oral cancer (1)

Dr Suwas Darvekar

Sangeeta Darvekar Charitable Trust , a registered trust with registration

no E/3092/Thane dated 30/4/03 presents an awareness program on

Oral Cancer and named itOral Cancer Awareness.org

Dr Suwas Darvekar

As a social obligation we started a charitable organization namely Sangeeta Darvekar

Charitable Trust and as a dentist I used to see a lot of patients with complications arising out

of habits like gutka eating, keeping tobacco Quid in mouth and smoking. So we thought of

this awareness campaign.

Dr Suwas Darvekar

So we started an Awareness program and called it “Oral cancer awareness.org”

as we have a website with the same name. Dr Suwas Darvekar is the force behind this

campaign.He is helped by Mr. Vincent Nazareth of

‘Crusade Against Tobacco’

Dr Suwas Darvekar

This program won’t have been possible without the help from TATA MEMORIAL HOSPITAL.

Dr Suwas Darvekar

Oral cancer is the most common cancer in India and according to Dr Geoff Craig “People are dying of oral cancer because

of ignorance”.

Dr Suwas Darvekar

So Sangeeta Darvekar Charitable Trust thought of a

mass awareness program about oral cancer, its causes,

its treatment and resultant problems and the way of preventing this cancer.

Dr Suwas Darvekar

So we approached Dr Surendra Shastri head of preventive oncology at TATA MEMORIAL HOSPITAL and he gave us a stunning information that ”There are about 7,00,000 new cases of cancers diagnosed

every year 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.”

Dr Suwas Darvekar

On receiving this stunning news we thought of enquiring for the reason of such high incidence of oral cancer. We found that the reason for such high prevalence of

oral cancer in India was primarily because of the most common form of tobacco

consumption is keeping the tobacco in mouth. Be it in the form of Gutka,tobacco

Quid and Mava,betel leaf with tobacco(Pan), snuff or misri and so on.

Dr Suwas Darvekar

Tobacco when kept in mouth leaches out carcinogens, which act on oral mucosa causing neoplastic changes. Habit of

smoking is also equally dangerous.

Dr Suwas Darvekar

Tobacco contains potent carcinogens including Nitrosamines (nicotine), polycyclic aromatic hydrocarbons,

Nitrosodiethanolamine, Nitrosoproline, and polonium. Tobacco smoke contains carbon monoxide, Thiocyanate, hydrogen

cyanide, nicotine and metabolites of these constituents.

Dr Suwas Darvekar

Tobacco in India most commonly consumed in the form of gutka, quid pan or smoking in the form of bidi

of cigarette.

Dr Suwas Darvekar

Gutka is a flavored tobacco mixture with betel nut lime, and harmful additives like magnesium

carbonate. It is extremely addictive and is apparently targeted at youngsters.

Quid is the mixture of tobacco and lime and extensively

consumed in India.

Dr Suwas Darvekar

Dr Suwas Darvekar

According to the B.B.C ‘4 in 10 of all cancers in India are oral cancers’.

And this because of extensive use of tobacco and betel quid.

Dr Suwas Darvekar

Precancerous lesions There are three most common precancerous lesions seen in the mouth and they

are

1.    Oral leucoplakia

It is characterized by white patch on the buccal mucosa or any place in the mouth and is adjacent to the place where the tobacco quid is kept. The

less likely place is floor of the mouth and tongue although 93% of leucoplakia

at this sites turn malignant.

Dr Suwas Darvekar

ORAL LEUCOPLAKIA PATCH

Dr Suwas Darvekar

Dr Suwas Darvekar

2. Erythroplakia

This is characterized by red velvety patch which is not associated with any trauma or inflammation. It may present with or

without leucoplakia. This lesion is easily missed out but is considered to have

great malignancy potential.

Dr Suwas Darvekar

Erythroplakia

Dr Suwas Darvekar

3.Oral sub mucous fibrosis.

