Ulcers, sore throat, a painful tongue and difficulty chewing – are these just your regular ailments or symptoms of something more like mouth cancer?
In the news recently: A 24-year-old university student, Muhammad Faid, was diagnosed with mouth cancer, making him the youngest patient ever. Faid had a painless ulcer that appeared on the left side of his tongue. He didn’t think much of it until his mother realised that the ulcer did not disappear since being discovered end of 2016. Then things got worse as Faid soon began to sustain bleeding with cavity appearing on his tongue. By the time he was diagnosed with mouth cancer, Faid was already a Stage III patient and doctors had to surgically remove three-quarters of his tongue promptly[1].
Faid’s case is typical where mouth cancer patients are normally diagnosed at a later stage, making treatment and recovery more complicated. This is mainly because the early symptoms of mouth cancer like ulcers, sore throat, difficulty chewing and tenderness in the mouth are often overlooked as just your regular ailments when in fact, they could be warning signs of a more fatal disease.
Mouth cancer is fairly easily treated if detected early, however, late detection increased the mortality rate for the cancer as compared to other cancer types. “Patients come in at all stages, but the treatment outcome will be better if they come in at the early stages,” says Dr. Sobia Bilal, Lead for the Quit Smoking Service at the IMU Healthcare Oral Health Centre.
Dr. Hussien Al-Wakeel, Clinician-in-charge of the IMU Healthcare Oral Health Centre, agrees. “Mouth cancer starts painless but it is very easy to detect and very easy to manage if it is detected early. Often, it is neglected and the patient comes to the clinic at a very late stage where we cannot do anything unless we refer them for surgical procedures.”
Watch Out For That Ulcer
So what are the telltale signs of mouth cancer? “There are many kinds of ulcers. Main indicator are the ones that are not healing. So if you notice a stubborn ulcer that isn’t healing for over two weeks, go to a dentist immediately. We have the instruments to see the inner side of the mouth better and provide a diagnosis,” says Dr. Naveen Jnanendrappa, lecturer in the Department of Oral & Maxillofacial Surgery, IMU School of Dentistry.
Self-oral examination conducted at least once a month could help with early detection, says Dr. Wakeel. “Essentially, you want to check for abnormal lumps or ulcers that have not healed for more than two weeks – that is the cut-off time.” (Refer to appendix for diagram. Download at http://www.mouthcancer.org/downloads/)
MOUTH CANCER IN MALAYSIA
Sadly, in Malaysia, two persons are diagnosed with mouth cancer every day where 75% seek treatment at the later stages and only half of them survives[2].
According to the National Cancer Registry, Ministry of Health (Malaysia), mouth cancer is the third most common cancer among Malaysian Indian community. Dr. Bilal explains that the cultural habit of chewing tobacco could be the reason for this as tobacco is considered a common risk factor for mouth cancer. Other risk factors include smoking and alcohol consumption. However, it is interesting to note that more recently, for reasons that are still unclear, mouth cancer is increasingly diagnosed in individuals who do not practice these risk habits[3]. Which makes awareness the best “cure” for mouth cancer.
TREATING MOUTH CANCER
Treatment and management for the cancer is possible though exhaustive, especially if presented in late stages. Treatment begins with seeing how far along the cancer has spread, says Dr. Jnanendrappa. “A CT scan & MRI scan allows us to evaluate the spread of the disease. Ultrasonography helps us see where it has spread in the neck. A biopsy will be needed where a sample of the tumour is extracted for the pathologist to determine the types and grading of the cancer,” he further explains.
After which, the treatment course will be decided, depending on a few things like the patient’s age. “Basically, when you talk about treatment, there are three options: radiotherapy, chemotherapy and surgery. Surgery has been around the longest and more reliable. In radiotherapy, the radiation kills the cancer cells whereas in chemotherapy, you get some medications that again kill the cells,” explains Dr. Jnanendrappa.
Like all cancers, a better quality of life is what doctors are after with treatment for mouth cancer. Typically, a patient will face speech and eating problems when their oral cavity is affected by the cancer. Facial disfigurement may also be obvious and visible. “Once [patients] know that they have cancer, it’s a big deal. They need nutritional and psychological counselling. Speech therapists would also be needed because most of the time, when you cut a part of the tongue, you can’t speak properly. So you need to retrain how to speak properly. Also a social worker because in many places, these surgeries are quite expensive,” says Dr. Jnanendrappa.
Teo Soo Lay, an accredited practicing dietitian with IMU Healthcare Medical Clinic, explains how nutritional counselling works in this instance. “We want to make sure you stay strong. No matter the treatment type, patients will go through some weight loss, some vomiting and dry mouth. These will affect how much you’re going to eat further down the road. Patients need high energy and protein diets. Huge variety is always key – so often I’ve seen patients just drinking plain soup rather than going for something that is more substantial. The other goal I have is to restore digestive health to prevent malnutrition.”
Nutritional support is made after taking into account the patient’s assessments, dietary preferences and eating behaviour. “We will decide what would be the best plan together with the patient. We will support the patient nutritionally throughout their journey – we want to make sure that patients recover properly,” says Teo.
Additionally, some patients may seek pain management treatment in the form of complementary medicine like acupuncture. “The course of cancer treatment comes with side effects and may cause discomfort. If they have dry mouth, it helps them increase their saliva. Acupuncture could also help them to sleep better and get the rest they need. The main thing is to help them relieve these symptoms of discomfort, not to replace current medical treatment,” explains Anthony Wong Wei Bing, a Chinese Medicine practitioner at IMU Healthcare Chinese Medicine Centre.
Aside from awareness, the key is to reduce the rate of smoking which is a risk factor for mouth cancer, says Dr. Bilal. “According to the latest 2017 WHO monitoring report, there are 43% of male adult smokers in Malaysia which means one out of two Malaysian men smoke. The statistics is huge, the prevalence of smokers in Malaysia huge. We have to do something about bringing down the prevalence and controlling the risk factor at the grass root level”.
APPENDIX
[1] https://www.thestar.com.my/news/nation/2017/08/21/smoker-at-17-cancer-patient-at-24/
[2] http://www.freemalaysiatoday.com/category/leisure/2017/02/13/malaysians-developing-worlds-first-oral-cancer-vaccine/
[3] http://www.cancerresearch.my/research/oral-cancer/
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