Comprehensive Guide of Oral Cancer Treatment in India

Overview

Oral cancer is cancer that forms in the portion of the mouth. It may be present inside the cheeks, roof, or palate of the mouth, on the surface of the tongue, or on gums and lips.  According to studies, approximately 377,713 new cases of oral cancer are diagnosed each year worldwide. Oral Cancer Treatment cost in India ranges from USD 2789 to USD 6064. Oral cancer develops and grows through different stages giving rise to a variety of symptoms. The curability of oral cancer is around 85%.

What is Oral Cancer?

Mouth cancer or oral cancer is a broad term given for cancer that affects the insides of the mouth. This type of cancer resembles common problems of the mouth and lips like bleeding sores or white patches. However, potential cancers problem don’t go away. If treatment is not given, cancer may spread inside the mouth, throat, and other areas like the neck and head.

Oral cancer affects the mouth, along with the oropharynx. It consists of the roof of the mouth, a portion of the tongue, and the middle part of the throat which is visible through an open mouth. Cancer in these areas is called oropharyngeal cancer.

Treatment Options for Oral Cancer Treatment in India

• When surgery is done to remove the tumor– The doctor cuts away the tumor-affected area and the margin of surrounding healthy tissue to make sure there are no residual tumors. Smaller cancers may be removed by minor surgery. However, larger tumors may be treated through more extensive surgeries like the removal of a section of the jaw or a part of the tongue.
• When surgery is done for cancer that has spread to the neck– The surgeon may recommend surgeries to remove the lymph nodes and surrounding tissue in the neck to remove cancer spreading the lymph nodes in the neck or if there is an increased of this happening due to the size of the cancer. It is useful for deciding whether a patient needs additional surgeries or not.
• When surgery is done for reconstructing the mouth– A patient regains the ability to talk and eat through reconstructive surgery. In this, the doctor transplants bone, skin, or muscle from other body parts for mouth reconstruction. Dental implants may also be used to replace one’s natural teeth.

>>Radiation therapy: In this, high-energy beams like protons and X-rays are utilized to destroy cancer cells. It is either given from outside the body (external beam radiation) or through some wires and seeds that are placed in the vicinity of the cancer cells (brachytherapy). It costs USD 1814- USD 3628.

• It is commonly used after the operation but it may be used before or alone if early-stage cancer is detected. It may also be given chemotherapy to enhance its effectiveness. Radiation therapy may also help in relieving symptoms like pain. It is also recommended that the patient consults a dentist to get their teeth checked for removal of unhealthy teeth.

>>Chemotherapy: In this, certain chemicals and medicines are used to destroy cancer cells. The drugs in chemotherapy can be given alone but are often combined with radiation therapy. The side effects like vomiting, nausea, and hair loss depend on what kind of drug a patient receives. It costs USD 232- USD 722.

>>Targeted drug therapy: The specific drugs involved in this therapy alter the growth aspects of cancer cells. They can be used in combination with radiation therapy and chemotherapy.

>>Immunotherapy: It is used to fight off cancer cells through the patient’s immune system. The cancer cells have the ability to hide from the immune system and hence, are able to survive. It is usually a line of treatment for patients who do not respond well to other forms of treatment. It costs USD 1209 – USD 1814.