This condition is characterized by limited opening of mouth and burning sensation on eating of spicy food. This is a progressive lesion in which the opening of the mouth

becomes progressively limited, and later on even normal eating becomes

difficult.

It occurs almost exclusively in Indians and Indian communities

living abroad.

Dr Suwas Darvekar

Oral Sub Mucous Fibrosis

Dr Suwas Darvekar

This patient of SMF has so much of limitation in opening of mouth that it is difficult to put even 2 fingers in the mouth

Dr Suwas Darvekar

Smf is equally common in gutka eating ladies

Dr Suwas Darvekar

Dr Suwas Darvekar

Professor Newell Johnson an expert oral surgeon said, ”we know this condition, oral sub mucous fibrosis has highest

rate of transferring to malignancy of any of the so called pre-malignant lesions in the mouth. It is a very

serious condition.”

Dr Suwas Darvekar

The next stage after the precancerous lesion is the

Cancerous lesions.

Dr Suwas Darvekar

The most common form of cancer is Squamous cell carcinoma.

Dr Suwas Darvekar

It normally starts from any of the precancerous lesion in the mouth.

Dr Suwas Darvekar

Common sites of oral cancer

The most common sites of the oral cancer is the tongue and the floor of the

mouth. The other common sites are buccal vestibule, buccal mucosa, gingiva and rarely hard and soft palate. Cancer

of bucco-pharyngeal mucosa is common in smokers.

Dr Suwas Darvekar

DiagnosisInitially oral cancer may be asymptomatic but a check up of a small ulcerative lesion from a professional is recommended. But patients normally presents when pain and discomfort is

predominant and then the prognosis becomes poor.Diagnosis is established by many ways like applying dyes like toluidine blue which may give false positive results in inflammatory lesion but never false negative, using X rays and scans to see the extension of the lesion and the bony

involvement and the most confirmatory test is biopsy of the lesion and its histo-pathological examination

Dr Suwas Darvekar

It may start as a small ulcer, usually on the lateral border of the anterior two third of the tongue. It may

have varied presentation like a small papillary exophytic lesion, a flat nodule, ulceration within a pre existing

fissure or may occur in the absence of frank ulceration in an atrophic tongue. Once ulceration has occurred, the lesion becomes painful, making speech and swallowing

difficult. Tongue cancer rapidly extends to involve the floor of the mouth and lower alveolus, which makes

treatment difficult.

Carcinoma of the Tongue

Dr Suwas Darvekar

Cancer of Tongue following tobacco consumption

Dr Suwas Darvekar

Cancer of Tongue

Dr Suwas Darvekar

Dr Suwas Darvekar

Dr Suwas Darvekar

Dr Suwas Darvekar

The lesion is usually painless in early stages and only when it becomes ulcerated and secondarily infected or invades adjacent nerve, pain is the noticeable feature.

The tumor is usually at the level of the occlusal plane or below it. They may be proliferative warty exophytic growth with little fixation or deeply ulcerative invasive lesion.

The proliferative lesion though it looks dangerous is easily treatable and long-term prognosis is good as the metastasis to the local lymph nodes is relatively late.

Whereas the ulcerative lesion is not so easily noticeable in the early stages but is more dangerous because of their

invasive nature and the metastasis to the local lymph nodes is very early

Cancer of Gingiva and Buccal mucosa

Dr Suwas Darvekar

CANCER LESION COMING OUTSIDE THE MOUTH

Cancer Of Cheek after tobacco quid habit

Dr Suwas Darvekar

SAME PATIENT WITH THE CANCER LESION COMING EXTRA ORALLY

Dr Suwas Darvekar

Cancer of buccal mucosa after tobacco habit going extra-orally

Dr Suwas Darvekar

CANCER STARTING FROM BUCCAL VESTIBULE FOLLOWING HABIT OF PAN WITH TOBACCO

Dr Suwas Darvekar

Cancer of Buccal mucosa invading extra-oral tissues following tobacco quid habit

Dr Suwas Darvekar

Cancer of labial mucosa invading extra-oral tissues following tobacco quid habit

Dr Suwas Darvekar

CANCER OF CHEEK FOLLOWING EATING OF GUTKA

Dr Suwas Darvekar

Cancer of labial mucosa after tobacco quid habit

Dr Suwas Darvekar

Same patient with Cancer Of Gums

Dr Suwas Darvekar

CANCER OF GUMS FOLLOWING EATING OF GUTKA

Dr Suwas Darvekar

Carcinoma of the lip usually starts at the vermilion border of the lower lip. 95% of lip cancer affects the lower lip. It is in the form of a nodule, which ulcerates and forms a small scab,

