Dr Vikram D Kekatpure, Senior Consultant-Head & Neck Surgical Oncology, Cytecare Cancer Hospitals, Bengaluru, in conversation with ETHealthworld discusses the oral cancer burden in India and how it can be mitigated. Edited excerpts:
What makes oral cancer so alarming in India?
Oral cancer is a problem of our country, it constitutes about 30 percent of all cancers in our country compared to the western world where it constitutes 2-3 percent in the most developed world. It is our problem and we need to find solutions which are India centric because western world is not going to find a solution and we have moved towards that direction to find Indian centric solutions. This is a lifestyle related problem, 40-50 percent of our population uses some or other form of tobacco mainly chewing but smoking is fast catching up.
A lot need to be done in the field of tobacco prevention and awareness. About 80 percent of cancer patients come in advanced stages like stage 3 or stage 4 where the prognosis remains poor and that is where a community, society, governmental organisations can do a lot to downstage the tumours so that the survival improves, the functional aspects improve and the cost of treatment also comes down.
What strategies have been adopted to combat it?
The society as well as the government has a role to play in creating awareness, so if you see the average age of initiation in our country, it still remains around 16 and that is where we need to target our school and colleges and create tobacco awareness. Our government has done a bit by having warnings on the cigarette packets and pouches but I think there is a lot of scope for improvement on tobacco awareness and banning tobacco.
In our country oral cancer presents in advanced stages which needs a multidisciplinary management and I think that is where Cytecare is going to be different in a way that all our patients go through a tumour board which consists of not only the key specialities like radiation medical and surgical oncology but it is supported by radiology, pathology where the key treatment decisions can be influenced.
Besides medical professionals, I think there is a great role of social workers as well as counsellor so that a comprehensive treatment can be delivered. Most cancer patients are anxious about treatment, they have small day to day issues which they find difficult to discuss with medical professionals and that is where the role of counsellors and social workers comes in. So the core competence of delivery of cancer treatment, the supportive and the rehabilitative aspects also gets equal importance.
What are the challenges that still exist?
Oral cancer affects the basic human functions which are essential for survival like speech, swallowing, breathing and most importantly the cosmetic aspects, so patients and family is worried how a person will go back to the community after treatment. There has been a major problem why people end up in a denial mode for treatment.
People think that they will be functionally and cosmetically debilitated for life but that is a thing of past. Today if the people have a tumour which requires removal of the jaw then we have ability to replace the jaw, if dentition has to be removed then we have the ability to replace the dentition.
The aim should be that the patient going for a head and neck cancer surgery should come out of the treatment with no or very minimal functional deficits. The patient should be ready to go back to society, go back to his job and support the family.
What are the latest advancements in the management of head and neck cancer?
The technology has really come to help us in the way we manage head and neck cancer patients. Now we have ability of planning reconstruction based model. We can generate exactly a model of the defect and plan our reconstruction and surgery way before the patient goes for a surgery. So the final outcome is based on the technology in a way that we can rehabilitate and give functional reconstruction to a patient.
This technology has helped us in better reconstruction and the recent advances in molecular biology now help us to diagnose our patient’s early detection prognostics. So the overall counselling has become much easier, now we can based on the genetic testing biomarkers, prognosticate much better. The field in moving in the direction that in a few years time we would be able to tell based on blood test or urine test, prognosticate patients and tell them how they are going to behave in regard to their oral cancer.
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