Health Topics » Cancer » Our Cancerous Burden: It’s No Smoke At All   Login


July 2012
Our Cancerous Burden: It’s No Smoke At All
Dr Shona Nag
Both head-neck cancers and lung cancers impose a tremendous health burden on our growing population. They are essentially lifestyle cancers and can easily be prevented if tobacco use is avoided. Patients who develop these cancers often have advanced diseases, which cannot be cured. Treatments are associated with side effects and also prove expensive.

The focus in our country should be on prevention, and awareness among the public is paramount in saving precious lives.

According to one estimate, India will see a 500 per cent increase in cancer incidences by the year 2025 and as much as 220 per cent of that will be cancers with a direct link to the illeffects of tobacco consumption. That should be very strange to know when another ‘World No Tobacco Day’ has crossed by.

The two most common cancers in India, which are caused by tobacco, are cancers of the head-neck region and lung cancer.

Cancers Of The Head-Neck region
There are over 2,00,000 cases of head-neck cancer diagnosed in India every year. Head-Neck cancers make up almost 25 per cent of all cancers detected in India. Furthermore, the disease is diagnosed in advanced stages when it cannot be cured. Men are affected three times as commonly as women. Head-Neck cancers include the cancers of the following:
  • Cheek
  • Tongue
  • Other parts of the oral cavity
  • Throat
  • Upper part of the foodpipe
It is seen more commonly in the lower socio-economic strata and is related to the indiscriminate use of tobacco, use of lime with betel leaf and betel nuts, smoking, use of gutka and even alcohol.

Symptoms of oral cancer:

The sign that there may be a problem is when one finds an ulcer in the mouth or tongue which does not heal or there are red or white patches on the sides of the mouth. These could be precancerous and require immediate attention. A change in voice or difficulty in swallowing should also bring one to the doctor immediately.

Diagnosis and treatment of oral cancer: The diagnosis is made by an oncologist or an ENT specialist and is confirmed by a biopsy. Sometimes a CT scan or MRI is required. Only very early stages of disease can be cured and this is usually by surgery or by radiotherapy. However, most patients in India present to the doctor in late stages, which require radiotherapy, chemotherapy and then surgery if the other treatments are successful in making the disease operable.

This is one of the cancers where there is a lot of morbidity and disfigurement – some patients lose part of their tongue, or voice box or half their jaw. They then require plastic reconstructive surgery to correct these defects but never look quite the same again. After radiotherapy a patient may have difficulty in opening the mouth and remain on liquids for years. Others have swallowing difficulties or dryness of the mouth which persists. Then there are side effects of chemotherapy as well.

A simple way to catch this disease early, especially if you use tobacco, is to have an oral examination every six months by your doctor. The ideal situation, of course, would be to give up tobacco completely.

Lung Cancer
A hundred years ago lung cancer was a reportable condition. Today it accounts for more deaths than breast, colon and prostate cancers combined. It is the most common cancer in males in the West, although the incidence has come down of late, due to decrease in smoking. Contrary to this, the incidence of lung cancer is going up in the developing world and most cigarette companies are targeting China and India, so much so, that 1/3rd of the world’s smokers live in China!

The incidence of lung cancer in India is low as compared to the West but the sheer size of our population makes the overall lung cancer burden large.

Diagnosis of lung cancer:

More than 80 per cent of patients present in an advanced stage where they cannot be cured. The most common situation is a nagging cough which refuses to go away, or increasing breathlessness. Often patients in our country are diagnosed as having tuberculosis only to find no response to TB medication after one to two months. On further testing, lung cancer is found. Less than 10 per cent of patients with lung cancer live for more than five years and this is a bitter fact.

Treatment of lung cancer:
Only those that can be operated can be cured and this number is small. There have been major strides in the medical treatments for lung cancer.
  • Chemotherapy is the treatment of choice for advanced disease.
  • Newer therapies with targeted drugs like Erbitux, Avastin, Iressa, Tarceva have improved the outcome further and many patients now live for two to three years with a reasonable quality of life. But some of these treatments are expensive and beyond the reach of the common man.
  • Vaccines for lung cancer are being tested. This is one of the cancers for which a cure is being extensively researched.
Dr Shona Nag is Senior Consultant Medical Oncologist,Apollo Hospitals[Jehangir Hospital],Pune.

 Also See