which fail to heal completely. It is often misdiagnosed as a cold sore. Eventually the margins of the lesions become proliferative

and an extensive exophytic lesion with central ulceration develops.

Carcinoma of the lip

Dr Suwas Darvekar

CANCER OF LOWER LIP

Dr Suwas Darvekar

Cancer of palate It is usually an ulcerative lesion and may spread extensively before involving underlying bone.

Dr Suwas Darvekar

Cancer of Palate after habit of smoking

Dr Suwas Darvekar

Cancer of Palate after habit of smoking

Dr Suwas Darvekar

CANCER OF MAXILA AFTER SMOKING HABIT

Dr Suwas Darvekar

CANCER OF PALATE

Dr Suwas Darvekar

Alveolar carcinoma is common in mandible that maxilla. The lesion is warty nodular and

proliferative, although it may rarely present as erosive lesion. Unfortunately it mimics apical or periodontal disease and their diagnosis is often

delayed. Often the neoplastic nature is recognized when socket fails to heal following dental extraction for a supposedly periodontal

abscess.

Alveolar carcinoma

Dr Suwas Darvekar

Alveolar cancer after tobacco quid habit

Dr Suwas Darvekar

Alveolar cancer after tobacco quid habit

Dr Suwas Darvekar

Relapse caseHe was operated for cancer of lower jaw in oct

‘00

Dr Suwas Darvekar

Relapsed cancer in upper jaw in July 04

Dr Suwas Darvekar

This cancer is extremely malignant and even if there is slight delay it spreads to lymph nodes

of the neck. Once it spreads the prognosis becomes poor and death is inevitable and is because of erosion of major blood vessels and erosion of the base of the skull, Cachexia and secondary infection of the respiratory tract.

Dr Suwas Darvekar

The American joint committee on cancer has developed the Tumor (T), Node (N), and Metastasis (M) system of cancer classification. The TNM classification is basically a clinical description of the disease, but can also involve imaging in classification. T is the size of the tumor and T1 is <2 cm, T2 is >2 but < 4 cm, T3 is >4 cm and T4 is >4 cm with invasion of adjacent structures.N0 is no lymph nodeN1 is single ipsilateral node < 3 cmN2a single ipsilateral node > 3 cm but < 6 cmN2b multiple ipsilateral node < 6 cm.N2c bilateral or contra lateral nodes < 6 cmN3a ipsilateral node > 6 cmN3b bilateral nodes > 6 cmM0 is no metastasis and M1 is metastasis present. StagingStage I T1 N0 M0Stage II T2 N0 M0Stage III T3 N0 M0; any T1 T2 T3, N1 M0Stage IV T4 ANY N, M0; any T, N2 or N3; ANY T OR N WITH M1

Cancer classification and Staging

Dr Suwas Darvekar

Treatment availableTreatment is surgery, and in advanced cases surgery followed by

radiation therapy is performed. But even that is not always successful as more than 70% of the cases after treatment leads to

relapse and the result is death.

Dr Suwas Darvekar

The treatment is successful only if the lesion is diagnosed early, but sadly many times, it is ignored and the patient reports when the lesion has spread so much that the treatment is impossible or even if done

the long term prognosis is poor.

Dr Suwas Darvekar

The cost of the treatment is 3.5 lakh and in spite of this cost there is no guarantee of sure cure.

Dr Suwas Darvekar

Differences in genetics have not been identified in relation to risk and survival.

