Tobacco kills! Oral cancer screening

Dr Madhu Oswal Thakkar

Muktaa Charitable Foundation

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Ramesh, 35 years , plumber, breadwinner, only son of his old mother.Eating Khaini since he was 12 yearsDied after fighting cancer for 2 years

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How will I live now?

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•Renu , 30 years old, mother of 3 teenagers, housemaid.•Eating mishri since childhood•Non healing ulcer in mouth•When she presented at TMH, case was inoperable•Died within 3 months of diagnosis

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Who will look after these innocents?

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•Vinod, farmer from Nagar, worked day and night to see his sister get married•Ate 15 pouches of “Manikchand” everyday •Today he can have just liquid.•Condition is untreatable

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Tobacco truly kills Tobacco kills 900,000 people every year

In india one people die every 40 seconds because of tobacco related problems

By 2020, 12 lakh people are estimated to die every year due to tobacco use

Tobacco users loose an average of 20-25 years of non-tobacco life expectancy

Out of 100 teenage smokers in India today, 50 out of them will eventually die of tobacco- related disease.

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Tobacco Use In India India is the third largest producer and consumer of tobacco

in the world. 275million active tobacco users in India. i. e 35% of

Indians consume some form of tobacco

Smokeless tobacco use in India is the highest in the world.

25.9 percent of the adults( 32.9 percent of men and 18.4 percent women) use smokeless tobacco.

Among smoking forms of tobacco, bidis are the most prevalent form (9.2 percent) followed by cigarettes (5.7 percent).

Exposure to second-hand smoke remains high with 52.3 percent and 29.0 percent of the population exposed to second-hand smoke at home and at public places (mainly in public transport and restaurants) respectively.

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Misleading Advertising

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14 MINUTES OF LIFE IS LOST FOR EACH CIGARETTE SMOKED

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Hazards of Tobacco 1. Chronic bronchitis

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2.2. EmphysemaEmphysema

3.3. CardiovascularCardiovascular diseasedisease

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4. Lung and other 4. Lung and other

cancerscancers

5. Tuberculosis5. Tuberculosis

6. Increases the risk of 6. Increases the risk of heart strokeheart stroke

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8. Babies born with lower birth weight from 8. Babies born with lower birth weight from habitual smoker parent (s).habitual smoker parent (s).

7. Increasing vulnerability of sexual and 7. Increasing vulnerability of sexual and reproductive healthreproductive health

10. Blood pressure, exacerbates 10. Blood pressure, exacerbates asthma and causes impotence, asthma and causes impotence, infertilityinfertility

9. Kidney and liver 9. Kidney and liver diseasesdiseases..

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Pregnancy & Secondhand Smoke

Pregnant women exposed to ETS 6 hours a day pass carcinogens to the blood of unborn

ETS for 2 hours a day causes 2 times risk of low birth weight

Miscarriage

Prematurity

Low birth weight

Sudden Infant Death Syndrome (SIDS)

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Tobacco and Oral Cancer India has the highest number of oral cancer cases in the

world

Of 7-8 lakh registered cancer cases every year, 40% are of oral cancer

Annually 130,000 people succumb to oral cancer in India1

60 to 80 % present in advanced stage

14 deaths per hour

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How will the patient present?

Leukoplakia, Erythroleukoplakia or ErythroplakiaDifficulty in opening mouthNon healing ulcer or noduleBleeding in the mouth.Loose teethDysphagiaDifficulty wearing dentures.Lump in the neck.EaracheHoarseness

Most are asymptomatic

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LeukoplakiaWhite painless, bright white and sharply

defined, slightly raised plaqueCannot be scrapedMalignant transformation: 3-33% over 10

yearsSpeckled or verrucous leukoplakias are more

likely to be premalignantClinical, not histological

Leukoplakia :3 Stages Stage 1: Nonpalpable, translucent whiteStage 2 : Localized or diffuse, slightly

elevated plaques, irregular outline, opaque white ,fine, granular texture.

Stage 3: Thickened, white lesions, showing induration, fissuring, and ulcer formation.

Leukoplakia: When to worry?Verrucous leukoplakiaErosion or ulceration within the lesionNodule in lesionHard in its peripheryAnterior floor of the mouth and undersurface

of the tongue

•Asymptomatic red, smooth, soft, velvety texture macule/s or patch/s

•In level with or depressed below the surrounding mucosa.

•Less than 1.5 cm well-demarcated

•Floor of mouth, tongue and palate

•High chance of frank malignancy or severe dysplasia.

Erythroplakia

Erythroleukoplakia

Erythroplakia

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Oral Sub Mucous Fibrosis

Areca nut (Arecoline, copper): Incresae production of collagen

? ChilliGenetic factorDeficiencies of Iron, B complexProgress : UnpredictableNo treatment

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This patient of SMF has so much of limitation in opening of mouth that it is difficult to put even 2 fingers in the

mouth

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Diffential Diagnosis

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Common sites of oral cancerTongue –middle of lateral 1/3 rd Floor of the mouth Buccal vestibule and mucosaGingiva, hard and soft palate Bucco-pharyngeal mucosa in smokers.

You tube: http://www.youtube.com/watch?v=q-W_RqQmnlk (Uni of Michigan School of Dentistry)

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Cancer of Tongue

90% SCC

Dr Suwas Darvekar

Cancer of Tongue

90% SCC

Dr Suwas Darvekar

Common sites of oral cancerTongue –middle of lateral 1/3 rd Floor of the mouth Buccal vestibule and mucosaGingiva, hard and soft palate Bucco-pharyngeal mucosa in smokers.

You tube: http://www.youtube.com/watch?v=q-W_RqQmnlk (Uni of Michigan School of Dentistry)

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Steps to quit-tobacco 1. Deep Breathing

2. Drink lots of water and fluids

3. Stay away from alcohol, sugar and coffee and

avoid fatty foods

4. After dinner, instead of a cigarette, treat yourself to a cup of mint tea or a peppermint candy

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5. Go to a gym and jog around the block or 5. Go to a gym and jog around the block or parkpark for to change your normal routine.for to change your normal routine.

6. Ask friends and family members not to 6. Ask friends and family members not to smokesmoke in your presence.in your presence.

7. On your quit day, hide all ashtrays and 7. On your quit day, hide all ashtrays and destroydestroy all your cigarettes.all your cigarettes.

8. Write down ten good and bad things 8. Write down ten good and bad things about beingabout being a nonsmoker and smoker.a nonsmoker and smoker.

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Children & Secondhand Smoke

Coughing and wheezing

Asthma

Ear infection

Sore throats and colds

Eye irritation

Hoarseness 4804/08/23 48www.mcf.org.in

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Acknowledgement

Many clinical slides from Dr Pankaj Chaturvedi’s slide-set

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