Risks of oral cancer high as most Pakistani youths failing to undergo timely screening’

“A vast majority of youngsters in Pakistan are still failing to undergo comprehensive oral screenings, and this greatly increases the risk that early signs of oral cancer will go undiagnosed for too long due to its painless nature,” said Prof Jehan Alam, consultant oral & maxillofacial surgeon & head of the Department of Dentistry, Jinnah Postgraduate Medical Centre.

He was addressing a webinar organised by the Neurospinal & Cancer Care Institute on the occasion of World Oral Cancer Awareness Month last week.

“A patient does not get a comprehensive oral health screening, which also examines the state of the internal soft tissue and mucosa, the thin layer of skin on the inside of the oral cavity, or on the tongue that pre-cancerous lesions first appear, mostly as white patches and ulcers, over time, and in the absence of the required treatment, the lesions can develop into oral cancer, other types occur on the salivary glands, larynx (voice box) or throat, oral cancer affects men more often than women, at a ratio of about 3:1,” Prof Jehan further said.

“In more than half the patients who had follow-up neck dissections, the cancer had already metastasized to the neck. Often, it is not the oral cancer itself that is fatal. Instead, the cancer spreads to the neck and chest, and this is what proves deadly,” he said.

“The symptoms of head and neck cancers include a lump or a sore that does not heal, a persistent sore throat, difficulty in swallowing, and a change or hoarseness in the voice. These symptoms may also be caused by other, less serious conditions. Therefore, it is important to check with a doctor on experiencing any of these symptoms. The doctor can further recommend tests to arrive at a diagnosis. Seeking medical consultation provides an opportunity to undergo timely screening, especially for those at high risk of the disease,” Prof Jehan advised.

“The good news is that oral cancers are often preventable, simply by avoiding negative habits like smoking, alcohol consumption and tobacco use. What is worrying, however, is that a large proportion of young people are involved in one form or another of smoking, whether it is cigarettes, sheesha or loose tobacco,” said Dr Abdul Qayyum (consultant oncologist & assistant professor, Dr Ziauddin Hospital, Karachi).

“This is an alarming situation, demanding urgent attention to increase awareness of the importance of a healthy lifestyle and the highly damaging effects of chewing various hazardous concoctions; smoking sheesha (a type of smokeless tobacco, SLT) have become particularly popular with young people who are attracted to sheesha’s romantic allure – it is seen as fashionable and exotic. Given that sheesha is often smoked with friends and family, this strong social element to the addiction may be the reason the smoking cessation drug, varenicline, which is effective for cigarette smokers, doesn’t have the same effect on daily shisha smokers. These substances contain around 28 known carcinogens amongst which arecoline, nonvolatile alkaloid, nitrosamines, volatile aldehydes, flavonoids and tannins are of prime importance.”

“Typical one-hour long sheesha smoking session involves inhaling 100-200 times the volume of smoke inhaled from a single cigarette and is more addictive than cocaine. All these chemical compounds change the normal morphology of the cells, thus inducing cytogenetic or genetic alternations lead to aggressive form of oral cancers,” Dr Abdul Qayyum added.

Guest speaker Dr Lubna Saleem, medical oncologist at the cancer foundation hospital, Karachi, said treatment plans for the patient depends on several factors, including the exact location of the tumor, stage of the cancer, age and overall health. The best treatment results are achieved for patients in early stage of the disease. Treatment for oral cancers can include surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy or a combination of treatments.

Highlighting the role of immunotherapy, she said that the latest revolutionary class of anticancer therapy can be used to treat oral cavity and oropharyngeal cancers. Immunotherapy is the use of medicines to help boost a person’s own immune system to find and destroy cancer cells more effectively with fewer side effects than “aggressive” chemotherapy.

“The beauty of immunotherapy is that some patients experience an impressive, even a lasting response. It is also an option as the first treatment in some people whose cancer has recurred, is metastatic, or cannot be removed with surgery.”