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Oral Cancer: Beware North East India


Cancer never kills but delay always. It is a true saying. The most curable cancer is becoming a treat to North East India. The North East region especially Assam and Meghalaya is turning to be the stock house of Oral cancer due to many reasons. The oral cancer is said to be easily detectable and treatable but still the patients in north east come to know of it at the final or last stage. Any type of cancer which occurs in some internal organs, requires several investigations to be diagnosed, but to detect any sort of cancerous formation in the oral cavity, a person requires a mirror and the sunlight. It clearly means that the people in North East India are still not properly aware of the disease so called-Cancer. As like the other cancers, oral cancer can be healed only at the earlier stages when it does not spread. But later it becomes impossible to treat and the patient has to follow only the palliative treatments.


In the field of cancer, the basic knowledge and proper awareness is very necessary. Each and every individual should know what exactly the oral cancer is? In simple words, oral cancer means the cancer in oral cavity. Its means abnormal growth or ulcer inside the oral cavity. The oral cancer is a subtype of Head and Neck Cancer and the oral cavity includes lips, tongue, inner parts of the cheeks, floor of the mouth, gums, hard and soft palates (roof of the mouth). The most common type of oral cancer is the Squamous Cell Carcinoma, followed by Adenocarcinoma at the second place. Almost all the types of oral cancers look similar. Only after the proper investigations, the exact type of cancer can be known. The most common site of cancer in the oral cavity is the tongue, or sometimes the base of the tongue. Any changes or abnormality in the oral cavity should be immediately consulted with ENT specialist or experienced physician. Most of the oral cancer tends to spread rapidly.


The warning signs and symptoms of oral cancer are very important. By knowing the signs only a person can help itself to detect a cancerous tumour or ulcer in the early stage. The common symptoms are Leukoplakia (white patches) or Erythoplakia (red patches) on the soft tissue of the mouth usually painless at the initial stage. In the case of cancer on tongue, a person might develop small ulcer on the tongue in colored or dark condition that cannot be healed with general medications. Patient may feel burning sensation or pain at the advanced stages. Change in taste buds, difficulty in swallowing, uncommon sensation while taking foods or drinks are other common symptoms. Advanced stage of the ulcer or tumour may also lead to unmanageable bleeding.


The tradition of chewing Betel Nut in North Eastern states of Assam and Meghalaya is very old. Most of the people in this region like to have betel nut with the betel leaf. But many of them like the combination of Slaked lime and raw tobacco along with the betel nut and leaf which is very dangerous and contributes causing highest number of oral cancers in the region. According to a British Journal 358 male and 144 females are found to be suffering from oral cancer, just due to the habit of chewing betel nut. Even the International Agency for Research on Cancer or IARC has declared the betel nut as one of the major Carcinogen, that provide aid to cancer and it has reached to the conclusion that there are sufficient evidences that chewing of betel nut leads to cancer.


Whoever likes the habit of habit of betel nut, not surely known what the betel nut actually is? One can find plenty of betel nut trees and betel leaf cultivations in North East India. Betel nut in other language is also known as the Areca nut. It can be availed in either fresh or dry forms. The fresh form of betel nut is greenish in colour with a soft layer inside where as the colour of the dry betel nut is brownish and hard from every side. However the fresh form of betel nut is mostly preferable in the north east region of India. In local language a fresh betel nut is known as Tamol and the dry is called as Supari. Frequent and regular scratches of betel nut forms ulcers in the oral cavity. Betel nuts are served as mouth fresheners usually wrapped in betel leaf. The betel leaf is very well known as Paan in this region of India. Just like the betel nut, the betel leaf had been also found as a cancer causing agent. Although being green in colour, the betel leaf does not contain any necessary vitamins or minerals like other green leafy vegetables. Sometime the betel leaf filled with betel nut is served with slaked lime. This lime is a chemical compound that contains inorganic substances like carbonates, oxides and hydroxides. This strong chemical compound often burns the soft tissues or mucosa in the oral cavity that form scars or ulcers. In many occasions tobacco is also filled in betel nut along with betel nut and lime. This chewable tobacco causes irritation on the soft membranes in the oral cavity. This may alter the normal process of cell division. These tobaccos help to form free radicals that try to steal electrons from the molecules in the body. This way the free radicals affect the normal cells making them go abnormal and disabled. Combining betel nut, betel leaf, lime and tobacco together one can lead the way to oral cancer very fast. This combination is favorable in most of the places of Meghalaya.


