‘Tumour depth matters more than its size’

In oral cancer, tumour depth matters more than its size. Over the past 30 years, staging of oral cancer was done by the size of the tumour. But the new staging system for head and neck cancer that will be effective from January 1, 2018, will include the depth of invasion.

"This is an exciting time to understand the diagnosis, staging and to find appropriate treatment for oral cancer. Now, we have evidence that shows that the cure for cancer is dependent on how deep the tumour is growing, which might be more important than how big the tumour is on the surface," said Dr Terry Day, director, division of head & neck oncology, Medical University of South Carolina, US.

He said the depth of invasion could sometimes predict how aggressive the cancer would be and predict whether it is spread to the lymph nodes or the blood stream.

"The most important change in oral cancer is how deep the cancer has grown into the tissues," said Dr Day.

India has the most cases of oral cancer per capita. And there are rising incidents in the US and other countries in younger people who don't use tobacco.

In Kochi to speak at continuing medical education on "comprehensive management of head and neck tumours" at Aster Medcity, Dr Day was impressed with the personalized care of patients given by the hospital and said the technology available in the hospitals here is same as in the US.

Dr Day said that the new guidelines on oral cancer show that surgery is the best treatment option.

"In the past, chemotherapy and radiation therapy was best but that is not true anymore. Chemotherapy alone has not cured any oral cancer. If the cancer has spread through the body and if someone is dying of oral cancer and there is no other treatment remaining then immunotherapy is the best option. It doesn't cure cancer but it can keep people alive longer without any side effects of chemotherapy," he said.
However, he admitted that if the patient has cash and don't have insurance coverage it is very difficult to afford.

"Immunotherapy is very expensive and that is true around the world. Until you have some insurance or health coverage through companies or government, it is going to be difficult for one individual to afford. It does have fewer side effects and mostly extends life on an average by one year. I have number of patients with immunotherapy and they have a quality of life. Tumour doesn't go away but it slows the growth and seems to reduce the symptoms," he said.

The main concern in European countries, US and India for oncologists is the rising incidence of oropharyngeal cancer due to HPV virus.

Laying emphasis on early detection to fight cancer, he said that any patch that is red or white and lasts two weeks or longer should be evaluated and should do a biopsy.



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