Cancers of Gastro-Intestinal Tract
Gastro-intestinal tract begins at the mouth and ends at the anus. In between it comprises from above downwards pharynx, oesophagus, stomach, small and large intestine.
The functioning of this system along with its associated organs such as pancreas, gall-bladder and liver is digestion and absorption of food.
Cancer of the Mouth (Oral Cancer)
Cancer of the tongue, mouth and pharynx is much more common in India, Bangladesh, Sri Lanka, Thailand and Indonesia than in other countries. It accounts as much as 30 to 50 per cent of all cancers in India. In the Western countries, it accounts for only 3 to 5 per cent of all cancers.
Causes
Approximately 90 per cent of oral cancers in India can be attributed to tobacco chewing and also smoking. These cancers almost always occur on the side of the mouth where the tobacco quid is kept, and the risk of cancer rises drastically for those who keep the tobacco quid in the mouth over-night. A link also seems to exist between infection with HSV (Herpes simplex virus) and oral cancer.
Symptoms
Onset of the cancer at this site is usually preceded by the inner lining of the lip turning into a white patch on which a hard mass slowly develops, the top of which some times becomes an ulcer.
Cancer of the lower lip is generally caused by the habit of depositing khaini, a mixture of tobacco and lime under the lower lip from where it is chewed slowly. It is seen in the eastern parts of Uttar Pradesh and Bihar.
Cancer of the cheek appears as a hard thickening which is painless. Sometimes an ulcer forms over it. If a painless swelling or an ulcer with a hard base forms and does not heal up in about two weeks, one must consult a competent doctor to rule out cancer.
Chewing or smoking tobacco and the chronic irritation caused by irregular teeth have been suspected to lead to cancer at this site. Cancer of the tongue involves the back of the tongue and at this site grows unnoticed for many months. It then involves lymph glands in the neck which become enlarged and sometimes it is for them that the patient seeks medical advice. This is generally seen more often in men.
Diagnosis
Routine: Physical examination of the local part provides a suspicion.
Blood: Hb, RBC, TLC, DLC, may be normal. ESR may be raised.
Special: Biopsy examination of the involved part confirms the diagnosis.
Treatment
Surgery: Excision of the involved part, the surrounding areas and the lymph nodes, if involved.
Radiation: It is given when suspicion of spread is present, and the whole of the involved area has not been removed through surgery.
Chemotherapy: It is not of much use.
Prognosis
Presently, more than 50 per cent of oral cancers are detected only after they have reached an advanced stage. Such cancers are disfiguring and painful, the treatment required is both extensive and expensive, and survival rates are low, with less than one-tenth of the patients surviving 5 years.
Surgery and radiotherapy can cure only the early cancers.
Indian Studies
From the Radiotherapy Department of Safdarjung Hospital, New Delhi, in 1987, it was reported that 6 per cent of all the cancer patients coming to the Department for treatment were that of oral cancer. Generally, the disease was far advanced and the survival rates were low with radiotherapy and/or surgery. The treatment with chemotherapeutic drugs was mostly palliative, though their combination with radiation or surgery produced good results in some instances.
In a study reported from Tata Institute of Fundamental Research, Bombay, in 1986, total oral cancer patients numbering 65, could be detected, in a house to house survey of 470,000 villagers in Ernakulam district, Kerala. The average age at the time of diagnosis of oral cancer was 35 years, and 78 per cent were men. The information regarding the tobacco usage was available for 64 patients, and prior to the diagnosis of oral cancer, all of them used tobacco in one form or the other. Even after the treatment of oral cancer, 43 per cent of the patients continued using tobacco, mostly as a smoking habit More than half of the patients (33 out of 58) were treated less than 5 years before the survey was carried out This indicated that the survival rate of oral cancer patients was probably not very good.
Early Detection
Signs & Symptoms
· History of chewing tobacco. Non-healing hard-based ulcer can anywhere in the mouth:
· 1. inside the lower or upper lip
· 2. on the side of the tongue
· 3. inside the cheek
Investigations
· Biopsy examination of the part involved.