With the third World Head and Neck Cancer (HNC) Day organised by the International Federation Head and Neck Oncological society (IFHNOS) by global cancer specialists due to take place on July 27, a hitherto sidelined cancer, namely Oral Cancer, which has raised concerns among health officials on account of its rise globally and in Sri Lanka, will be brought to the table with discussions focussing mainly on raising more public awareness and devising strategies of reducing the risks of all those vulnerable to this disease.
The Sunday Observer spoke to Senior Registrar in Community Dentistry, National Cancer Control Programme, Dr. Nadisha Ratnasekera, to find out more about this disease ,believed to be one of the most preventable and curable of all cancer diseases if detected and treated early. Drawing on her expertise, she ably fielded our questions on how it is caused, what drove this disturbing trend to spread especially among young people leaving damaging scars- both physical and mental, and most importantly how we could reduce the risks of this silent disease that often catches one unawares, with a few simple Do’s and Don’ts.
Excerpts
Q: The International Federation of Head and Neck Oncology Societies has declared July 27 as World Head and Neck Cancer Day ( HNC). Why is it important to set aside a whole day to discuss this particular health issue and what is the global incidence of these cancers ?
A. The whole day is dedicated to HNC because it is a very important health problem across the world as HNCs are quite common. There are over 500,000 cases globally each year. Furthermore, HNC cancer is preventable and could be detected very early. So oncologists use this special day to increase the awareness on the cause and early signs of the disease, and also to sensitise the public about the difficult cancer journey that patients go through while at the same time easing their painful journey to recovery and rehabilitation.
Q:. What is the theme of this year’s World Head and Neck Cancer Day and what is its relevance to Sri Lanka particularly?
A. Theme for this year is “Check your mouth prevent oral cancer”. This theme is very relevant to Sri Lanka because oral cancer is the most common cancer among males in Sri Lanka. Out of all the strategies used to early detect oral cancer for a good prognosis is the self mouth examination. If we empower our high risk communities to check their own mouths without the need of any special facility we can think of a better prognosis of our patients with oral cancer in time to come.
Q: What is the current prevalence rate of fatalities caused by HNC in the world? How does Sri Lanka compare with the global rates.?
A. There are about 200,000 head and neck cancer related deaths globally per year which is quite high. When it comes to Sri Lanka, the majority of HNC cases are oral cancers. So, there are about 2-3 deaths happening per day due to oral cancer in Sri Lanka which comes to nearly 1000 deaths per year.
Q: Are there different types of oral cancer? If so, what are they? Which of them are the most common here? Why?
A. My answer to the first question is Yes. But I must add that mainly it is Squamous Cell Carcinoma which is prominent in our population. However, we can also divide oral cancer according to the site of the cancer like lip cancers and floor of the mouth cancers, tongue cancers. In Sri Lanka what is more common is cancers on the cheek. This is mainly due to the habit of betel chewing where they keep the betel quid inside the mouth in between the cheek and teeth.
Q: Occupation wise I’m told that bus drivers and three wheel drivers are more prone to OC due to their having to travel long distances on empty stomachs and fill their hunger pangs with betel chewing or smoking. Why? Your comments?
A. While you are correct in saying that oral cancer is more common among bus drivers and three wheeler drivers, I would like to add that it is not only them, but estate workers and daily labourers as well who are also at risk. What is common is that these patients are from a relatively low socio-economic background.
They mainly follow these risky habits due to many social factors like poor education background and poor knowledge about these habits, myths such as this habit would help to keep them up late night along with several psychological reasons.. So this is a complicated situation where we can not blame these patients for their habits. Instead we have to support them gently to overcome them.
Q: So what are the main causes that drive this cancer?
A. Main causes are chewing tobacco with betel or any other form, chewing arecanut packets, smoking and drinking alcohol.
Q: Of these which are most common in Sri Lanka?
A. As I mentioned earlier, the most common is betel chewing. This is a dangerous trend. If the usage of these areca-nut packets, which is increasingly becoming popular among our youngsters, continues, it will pave the way to a disaster in near future. We will experience a lot of youngsters with oral cancer in Sri Lanka. Therefore, this is a red notice to all the parents, teachers and youngsters reading this article to be aware of these new products in the market and empower your loved ones to say ‘no’ to them.
Q: Who are those most vulnerable to Oral Cancer- age wise and gender wise?
A. The adult group is from 65-75 years and the males are more prone to Oral cancer.
Q: What are the early symptoms of oral cancer? At what stage are they first visible to the eye?
