Docstoc

Oral Cancer Sangeeta Darvekar Charitable Trust a registered trust with

Document Sample
Oral Cancer Sangeeta Darvekar Charitable Trust a registered trust with Powered By Docstoc
					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 it
     Oral 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
                             Diagnosis
Initially 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
         Carcinoma of the Tongue

    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.




                        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
     Cancer of Gingiva and Buccal mucosa
  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




                        Dr Suwas Darvekar
 Cancer Of Cheek after tobacco quid habit




CANCER LESION COMING OUTSIDE
         THE MOUTH




                           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

 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.




                           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

   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.




                    Dr Suwas Darvekar
Alveolar cancer after tobacco quid habit




               Dr Suwas Darvekar
Alveolar cancer after tobacco quid habit




               Dr Suwas Darvekar
              Relapse case
He 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
          Cancer classification and Staging
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 node
N1 is single ipsilateral node < 3 cm
N2a single ipsilateral node > 3 cm but < 6 cm
N2b multiple ipsilateral node < 6 cm.
N2c bilateral or contra lateral nodes < 6 cm
N3a ipsilateral node > 6 cm
N3b bilateral nodes > 6 cm
M0 is no metastasis and M1 is metastasis present.

Staging
Stage I   T1 N0   M0
Stage II T2 N0    M0
Stage III T3 N0   M0; any T1 T2 T3, N1 M0
Stage IV T4 ANY   N, M0; any T, N2 or N3; ANY T OR N WITH M1


                                Dr Suwas Darvekar
       Treatment available
 Treatment 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 Question
1.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. Am 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.org
Please 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, 9869368937
        Email: 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:4 September 2010




                              Dr Suwas Darvekar

				
DOCUMENT INFO