Dr Suwas Darvekar

Commando operation is resection of half of the mandible with floor of the mouth and block desection of the neck to remove the entire

lymphatic drainage of the neck together with sterno-cleido mastoid muscle and internal jugular vein.

In the following photographs you will see what a commando operation looks like.

Dr Suwas Darvekar

This is a patient who has undergone a commando operation for oral cancer

Dr Suwas Darvekar

INTRA ORAL VIEW OF POST SURGICAL PATIENT

Dr Suwas Darvekar

EXTRA ORAL VIEW OF THE SAME PATIENT

Dr Suwas Darvekar

This is a patient who has undergone a commando operation for oral cancer

Dr Suwas Darvekar

This is a patient who has undergone an operation of his palate, nose and right eye for cancer of palate extending to

nose and right eye.

Dr Suwas Darvekar

This is a patient who has undergone a commando operation for oral cancer

Dr Suwas Darvekar

This is a patient who has undergone a

commando operation for oral cancer. Because of the operation he has lost control on his left side of the mouth and

hence saliva is seen drooling from left side

of the mouth.

Dr Suwas Darvekar

Frequently Asked Question1.How do I prevent oral cancer ?2.Why is that not all people consuming tobacco have oral cancer ?3.Who is more susceptible to oral cancer ?4.I have a precancerous lesion in my mouth, would I get cancer ?5.How is the diagnosis established ?6.What is the treatment available ?7.what is the approximate cost ?8.I Occasionally chew tobacco/smoke, and keep tobacco only for very short time. A

m I susceptible for cancer ?9.My friend has been told that he has oral cancer, but he does not believe it. what to

do?10.My dentist has recommended the biopsy of the premalignant lesion. What should

I do?11.I have oral cancer and I am taking ayurvedic medicine. Will that help? 12.My Friend had cancer after tooth extraction. Was the doctor negligent?

Dr Suwas Darvekar

How do I prevent oral cancer ?Stopping all the habits of tobacco consumption. Stopping means complete stop to the habit. Reducing the consumption of tobacco does not reduce your risk of

cancer. But stopping certainly reduces the risk.

Is tobacco the only cause of oral cancer ?Tobacco is the major cause of oral cancer but certainly not the only cause. Their are other causes like poor oral hygiene, chronic trauma from sharp tooth or an ill

fitting dentures. Their are other agents like some viruses which are thought to cause or expedite the effect of tobacco in causing oral cancer.

Why is that not all people consuming tobacco have oral cancer ?Their are many factors like genetic make of the person, his diet and many

unknown factors that  increases or decreases the susceptibility of person of  having oral cancer. But one thing is certain that tobacco consumption increases

your susceptibility by almost 8 times. That means a person consuming tobacco is more prone to have oral cancer or other tobacco related problems.

Who is more susceptible to oral cancer ?Anybody consuming tobacco is susceptible to oral cancer. Differences in

genetics have not been identified in relation to risk and survival. That means a Caucasian or a mongoloid, Black race all are equally prone to oral cancer if they

consume tobacco. 

Dr Suwas Darvekar

I have a precancerous lesion in my mouth, would I get cancer ?It depends on whether you continue your habit or not. If you stop your habit then your chances of getting oral cancer decreases drastically. But it is always better to get your precancerous lesion checked by a Dentist. He will suggest you the

best thing for you and may be he will take a biopsy sample of the lesion for histo-pathological check up. Or he may apply some specific Dyes to the lesion so that

check its neoplastic potential.

How is the diagnosis established ?Diagnosis is established by many ways like applying dyes like Toluidine blue which may give false positive results in inflammatory lesion but never false

negative, using X rays and scans to see the extension of the lesion and the bony involvement and the most confirmatory test is biopsy of the lesion and its histo-

pathological examination

What is the treatment available ?Treatment is surgery, and in advanced cases surgery followed by radiation

therapy is done. But even that is not always successful as 70% of the cases after treatment leads to relapse and the result is death. The treatment is successful

only if the lesion is diagnosed early, but sadly many times, it is ignored and the patient reports when the lesion has spread so much that the treatment is

impossible or even if done the long term prognosis is poor

Dr Suwas Darvekar

What is the approximate cost ?Cost involved is approximately Rs 350,000/- . The cost may vary because of many

things like the extent of the lesion, any metastasis and many other factors.