Diagnostics Tests for Oral Cancer in India

• Physical exam: Doctors and dentists often find oral and lip cavity cancers during regular checkups. If one shows indications of oropharyngeal or oral cancer, the doctor completes the examination by asking about one’s family history, symptoms, etc. Then the doctor will look check for lumps in the lips, neck, cheeks, and gums. People with this kind of cancer of higher chance of other neck and head areas. The doctor checks the area behind the nose, larynx, neck, and lymph nodes. It costs USD 20- USD 40.
• Endoscopy: It is a thin, flexible tube that has an attached camera and lights to it. It is inserted through the nose neck and head regions. A more rigid hollow tube is placed in the mouth to check the back of the throat. To ease the patient during the checkup, general anesthetics are given. It costs USD 120- USD 604.
• Biopsy: In this, a small amount of tissue is removed for examination. A biopsy can confirm the presence of cancer. The kind of biopsy performed depends on the location of the cancer. It costs USD 48- USD 120.
  • In fine needle aspiration biopsy (FNA), a fine needle is inserted directly in the doubtful area.
  • In oral brush biopsy, a small brush is used to gather cell samples during routine oral exams. If cancer is confirmed, a traditional biopsy is performed.
• HPV testing: It is linked to an increased risk of oropharyngeal cancer. If a person has HPV, it can help in determining the cancer stage. It costs USD 24- USD 36.
• X-ray: It is used to form images of abnormal observations in the neck or mouth. It costs USD 3 – USD 72.
• Magnetic Resonance Imaging (MRI): It uses magnetic fields to form detailed images of the body, particularly soft tissue like the base of the tongue or tonsils. It can measure the tumor size as well. A contrast medium or dye is used before the scan to form clearer images. It can be administered in liquid form in the veins or can be given as pills orally. It costs USD 18- USD 302.
• Computed tomography (CT Scan): It uses x-rays that form images from different angles. It forms a 3D image to show tumors or abnormalities, and estimate the size of the tumor. It also shows the spread of cancer in the neck and the lymph nodes. A contrast medium is given in this as well.
• Positron emission tomography (PET Scan): It is usually performed along with CT Scan. A minimal amount of radioactive sugar is injected into the patient. This radioactive substance is absorbed by the cells that utilize most of the energy. As cancer cells use maximum energy, this scan proves to be effective. Hence, this produces images of the affected area in the body. This amount of radioactive material is not dangerous. It costs USD 120- USD 423.
• Ultrasound: It utilizes sound waves to produce images of the internal organs. It can detect the spreading of cancer in the lymph nodes and the neck. It costs USD 7- USD 18.

After completion of the suggested treatment, you may be required to visit the oncologist initially every week for a couple of weeks, followed by a monthly visit to keep the condition in check and confirm treatment success. Based on the follow-up assessment and review, the oncologist may further make recommendations for the future. Each such follow-up visit may cost around $20 to $40. The cost of any complex tests or radiological assessment would be additional (USD 193 to USD 322)

Factors Affecting Oral Cancer Treatment Cost in India

• The cost of oral cancer treatment in India is affordable. The treatment itself, equipment, medicines, post-treatment cost, transportation, etc. are comparatively lower than in other countries.
• The medical professionals and staff are highly skilled, qualified, and well-experienced. The patients can consult and interact with the doctors one-on-one, and find out the best treatment plan suited to their stage and type of oral cancer.
• The hospitals have the best facilities like comfortable beds, modern operation theatres, special units for cancer care, first-class testing labs, ambulatory facilities, etc.

Stages of Oral Cancer 

• The TNM system is the most common staging system used for cancer. In this,
• T: It is the extent and size of the main tumor, also called the primary tumor.
• N: It is the lymph nodes near cancer.
• M: It refers to metastasized cancer ( spreading cancer)
• Stage 0: It is also called carcinoma in situ (CIS) and is a very early stage of cancer. It is called the pre-cancer stage. There is a presence of cancer cells but are contained in the lining of the mouth. Cancer has not spread. If not treated, the risk of developing invasive cancer increases.
• Stage 1: It is the primary stage of invasive cancer. In this, the cancer is smaller than 2cms and is 5mm or less deep. It has not spread to nearby lymph nodes, tissues, and other organs. The tumor staging is T1, N0, M0.
• Stage 2: The cancer is smaller or 2cm in size but is smaller than 4cm, and is at 5mm but not deeper than 10mm. Cancer has not spread to the other organs or the lymph nodes. The TNM staging of this stage is T2, N0, M0.
• Stage 3: It can have one of the following cases:
  • It is larger than 2cm but not more than 4cm. It is deeper than 10mm but has not spread to any body part or lymph nodes.
  • It is larger than 4cm but not deeper than 10 mm. Cancer has not spread to any body parts or lymph nodes.
  • The size of cancer can be variable but one of the lymph nodes consists of cancer cells on the same side of the neck, and the lymph node is less than 3 cm.

