth, tooth decay, and damage to the jawbone
• Chemotherapy: The complications of chemotherapy depend on the specific drugs administered. Common side effects encompass nausea, vomiting, and hair loss. It is advisable to consult your doctor to understand which side effects are likely with the chemotherapy drugs prescribed to you
• Targeted Drug Therapy: Targeted drug therapies can lead to side effects such as skin rash, itching, headaches, diarrhea, and an increased susceptibility to infections

After undergoing various oral/mouth cancer treatment methods, it is essential to follow a comprehensive post-procedure care plan to optimize recovery and address potential complications. Here is an overview of post-procedure care for different treatment approaches:

Post-Surgery Care:

• Pain Management: Adequate pain control is paramount. Your medical team will prescribe pain relievers and offer instructions on their usage.
• Diet: Initially, you may be required to follow a soft or liquid diet to facilitate healing. Gradually, you can transition to a regular diet as your tolerance improves.
• Oral Hygiene: Maintaining excellent oral hygiene is essential to prevent infections. Gentle rinsing with a saltwater solution, as directed by your healthcare provider, can be beneficial.
• Speech and Swallowing Therapy: If the surgery affects your speech or swallowing abilities, speech therapy and exercises may be recommended to enhance these functions.
• Monitoring: Regular follow-up appointments are crucial to monitor your progress in healing and promptly identify any potential complications.

Post-Radiation Therapy Care:

• Oral Hydration: Radiation therapy often leads to dry mouth. Stay hydrated by sipping water frequently and consider using artificial saliva or prescribed oral moisturizers.
• Oral Care: Maintaining proper oral hygiene is vital to prevent dental issues like cavities and gum problems. Seek guidance from your dentist or oral health specialist regarding oral care products.
• Diet: Initially, you may have dietary restrictions due to swallowing difficulties. Over time, you can reintroduce a regular diet, but severe swallowing problems may necessitate a feeding tube.
• Skin Care: If radiation therapy affects the skin in the treated area, follow the skincare recommendations provided by your healthcare provider.
• Monitoring: Regular follow-up visits are essential to assess your response to treatment and manage any side effects.

Post-Chemotherapy Care:

• Pain and Discomfort: Continue managing pain as necessary and as prescribed.
• Nutrition: Address any nutritional deficiencies and maintain a balanced diet. Consult with a dietitian if needed.
• Oral Health: Vigilant attention to oral hygiene and dental health is critical to manage potential complications such as cavities.
• Emotional Support: Coping with chemotherapy side effects and emotional challenges is vital. Seek support from healthcare providers and support groups.
• Monitoring: Regular check-ups and blood tests may be required to monitor your treatment response and address side effects.

Post-Targeted Drug Therapy and Immunotherapy:

• Skin and General Health: If you experience skin-related side effects, continue any prescribed skincare routines and promptly report any new or worsening symptoms to your healthcare team.
• Nutrition: Maintain a balanced diet to support overall health and recovery.
• Emotional Support: Similar to chemotherapy, targeted drug therapy and immunotherapy can be emotionally challenging. Seek emotional support as needed.
• Monitoring: Regular follow-up appointments enable your healthcare team to assess your progress and address any ongoing concerns.

Individuals with oral/mouth cancer are at risk of cancer recurrence and the development of new cancers in the head and neck region. Therefore, they require close monitoring following treatment. Your healthcare team will determine the appropriate tests and their frequency based on factors such as the cancer type and stage, the treatment modality received, and the likelihood of cancer recurrence.

After completing your treatment, you will likely have ongoing follow-up appointments with your doctor for several years. Attending all of these follow-up visits is crucial. During these appointments, your medical team will inquire about any issues you may be experiencing, conduct physical examinations, and may order endoscopies, lab tests, or imaging studies to detect signs of cancer recurrence, new cancers, or treatment-related side effects.

Most Cancer treatments can lead to side effects, some of which may persist for a few weeks to several months, while others can last a lifetime. Certain side effects may not manifest until years after treatment completion. Your doctor visits provide an opportunity to seek clarification, discuss any changes or concerns you've noticed, and ask questions.

Promptly reporting any new symptoms to your doctor is of utmost importance. Doing so can aid in the early detection of recurrent or new cancers when they are in their early stages and more manageable.

You may be instructed for following:

Endoscopy: Your endoscopy examinations will occur at the following intervals:

• Approximately every 1 to 3 months during the first year
• Approximately every 2 to 6 months during the second year
• Approximately every 4 to 8 months during the third to fifth years
• Annually after the fifth year

• Smoking Cessation: If you faced challenges quitting smoking before treatment, your physician may recommend counseling and medication to assist you in quitting. It is of utmost importance to quit smoking because individuals with early-stage oral cavity or oropharyngeal cancer remain at risk of developing new smoking-related cancers if they continue smoking. For more information on quitting smoking, you can refer to the Stay Away from Tobacco program or contact 1-800-227-2345.
• Blood Tests: If you received radiation to the neck, it may have impacted your thyroid gland. Consequently, regular blood tests will likely be necessary to monitor your thyroid function.
• Imaging: Chest X-rays and other imaging tests may be employed to monitor for recurrence or the emergence of new tumors, particularly if new symptoms arise.
• Dental Examinations: Individuals treated with radiation may experience issues such as dry mouth and tooth decay. Therefore, regular dental check-ups are frequently recommended.
• Nutrition-Related Challenges: Mouth and throat cancers, along with their treatments, can sometimes lead to problems such as alterations in taste, dry mouth, or tooth loss. These difficulties can affect eating habits, potentially resulting in weight loss and nutritional deficiencies.
• Rehabilitation for Speech, Hearing, and Swallowing: Radiation, surgery, and specific chemotherapy medications can lead to issues with speech, swallowing, and hearing. Speech therapists possess expertise in managing speech and swallowing difficulties and can provide guidance on coping with these challenges.

The 5-year relative survival rates for individuals diagnosed with oral/mouth cancer or oropharyngeal (the region of the throat behind the mouth) cancers between 2012 and 2018 are as follows:

• Lip:

If you or someone dear to you is embarking on the challenging path to conquer cancer, it's heartening to discover that the expenses associated with treating Oral/Mouth Cancer in India are exceptionally reasonable, while the quality of healthcare services remains at the forefront of global standards.

Nonetheless, the cost of Oral/Mouth Cancer treatment in India might fluctuate contingent on the subsequent key aspects:

• Health insurance coverage
• Out of pocket expense
• Admission charges
• Cardiologist remuneration
• Patients age
• Stage of cancer
• Patients medical state
• Diagnostic procedure charges
• Medication cost
• Complications encountered post-procedure
• Hospital category
• Chosen room category for admission
• Additional laboratory or diagnostic assessments like X-rays, CT scan, PET and others

The cost of Oral/Mouth Cancer diagnostics are:

MedFlick, your trusted healthcare companion, is dedicated to ensuring that your medical journey goes as smoothly and successfully as possible.

• Individualized Guidance: Personalized guidance throughout your medical journey.
• Access to a broad network of prominent hospitals, top doctors, and skilled surgeons.
• Transparent and Competitive Pricing: A full breakdown of treatment costs that eliminates surprises and offers you cost-effective solutions.
• MedFlick provides everything from travel arrangements to hotel and visa help to lodging.
• Multilingual Support: Breaking down language barriers to allow patients and medical professionals to communicate more effectively.
• The road to a successful oral/mouth cancer treatment procedure is long and winding, full of hope, resilience, and the promise of a brighter future. With MedFlick as your guide, navigating this life-changing adventure becomes simple and liberating.