According to Globocan, there were 1,19,992 new cases of oral cancer and 72,616 deaths reported in India in 2018 alone. Studies have found a definitive link between use of tobacco (smoking) and development of oral cancer.
TYPES AND SUBTYPES
Cancer may be classified based on its appearance under the microscope and behaviour of the tumour. Oral cancers can be classified based on parameters such as type of cell (squamous cell carcinoma, papillary carcinoma, verrucous carcinoma etc.), depth of invasion of cancer (<4mm or >4mm), Infiltration into blood vessels or nerve (vascular and perineural infiltration respectively).
These are determined by a pathologist based on the sample from the tumor.
STAGING OF ORAL CANCER
If you are diagnosed with oral cancer, your doctor will run more tests to determine the extent (stage) of your cancer. Your cancer's stage is an important input in deciding on your treatment. The stage of a cancer describes the size of the cancer and how far it has spread. It may be described as stage 0 to stage IV and takes into account: the size of the cancer, whether the lymph nodes are affected, if the cancer has spread to other parts of the body.
- Stage 0: The cancer is only growing in the outermost layer of the oral cavity (also known as carcinoma in situ).
- Stage I: The tumour is 2 cm or smaller, and no cancer cells are present in nearby structures, lymph nodes or distant sites.
- Stage II: The tumour is 2 cm to 4 cm across, and no cancer cells are present in nearby structures, lymph nodes or distant organs.
- Stage III: The tumour can be one of the following: The tumour is larger than 4 cm, and no cancer cells are present in nearby structures, lymph nodes or distant sites OR the tumour is of any size and has spread to one lymph node on the same side but has not grown into nearby structures or spread to distant sites.
- Stage IV: It is of three subtypes Stage IVA (The tumour is of any size and growing into nearby structures, may or may not be present in the lymph nodes, cancer has not spread to distant sites.) Stage IVB (the tumour is of any size and has invaded deeper tissues and structures including lymph nodes which are greater than 6cm), Stage IVC (the tumour has spread to distant organs in the body).
Sources: Globocan; Cancer Treatment Centres of America; European Society of Medical Oncology (ESMO)
DIAGNOSTIC TESTS FOR ORAL CANCER
- Physical exam: A doctor will examine the lips and mouth for abnormalities such as sores and white patches (also known as leukoplakia).
- Biopsy: If a suspicious area is found, a sample of cells will be removed and sent to a lab for testing. The pathologist analyses the cells for cancer. Sometimes they may detect precancerous changes which can indicate a future risk of cancer.
- Endoscopy: The clinician will inspect your throat (also referred to the nasopharynx, oropharynx and laryngopharynx) with a small, flexible camera under local anesthesia. It is primarily done to look for signs that cancer has spread beyond the mouth.
- Radiological Tests: The doctor may start with simple tests such as neck ultrasound and dental CT. More advanced tests such as MRI may be used for the staging of the tumour which helps decide the treatment protocol. Imaging tests such as X-ray, CT, MRI and positron emission tomography (PET) are done to look for spread of the cancer beyond the mouth.
The management of cancer depends on various factors, including the stage of the cancer, additional health issues, age etc. Surgery, radiation or chemotherapy may be used.
- Targeted therapy: Targeted drugs block specific pathways in cancer cells to stop their growth. These drugs are used alone or in combination with chemotherapy or radiotherapy. Side effects: These depend on the agent used but common side effects include skin rash, itching, headache, diarrhoea and infections.
- Surgery: The aim of surgery to remove all of the cancer cells. This includes both the tumour and a margin of healthy tissue that surrounds it. Early-stage and smaller cancers may be removed by minor surgery but large tumours require more-extensive procedures such as removing a part of the jawbone or tongue. If there is spread to lymph nodes, especially in the neck, those will be removed as well. [i] Post the operation a reconstruction procedure is conducted using tissue flaps and skin grafts. These are done so that the patient can regain the ability to talk and eat. Side effects: Bleeding, infection, post-surgery a tube will be needed for feeding until reconstruction is done, voice and speech will be affected.
- Radiotherapy: Radiation therapy uses high-energy beams to kill cancer cells and may be delivered from a machine outside the body (external beam radiation), or with radioactive seeds placed near the tumour (brachytherapy). Radiation therapy is often used after surgery to clear any cancer cells that may have been left behind. Side effects: Damage to the jaw bone, dry mouth, scarring, swelling, problems with swallowing, tooth decay etc.
- Chemotherapy: Chemotherapy uses chemical agents to kill cancer cells. These drugs can be given alone, in combination with other drugs or in combination radiotherapy. It is sometimes called biologic. Side effects: Side effects depend on the agent used but commonly include nausea, vomiting, hair loss, kidney damage, nerve damage, tingling sensation, lowered immunity, soreness of palms and feet, numbness, skin peeling etc.
- Immunotherapy: This form of therapy uses your immune system to fight cancer cells. It is commonly used for advanced cancer especially in those not responding to regular treatment.
- Palliative Care: The diagnosis and treatment of oral cancer can have a deep psychological and physical effect on patients. Palliative care specialists help patients with these symptoms and hence help in rehabilitation post-surgery. In some cases, distress management, through a professional psychological counsellor, may be required to help the patient cope with cancer.