NOTE: The staging of cancer is T2, N0, M0 or T1,2, or 3, N1, M0

• Stage 4: It is the advanced stage of oral cancer. It is divided into 3 stages:
  • Stage 4a: Cancer has spread further into the surrounding structures. It may also spread to 1 lymph node smaller than 3cm. It can also mean that cancer has spread to either side of the neck. The node can be 3 to 6 cm in size.
  • Stage 4b: Cancer has spread to areas like the base of the skull, behind the jaw, and carotid arteries or areas of the neck. The lymph node is more significant than 6cm in size. Cancer has spread to nearby tissues. The cancer staging for this is any T, N3, M0 or T4b, any N, M0.
  • Stage 4c:  It means that cancer has spread to other organs like bones or lungs. The cancer staging for this is any T, any N, M1

Grades of Oral cancer

The grade of cancer tells us how much the cancer cell looks like a normal one. This gives an idea of how the cancer cell will behave and the kind of treatment that is to be given. There are 3 grades:

• Grade 1 or low grade- the cancer cells look like normal oral cells
• Grade 2 or intermediate grade- they look somewhat different from the normal oral cells
• Grade 3 or high grade- looks nothing like normal cells and appears abnormal.

Best Hospitals for Oral Cancer Treatment in India

>>Jaypee Hospital, Noida

Jaypee Hospital has been accredited with ISO and NABH credentials. It has a 525-bed and 150-critical care-bed facility. It has 18 modular operation theatres. It offers modern technologies like 256 Slice CT Scan, Gamma camera, Dual Head 6 Slice Spect CT, etc. Interpreter services for foreign patients.

>>Sri Ramachandra Medical Centre, Chennai

Sri Ramachandra Medical Centre has been accredited with NABH, ISO, NABL, and JCI. It consists of 800 beds that include 200 ICU beds. It has a fully functioning Blod Bank Unit. It houses specialties like cardiac sciences, oncology, transplants, gastroenterology, neurology, etc.

>>Aster Medicity, Kochi

Aster Medicity is accredited with NABH and JCI. It has a 670-bed facility. It offers technologies like Minimal Access Robotic Surgery (MARS), ORI Fusion Digital Integrated Operation Theatres, digital anesthesia facilities, etc. 24-hour Trauma and Emergency care services are available.

>>Wockhardt Hospital, Mumbai

Wockhardt Hospital is accredited by NABH credentials. It has a 350-bed capacity. It has 8 operation theatres. It has special units like cardiac sciences, gynecology, oncology, urology, orthopedics, etc. available for treating a variety of diseases. It has one of the largest Intelligent ICCA systems.

>>Max Smart Super Speciality Hospital, Delhi

Max Smart Super Speciality Hospital is accredited with NABH credentials. It has a 250-bed capacity and 12 modular operation theatres. It offers technologies like GE Lightspeed 16-slice CT scanners, Allegretto Wave Eye-Q excimer laser, Optical Coherence Tomography, etc. A unit for observation and emergency resuscitation is present as well.

Top Doctors for Oral Cancer Treatment in India

Qualification: MBBS, MS

• He has a fellowship from Rotary Cancer Hospital and AIIMS
• He is a member of IASO, ASI, IHPBA, AMASI, IAGES, ESSO, ISO, EUSOMA, and IASG associations.
• He has successfully performed procedures like colorectal cancer treatment, hemicolectomy, Whipple’s procedure, breast cancer treatment, etc.