I Occasionally chew tobacco/smoke, and keep tobacco only for very short time. Am I susceptible for cancer ?

Tobacco has many chemicals which can cause cancer and lower intake doesn't mean less susceptibility. If a person is genetically more predisposed then even

little consumption can trigger malignancy.

My friend has been told that he has oral cancer, but he does not believe it. what to do?

Cancer is very well treated with fewer complication in early stages. So if a doctor has said that your friend has cancer than don't neglect it. If you don't believe get it

checked from an authority. Remember time is an essence here. Even if their is slight delay the prognosis rapidly goes from good to bad to worse.

My dentist has recommended the biopsy of the premalignant lesion. What should I do?

 Biopsy is the only confirmatory test of whether you have oral cancer or not. If your Dentist has recommended a biopsy he has given you the right advise. Go

ahead and do it at once without any delay. 

Dr Suwas Darvekar

I have oral cancer and I am taking ayurvedic medicine. Will that help?   I am not an authority on ayurvedic medicine. But it has been generally noted that

ayurvedic medicines don't work once you have oral cancer and you have to undergo surgery. So don't wait, get the surgery done at once. May be if the lesion

has not progressed you will have a excellent prognosis.

My Friend had cancer after tooth extraction. Was the doctor negligent?No! You can never have oral cancer with any dental procedure performed by your

Dentist. The predominant sign of alveolar and gingival carcinoma is mobile tooth/teeth, and only after extraction when the socket doesn't heal and their is some growth, you find out that the tooth/teeth were mobile because of cancer. This is a case of misdiagnosis and not wrong treatment. This type of diagnosis can be missed even by the best of Dentist. Usually such cases give a history of

tobacco consumption.

Dr Suwas Darvekar

So friends if you want to save money, lead a healthy life style

don’t want to suffer from cancer and its associated problems, stay away from tobacco in any form be it

Gutka, tobacco Quid,pan,snuff,Mava Misri, Smoking and so on.

Dr Suwas Darvekar

Wish you a healthy life without tobacco and oral

cancer.

Dr Suwas Darvekar

This is Dr Suwas Darvekar who has been the force behind this awareness campaign.

Dr Suwas Darvekar

This presentation can be freely copied and shown without alteration to your friends, relatives and

any audience. An awareness campaign is not possible with few individuals so we want maximum

people to cooperate in this effort as this is one cancer which is completely preventable.

Any one who needs a CD of this presentation can obtain by sending Rs 50/- only or copy it free of

cost from www.oralcancerawareness.orgPlease remember no alteration is permissible in this presentation as it would lead to copyright

infringement and therefore a punishable offence.

Dr Suwas Darvekar

We want to convert this presentation into a Video and plan to add the interviews of leading doctors on oral cancer

and interviews of the patients as to how they got this cancer. All the written matter in this presentation will be converted into dialogues with a professional Voice. The whole presentation will then be converted into a VCD of

leading local languages initially and later on in all the vernacular languages and will be circulated throughout

India and possibly world over. This requires strong financial capabilities which we are lacking. Therefore we request all the like minded peoples and organizations to

help us for this noble cause.

Dr Suwas Darvekar

You can contact us at Sangeeta Darvekar Charitable Trust

602/A, Sealand Tower, Jesal Park, Bhayandar East, Dist Thane 401105

Phones: 28149233, 28162440, 9869368937Email: sndarvekar@rediffmail.com

Website: www.oralcancerawareness.org

Dr Suwas Darvekar

Contributed by Dr Suwas Darvekar.Copyright © 2003  [Sangeeta Darvekar Charitable  Trust]. All rights

reserved.Revised:April 12, 2023