A. The good news about oral cancer is that it doesn’t just pop-up. Instead there is a condition called Oral Potentially Malignant Disorder where these lesions are more prone to follow up by an oral cancer. Therefore, if we can identify these lesions we can avoid it becoming a cancer.
Q: Can anyone who smokes or chews betel be able to recognise these symptoms if they looked at it with a mirror?
A. Yes of course. The lesions present as red or white patches. Also, if a person finds any difficulties in mouth opening, tongue movements or burning sensation in the mouth he or she must visit the nearest dental doctor because these are the early symptoms.
Q: Who makes the diagnosis and what is the procedure if a person with suspicious symptoms comes to your clinic?
A. Generally, the majority of the patients visit the nearest dental or medical doctor if they come across any susceptible lesion. From this grassroot level patient will be referred to a specialised care unit which is an oro- maxilo-facial unit or any other cancer treatment unit. The patient will be seen by a consultant in this tertiary care unit and then in most cases a biopsy is taken for the diagnosis. Once the biopsy report is available the diagnosis will be revealed to the patient in a methodical manner. Oral cancer can be treated surgically which is the most common treatment or with chemotherapy or radiotherapy or a combination of above three. The decision on the type of treatment is taken by the consultant.
Q: Is OC curable? How? What are the techniques available here given the advanced hi tech age we are now in to detect and treat it early?
A. If the cancer is detected very early then the prognosis is very good where one could call it as a cure. So it all depends on how early the cancer is diagnosed. The treatment of oral cancer today is much more advanced to what it was. Now they no longer use invasive surgeries where a huge area of the face or around the lesion is removed during surgery in most cases and only the area which has cancer cells is removed. Moreover, after removal the reconstruction methods are well advanced now where attempts are being made to reconstruct the area to what it was before
Q: What are the main adverse health impacts of oral cancer physically and mentally on a person?
A. Oral cancer affects a person physically, mentally, financially, socially and spiritually. However, if we elaborate on the physical and mental aspects, physically- due to the location of the lesion, the impact on the face of the patient is critical.
This is due to the disease as well as the treatment outcomes which is unavoidable. The face is considered to be the sole identity of being a human.
Therefore, when the face is disfigured the negative impact on the psychology of the patient and also the caregiver is massive. Moreover, patients with oral cancer experience many difficulties when performing the basic day to day functions like breathing, eating, swallowing and speaking. These are basic functions that any human requires to perform, and hampering them can result in massive psychological distress to both the patients and caregivers.
Secondly with regard to the mental impact, the cancer journey is a stressful one. Therefore, these patients who are already undergoing daily life struggles due to their low level socio-economic status, are in need of high levels of emotional support.
Q: Babul is a recently introduced substance that is now becoming very popular . What is Babul? Who uses it most among Lankans?
A. This is an upcoming risky behaviour of our youth. This is an areca nut presented in the form of a small packet. Unfortunately, this is available in our markets and our schoolchildren and youngsters are more prone to this habit.
It is found that consumption of these packets causes Oral Submucous Fibrosis (OSMF) which is the most common Oral Potentially Malignant Disorder (OPMD) in Sri Lanka. There is a high chance of OSMF to transfer into oral cancers.
Therefore, this is a red notice to all the parents, teachers and youngsters reading this article to be aware of these new products in the market and empower your family to avoid them.
Q: As you are a member of the National Cancer Programme, tell us briefly what the NCCP is doing to prevent the spread of OC?
A. The National Cancer Control Programme is the national body in coordinating cancer control activities in Sri Lanka.
Based on the available evidence this national programme carries out many activities with regard to prevention, early detection, diagnosis and treatment, rehabilitation, survivorship and palliative care of all cancers.
With regard to oral cancer the preventive programmes are basically to empower the general public as well as the health staff on risky behaviour. In addition, we are also attempting to initiate various regulations to control these habits.
Q: Have you a message to the public on reducing oral cancer risks? Can you offer them some easy to follow Do’s and Don’ts?
A. Following are a few simple things which one can do especially if you are part of the OC vulnerable groups:
l Avoid the above risky habits. This will protect everyone not only from oral cancer but also from many other common cancers.
l Do self-mouth examination, that is check inside your own mouth for any abnormal changes in the colour, texture and shape. Do this every day after brushing in front of the mirror. Make it a habit; A habit which will save your life
l Visit your dental doctor once a year at least for a normal screening of your mouth
Q: Do you have a contact number to call for more information?
A. You can contact the National Cancer Control Programme on 11 2368627 or the official website https://www.nccp.health.gov.lk/en