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Qualification: MBBS, DNB

• He is a member of DMC and MCI associations
• He has successfully treated symptoms like persistent fevers, swallowing difficulty, hoarseness, changes in bowel habits, unexplained bruising, etc.
• He has published a case report on a Neuro-Endocrine Tumour of the Cervix

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Qualification: MBBS, MD, DM

• She is a member of ESMO, MASCC, ASCO, and IJSPRO
• She offers cancer treatments through biological therapies, targeted treatments, chemotherapy, and hormonal therapy.
• She has successfully treated diseases like breast cancer, ovarian cancer, meningitis, stomach cancer, etc.

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Qualification: MBBS, MD, DNB

• He is a member of ICON, ISMPO, and ESMO associations.
• He has performed commendable treatment procedures for breast cancer, pancreatic cancer, uterine cancer, cervical cancer, etc.
• He has been appointed as the editor-in-chief for the textbook Oncology, Theme Publications, Germany.

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Qualification: MBBS, MS, DNB

• He is a member of ASI, NAMS, IASO, and IASGO associations.
• He has successfully treated symptoms like headache, coughing up blood, hoarseness, chest pain, and shortness of breath.
• He provides treatment for mastectomy, Breast cancer, and larynx cancer.

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Different Types of Oral Cancer 

• Almost all types of oropharyngeal and oral cancers are squamous cell carcinomas. They primarily form in the thin and flat squamous cells that form the lining of the throat and mouth.
  • In-situ carcinomas: In this, the cancer cells are only present in the epithelial layer of the mouth (the top layer of the lining of the mouth).
  • Invasive carcinomas: The cells grow past the epithelial layer, and into the deeper layers of the oral cavity.
• HPV-related cancers: Certain HPV infections increase the chance of major squamous cell cancers called HPV-positive cancer. However, it is rarely linked to cancer in the oral cavity. This type of cancer is seen in younger people who have no previous history of alcohol or tobacco usage. These cancers are not related to HPV and have a better prognosis than squamous cell cancers (HPV-negative cancer). This is likely due to the shrinkage of cancer cells by radiation and chemotherapy.
• Verrucous carcinomas: It is a rare kind of squamous cell cancer that is often found in cheeks and gums. It is a slow-growing or low-grade cancer that seldom spreads to other body parts.

Other types of oropharynx and oral cavity cancers

• Minor salivary gland cancers: These cancers can begin to grow in the lining of the throat and mouth. There are many kinds of this cancer like adenoid cystic carcinoma, polymorphous low-grade, and polymorphous low-grade.
• Lymphomas: The base of the tongue and tonsils contain lymphoid tissue (part of the immune system), and cancer in these are called lymphomas.

Possible pre-cancerous conditions include:

• Leukoplakia– Grey or white areas that do not get removed when being scrapped.
• Erythroplakia– Red, flat, and slightly raised areas that bleed easily when scrapped.
• Erythroleukoplakia– It is a patch that contains white and red areas both.
• Dysplasia  (pre-cancer condition) is used to describe erythroplakia or leukoplakia and can be mild, moderate, or severe. This is based on how these abnormal cells look and the degree of dysplasia (help predict whether a lesion will turn cancerous).

NOTE: Most leukoplakia cases are not cancerous but some cases can be either cancerous when first observed or may turn cancerous due to changes. Erythroleukoplakia and erythroplakia are rare but are more serious. The red lesions turn out to be cancerous when checked through biopsies.

Signs and Symptoms of Oral Cancer

• A sore formed in the mouth or on the lip that is persistent
• Thickening or lump in cheek, lips, or mouth
• Mouthpain that does not go away
• A persistent sore throat or a feeling of something present in the throat
• A red or white patch on the tongue, lining of the mouth, or gums.
• Trouble while swallowing or chewing
• Pain or swelling in the jaw or trouble moving it
• Painful teeth or loosened teeth
• Numb feeling in the lip, tongue, or other areas in the mouth.
• A mass or lump in the back of the throat or the neck
• Changes in the voice
• Unexplained weight loss
• Ear pain