Sources: Mayo Clinic; European Society of Medical Oncology (ESMO); Cancer Treatment Centres of America;
MULTI-DISCIPLINARY TEAM (MDT): Unlike most other diseases, cancer treatment requires an integrated approach from several specialists, each with their own expertise. This team of specialists who would work together on your cancer, is referred to as the Multi-Disciplinary Team (MDT). Many global organisations have recognized the importance of a MDT for cancer treatment, as it improves coordinated care to you, as a patient. Your MDT would include specialists from the following:
- Medical Oncologist: Specialist that decides the optimum course and agent for chemotherapy
- Oral and Maxillofacial Surgeon: A surgeon specialised in operating on head and neck cancers
- Otorhinolaryngology (ENT)/Head and Neck Surgeon: A surgeon that treats all conditions of the ear, nose and throat
- Plastic Surgeon: A surgeon that specialises in reconstruction surgery
- Radiologist: A specialist who interprets MRI, X-rays and CT scans
- Pathologist: A specialist who studies tissues under the microscope and provides insights regarding cancer cells that help decide treatment
- Radiation Oncologist: A specialist that decides the optimum course and agent for radiotherapy
- Palliative care specialist: Helps patients deal with the physical and psychological symptoms involved with the diagnosis and management of oral cancer.
Some hospitals that take an organ-based approach to cancer, have a separate department for Head and Neck cancers. These teams comprise of specialists who have dedicated training in cancers occurring in mouth, nose, throat, larynx, sinuses, or salivary glands.
TUMOR BOARD: A tumor board is a meeting where your Multi-Disciplinary Team discusses cancer cases and shares knowledge. The board’s goal is to determine the best possible cancer treatment and care plan for an individual patient. Having fresh perspectives from other doctors makes it much easier to come up with that plan.
In some hospitals, all cancer cases are discussed at the Tumor Board, while in other hospitals the Tumor Board focuses on cases where a doctor seeks inputs from other specialists on the patient’s case. It’s OK to ask your doctor if or why your case was discussed at a tumor board. Or if it wasn’t, why not? In some cases, a patient’s treatment plan is very straightforward using standard treatment guidelines, and the doctor may feel a tumor board review isn’t needed. However, you can request that one be done.
SUPPORT GROUPS: These are offline or online groups that connect patients suffering from cancer. Do find out about a support group around you. The hospital where you are being treated may have a support group that you could join.
Sources: Mayo Clinic
Choosing your oncologist and hospital is a very important decision, we recommend you make the time to research your options. We profile hospitals and doctors based on the range of services they offer for Oral cancer treatment, use our search tools to help you find a suitable medical provider. You may call us for any assistance while selecting or booking.
If you’ve been diagnosed with cancer, you need to find an oncologist to begin your treatment. An oncologist is a doctor who specializes in treating cancer. For oral cancer, you can start by visiting a Medical oncologist or a Surgical oncologist. Choose someone you are not only confident about but also comfortable with.
TIPS TO FIND AN ONCOLOGIST
- Look for Specialists: Look for doctors who treat your specific type of cancer - oral cancer or head and neck cancers. You may need to work with more than one type of oncologists – surgical, medical or radiation oncologists.
- Gather Feedback: Discuss with friends and family, especially those who’ve taken similar treatment before. Online communities are a quick way to get feedback from others who’ve experienced your type of cancer before.
- Check the doctor’s credentials: Find out if the doctor has received any advanced training. There may be super-specialists available for head and neck cancers, who have received dedicated training on treating these types of If doctor’s credentials are not available easily, you have the right to ask for it from the doctor directly.
- Review doctor’s experience: Check how long the doctor has been practicing after completion of formal oncology education. How many patients with your type of cancer – oral cancer – does the doctor see every year? In case of surgeons, studies have proven that higher volumes of surgeries lead to better outcomes. Organ-specific surgeons are also available in some hospitals, they have advance training and experience in operating cancers in specific organs.
- Find out hospital affiliations: Which hospitals does the doctor practice in? The availability of a multiple types of doctors at the hospital where you get treated is important. Find out what support staff is available at the hospital e.g. dietitian, counselor, home healthcare facilities etc.
TIPS TO FIND A HOSPITAL
- Lookout for hospitals with lot of experts: Look for hospitals that offer a multi-disciplinary approach to head and neck cancer treatment. This means each you receive inputs from many cancer experts. You will be helped by specialists including surgeons, medical oncologists, radiation oncologists, oncology nurses and other supporting staff. Find out if the hospital has surgeons with dedicated training for head and neck cancers? Does the hospital have Tumor Board reviews – how often are they conducted and will your case be discussed there if you wish?
- Work with a major cancer hospital, even if it is far: Most experts in high-volume centers are willing to work with your local doctors. Usually, part of the treatment (for example, surgery) can be executed in the major center and the post-surgery treatment is executed locally.
- Research hospital’s Head and Neck Cancer volumes: How many cases of Head and Neck cancers are treated in the hospital every year? High volume centers with multiple specialists available for head and neck cancers may have better expertise and specialized medical infrastructure required.
- Consider Clinical Trials Availability: Ask whether the doctor or hospital has access to clinical trials and if you are eligible for any. Clinical trials are research studies that test new ways to treat cancer that you can be involved with. By being involved, you can help improve treatments and outcomes for future patients.
- Insurance Acceptance: Check if the hospital accepts your insurance. Check if the hospital has a desk that can assist you with claims.
Sources: Rogel Cancer Center; Cancer.Net