Oral cancer in Pakistan: the warning signs everyone should know

Oral cancer is the second most common cancer in Pakistan and the most common in men in Karachi. The reason is not a mystery: paan, gutka, chalia (areca nut), naswar and tobacco, often used together and often from a young age. The tragedy is that oral cancer is visible. It sits in a part of the body you look at every day, and yet the majority of cases are diagnosed late, when treatment means major surgery and survival is poor. Diagnosed early, cure rates exceed 80 per cent.

Warning signs

• An ulcer or sore anywhere in the mouth that has not healed after two weeks.
• A white patch (leukoplakia) or red patch (erythroplakia) on the tongue, cheek, gum or floor of the mouth. Red and mixed red-white patches carry the highest risk.
• A lump or thickening in the cheek, tongue or neck.
• Progressive difficulty opening the mouth, a burning sensation with spicy food and a pale, stiff lining of the cheeks. This is oral submucous fibrosis, a pre-cancerous condition caused by areca nut, and it is extremely common in gutka users.
• Numbness of the lip, chin or tongue without injury.
• Loose teeth with no gum disease to explain them.
• Persistent hoarseness, difficulty swallowing or a sensation of something stuck in the throat.
• Bleeding from the mouth without an obvious cause.

Who should be screened

Anyone who uses or has used paan, gutka, chalia, naswar, cigarettes or shisha should have a full mouth examination at least once a year. Heavy alcohol use adds to the risk. So does a previous oral cancer, a family history, or long-standing sharp teeth and ill-fitting dentures rubbing the same spot. The examination takes ten minutes: the surgeon looks at and feels every surface of the mouth, the tongue underside, the floor of the mouth and the neck.

What happens if something is found

A suspicious area is biopsied under local anaesthesia. A small piece of tissue, a couple of stitches, results within a week. Most biopsies come back benign or pre-cancerous, and pre-cancerous lesions can be removed or monitored before they ever become cancer. If cancer is confirmed, staging scans follow and a multidisciplinary plan is made with surgical, radiation and medical oncology input. Dr Zaki Mehdi manages oral cancer as part of his hospital practice and has published on the factors that lead to earlier diagnosis.

Do not wait

The single most common reason for late diagnosis is that the patient waited: for the ulcer to heal, for the patch to go away, for a convenient time. If you have any of the signs above, or you use any of the products above and have never had your mouth examined, book a screening. It is the most valuable ten minutes we offer.