Causes of Oral Cancer

• Use of tobacco or alcohol: It is one of the main reasons of cancers in the head and neck. People who smoke are at a greater risk of developing this kind of cancer. Smoke from pipes, cigars, cigarettes, etc, and second-hand smoke can increase this risk as well. Even tobacco products like chew, snuff, dissolvable, spit or dip can be linked with cancers in the gums, the inner surface of the lips, and cheeks. Consumption of excessive alcohol can increase the risk.
• Betel quid and gutka: Many people in Southeast Asia chew betel quid which is the areca nut, lime, spice, and other ingredients. Many times, people mix tobacco with this. Therefore, these people have an increased risk of developing mouth cancer.
• Human Papillomavirus (HPV): It consists of more than 150 types of viruses. Some of these viruses form a growth called a wart or papilloma. HPV16 is the major virus that causes oropharyngeal cancer in the base of the tongue or the tonsils. It is also spread through sexually transmitted diseases (STDs).
• Gender: It is more likely to affect men twice as much as women. This is because men habitually smoked and consumed alcohol more in the past.
• Age: This kind of cancer takes several years to develop hence, they are not common in younger people. Most oral cancer patients are older than 55 years old.
• Ultraviolet or UV light: Lip cancers are seen more in people who have been exposed to sunlight for long hours.
• Nutrition: A diet that is low in vegetables and fruits can be linked to a high risk of developing oral cancer. Being obese or having excessive body weight can also contribute to developing oropharyngeal cancer.
• Genetic Syndromes: People with these syndromes or mutations in their genes have a very high chance of middle throat and mouth cancer.
• Dyskerarotosis congenital: In this, people have aplastic anemia, abnormal toenails, and fingernails, and rashes on the skin. There is a very high chance of developing throat and mouth cancers.
• Fanconi anemia: People affected by this syndrome have problems with blood at an early age, which may give rise to myelodysplastic syndrome and leukemia. The chance of being affected with oral cancer is also high.

Risk and Complications of Oral Cancer Treatment

Oral cancer treatment is a major surgery and comes with risks, like any other surgery. Many risks are minor and manageable but few are severe and require immediate treatment. These include:

• Accumulation of blood clots (risk of blockage or pulmonary embolism)
• Bleeding from the site of the wound
• Infections
• Numbness
• Swelling in the surgery area
• Lymphoedema (buildup of lymph fluid in the treated area)
• Shortness of breath
• Coughing up blood
• Redness around the wound
• Difficulty in swallowing
• Changes in the voice

Survival Rate of Oral Cancer in India

A 5 year survival rate can be observed in approximately 60% of the cases in India. The statistics have risen from 70% to 90% with early detection in stage 1 and stage 2 oral cancer.

How Can You Detect Oral Cancer at Home?

There are easy ways to check oneself at home for signs of oral cancer. A thorough examination of the neck and throat can be carried out. For this, the hands should be clean, a good source of light, and have a mirror.

• Face: One should look at the entire face for swellings. Inspect the skin for new moles or if old moles are growing in size. Turning the head from side to side to make it easier to check for lumps.
• Neck: One can check the neck by running the fingers under the jaw and feeling the large muscle on either side of the neck for swellings.
• Lips: Using the thumb, index, and middle fingers, one can feel the inside of the mouth. By pulling the lower lip downwards and upper lip upwards for any changes in color or sores. Using the index finger and thumb, one should check inside and around the lips for any bumps, changes in texture, and lumps.
• Gums: By using the thumb and index finger, one should check the outside and insides of the gum throughout.
• Cheek: One should open their mouth and pull away their cheeks to check for any white or red patches. By using their fingers, any lumps, ulcers, and tenderness can be checked.
• Tongue: By gently pulling the tongue to each side, upwards, and downwards, one can check for lumps, swellings, ulcers, or color changes.
• The roof of the mouth: One should tilt their head back and open their mouth wide enough to check the roof of the mouth. If there are any abnormalities, it should heal within 3 weeks. If not, one should visit the dentist.

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Frequently Asked Questions