World Oral Health Day: Why early-stage oral cancer often shows no pain, know hidden reasons behind late detection

Early-stage oral cancer often develops without pain, leading to delayed diagnosis. Understand why symptoms go unnoticed and how early detection can improve treatment outcomes.

Cancer is a term that sends a chill down your spine whenever it is heard of. People generally associate this term with breast, lung, or colon cancer, but they often overlook the most common forms of this deadly disease. It is astonishingly true that oral cancer is among the top three types of cancer in Southeast Asia. Also, India is considered to be the oral cancer capital of the world, owing to the tobacco consumption of its local populace. Since the mid-2000s, incidence rates have increased by about 1% per year.

The worst thing about this life-threatening disease is that patients often do not feel any pain or identify any visual symptoms during the early or the first stage. That causes a delay in detection, which allows the cancer to metastasise at its own pace. As a result, the convalescence becomes longer, and the treatment becomes expensive, and even incurable at times.

As per Cancer.org, the death rate for cancers of the mouth and throat increased by 0.7% per year from 2009 through 2022, after decades of its decline. This is mainly because of an increase in oropharyngeal cancer mortality of almost 2% per year during that time.

What is oral cancer?

According to Dr (Prof) U S Vishal Rao, distinguished Indian Head & Neck Surgical Oncologist and Robotic Surgeon, Member, Governing Council, National Cancer Grid (India), "Oral cancer is a malignancy that happens when cells in the mouth grow abnormally and uncontrollably. It can invade the surrounding tissues, attack the lymph nodes, affect the bones, and damage other organs. In severe cases, it can also lead to the death of a patient. Oral cancer can start its progression inside the mouth, tonsils, palate of the mouth, oropharynx, gums, lips, and tongue."

The progression of oral cancer

The progression of a healthy tissue, a precancerous oral lesion and further into a cancerous one is typically characterised by the following pathological stages:

1. Normal Mucosa: Healthy squamous epithelium.
2. Hyperplasia/Keratosis: Increased thickness of the cell layers, often appearing as a white patch (leukoplakia), without cellular abnormalities.
3. Mild Dysplasia: The lowest grade of abnormal cell growth, restricted to the basal and parabasal layers.
4. Moderate Dysplasia: Abnormal cells extending into the mid-portion of the epithelium.
5. Severe Dysplasia: Abnormal cells extending over the mid-portion, often appearing highly disorganised.

Who can be prone to oral cancer?

• People who chew tobacco or areca nuts (Supari/Pan Masala/Ghutka) or drink alcohol heavily are at a high risk. Smoking tobacco while drinking alcohol increases the risk most severely.
• People who have poor oral hygiene or long-term infection inside the mouth.
• People who are infected with sexually transmitted Human Papillomavirus (especially HPV-16).
• People who face excessive exposure to the sun and UV rays due to their profession.
• People suffering from malnutrition.
• People with oral cancer patients in their family tree have a higher chance of carrying that gene.

What causes delays in early-stage oral cancer detection?

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Absence of affordable and non-invasive early detection/screening tools is another important reason for delayed detection. Even clinical practitioners find it difficult to stage the precancerous conditions unless an invasive biopsy procedure is performed for clarity. Complications associated with biopsy often delay proper decision-making on the clinician's part. More importantly, a lack of an easily accessible and cheap screening solution that could be deployed even in the remotest parts of the world is the need of the hour.

Although point-of-care solutions are becoming widely popular these days, for ailments like cancer, they might not prove useful. Since the awareness related to early detection is limited in countries like India, the use of point-of-care screening tools might also be very scarce.

Disclaimer: Dear readers, this article provides general information and advice only. It is not at all professional medical advice. Therefore, always consult your doctor or a healthcare specialist for more information. TheHealthSite.com does not claim responsibility for this information.