Beside this the people in north east India are addicted to other sources of tobacco too. Tobacco is available on smoke or smokeless forms. The forms of tobacco in smoke forms are cigarette; cigar and pipe whereas the smokeless form of tobacco are chewable (ghutkha) and Snuff (khaini). The chewable form of tobacco, very commonly known as Ghutkha performs the same role as like betel nut, lime and raw tobacco does to cause cancer. The smoke from tobacco contains 60 known cancer causing substances where as the smokeless form of tobacco contains 28 chemicals that support a cancer. Mostly teenagers can be seen practicing the habit of tobacco in both the forms now days. In North East India, women are following the men to practice the culture of tobacco. The teenagers who are the future and the women who are the beauty and proud of the nation should not follow these ill practices. Smokeless tobacco is responsible behind causing cancer in the oral cavity more than the smoke form. In both the forms of tobacco, nicotine is present that spread through the blood stream making a person addicted to it. In chewable tobaccos, nicotine is absorbed through the lining of the mouth. Even when the tobacco is removed form the oral cavity is removed, the effect of nicotine remains there is gets mixed with the blood easily.


In many cases the use of Alcohol is also associated with the oral cancer. The person who prefers both tobacco and alcohol together develops very high risk of getting cancer including the cancer in oral cavity. Oral hygiene is also necessary to prevent the oral cancer. In remote places of the North East India, oral hygiene is not properly maintained. Regular and daily brushing of teeth, cleaning of tongue and use of mouth wash help to keep the oral cancer away. Beside this some infections like Human Pappiloma Virus Infections are also involved that supports the oral cancer. The virus exists in 120 types but type 16 is particularly known to be the risk factor and independent causative factor of oral cancer.


Alcohol is consumed almost in every part of the world. Tobaccos are smoked in every region on the globe. But along with the North east India, the betel nuts, betel leaf, lime and raw and smokeless tobacco is consumed in other countries of Indian subcontinent ( that includes India, Pakistan, Nepal, Maldives, Bhutan and Sri Lanka), Myanmar, Malaysia, Thailand etc. These countries are also developing the risk of oral cancer along with other head and neck cancers but not as like north east India.The betel nut and betel leaf has special and traditional significances in these countries. These are called by many names and are served in many forms in several occasions. As like in the North Eastern states of Assam and Meghalaya, in many other countries too, it symbolizes the mark of respect for others. The carcinogens that causes cancer in the oral cavity may also cause cancer in Larynx, pharynx, esophagus, lung (smoke from tobacco), liver (mainly alcohol), cervix (Human Pappiloma virus) etc.


At the starting stage or initial stages, when cancer is curable people don not feel the necessity to consult an expert or specialist. Due to awareness people prefers to go after the symptomatic treatments at very low costs. Sometimes due to poverty or illiteracy people in tribal belts or remote region of North East India follow the traditional, local or rural medications that cannot eliminate a cancer from the roots. Few people, mostly women take cancer as curse or the call from death. In reality cancer does not mean curse or death. It is a disease that is curable if detected on time. Negligence and irresponsibility towards this disease may take away someone's life.


The oral cancer is managed through Surgery, Radiation therapy and Chemotherapy. These are the three major treatments of cancer. In case of head and neck cancer including the oral cancer, radiation therapy is the first choice of treatment. In radiation therapy, a high dosed radiation id given on the affected part to kill the cancer cell. The target behind surgery is to remove the cancerous tumour or the entire affected organ completely before spreading to other organs. In chemotherapy drugs are given orally or through veins that attacks the cancer cells. In few of the cases, all the three types of treatments go parallel to each other. After the surgery a patient requires post operative management. In case of radiation therapy or chemotherapy, a patient requires the symptomatic management of the side effects. That is why the cancer treatments are followed by Nutrition therapy and the Rehabitation. To prevent the cancer, awareness it very important. To detection the cancer, alertness is required. To stay away from the oral cancer, betel nuts, betel leaf with lime and tobacco should be avoided and oral hygiene should be maintained. To treat a cancer, necessary treatments should be followed. The best way to avoid the oral cancers is to never start chewing tobacco, betel leaf or betel nut. Prevention is better than cure. Cancer is the second most cause of death after the heart diseases. Oral cancer is only one of the 200 different types of cancer. In the year 2007 cancer claimed the life of 7.6 million people around the world. The most important point to remember is that the death at old age is inevitable but the death at young age is unacceptable.


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