10 Myths About Oral Cancer

MYTH #1 I HAVE STOPPED SMOKING, I won’t GET ORAL CANCER.

FACT: More than 80% of oral cancers are related to smoking or chewing tobacco. People who smoke have 5 times more risk of developing oral cancer than those who don’t smoke. After quitting tobacco (smoking or chewing), your risk of getting oral cancer decreases very slowly. As compared to non-smokers the risk falls from 3.5 times, after 1-2 years of quitting, to double after 6-9 years of quitting. The risk is comparable to the general population after about 12-15 years of quitting tobacco.

MYTH #2 IT IS OK TO HAVE SMALL, NON HEALING ORAL ULCERS THAT ARE PAINLESS

FACT: Characteristically, cancerous (or potentially malignant) ulcers are PAINLESS. We should be watchful for any ulcer in the mouth that is painless, and not healing despite about 3 weeks of treatment. Usual aphthous ulcers in the mouth are irritable, have burning sensation & usually heals in 2-3 weeks time. Hence, PAINLESS ulcers are more dangerous than painful ones.

MYTH #3 BIOPSY WILL CAUSE SPREAD OF CANCER.

FACT: Biopsy is very crucial in the treatment of cancer. There is absolutely no proof that it leads to the spread of cancer. A study conducted in Mayo Clinic with pancreatic cancer patients, some of whom had FNAC & others did not show that patients with FNAC survived better as they could receive proper treatment based on FNAC results. The biopsy is also essential for the following reasons:-
A) It confirms the presence of cancer & this justify the use & risks associated with treatments like chemotherapy, radiotherapy or major surgery
B) A biopsy is needed to establish a correct treatment plan. For eg, straight surgery or chemotherapy followed by surgery or sometimes chemoradiation alone (& thus avoiding surgery)
C) It also allows detailed genetic testing & detection of mutations, so that targeted therapy or immunotherapies can be considered.

MYTH #4 PET-CT WILL TELL EVERYTHING ABOUT THE TUMOR.

FACT: PET-CT is rarely the initial investigation of choice. Oral cancers rarely spread to distant organs even in advanced stages and thus PET-CT should not be done routinely in Head & Neck cancers. PET-CT sometimes doesn’t give fine details of the tumor, for which additional MRI is also required in tongue or buccal mucosa cancers. Occasionally, PET-CT may show distant uptake due to some other reasons and not cancer and thus leading to unnecessary additional tests to confirm the same.

MYTH #5 ALL MY BLOOD REPORTS ARE NORMAL – THIS CANT BE CANCER

FACT: There is no specific blood test/tumor marker for the detection of Head & Neck cancers. Cancers are detected by symptoms, signs, scans (CT/MRI) and confirmed by a biopsy test. Routine blood reports will be normal in most of the individuals even in advanced stages of Head & Neck cancers.

MYTH #6 ORAL CANCERS CAN BE TREATED WITHOUT SURGERY

FACT: Surgery & Radiotherapy are the mainstays of treatment in head & neck cancers. Surgery is mostly the initial treatment in early and even in advanced oral cancers-if operable. Radiotherapy is usually given after the complete removal of the tumor by surgery. Tumors are usually removed with a cuff of normal tissue all around (margin) in order to reduce the spillage of cancer cells & thus prevent local recurrence.

MYTH #7 STAGE 4 ORAL CANCERS ARE INCURABLE.

FACT:, Unlike other cancer sites, Head & Neck cancers can be stage 4 without a distant spread and thus are potentially curable even in the 4th stage. Head & Neck cancers with the involvement of cheek skin or facial bones (mandible, maxilla) technically stage 4A cancers & some with even more extensive bony or muscle involvements, but without spread to distant organs are stage 4B. Both these stages are potentially curable using both surgery & radiotherapy. Only 4C tumors are cancers with distant spread and are incurable. So, even stage 4 (A&B) oral cancers are treated with curative intent.

MYTH #8 ORAL CANCER SURGERIES ARE DISFIGURING

FACT: Gone are the days when oral cancer surgeries left the patient with disfigured face & bad scars. Now with improved surgical skills, incisions are becoming smaller, they are placed strategically so that they are not easily seen. Robotic surgery has made it possible to remove neck tumors, thyroid gland & lymph nodes via hidden incisions. Tonsillar or base tongue tumors can also be removed via mouth opening without any scars using robotic surgery. Better reconstruction using free flaps (that is, tissues from other parts of the body) have given good cosmetic & functional outcomes.

MYTH #9 I WON’T BE ABLE TO EAT NORMALLY AFTER SURGERY

FACT: Oral cancer treatment may sometimes need the removal of part of the tongue or jaw. Also, surgery & radiotherapy causes some degree of reduction in mouth opening. Free fibular flaps can be used to reconstruct the jaw and even dental implants can be put at the time of surgery for dental rehabilitation. All this in association with proper mouth opening and swallowing exercises can enable the patients to eat and drink normally. The patient’s self-motivation & will power also plays an important role.

MYTH #10 RADIOTHERAPY IS NOT IMPORTANT AFTER SURGERY – CAN BE TAKEN LATER

FACT: The majority of oral cancer patients will require radiotherapy after surgery, due to some indication or the other. Radiotherapy reduces the chances of local recurrence to 50% and thus is very essential if indicated. Radiation should ideally start between 4 – 6 weeks after surgery but can be initiated even up to 16 weeks post-surgery. The expected benefit of radiation decreases steadily with an increase in the gap after surgery beyond 8 weeks. Thus, it is essential to start radiation on time & finish on time. Studies have shown that patients who complete radiation beyond 11 weeks after surgery had worse outcomes as compared to those who finished radiation within 11 weeks.