oral cancer

1. Dr Suwas
Darvekar
Sangeeta Darvekar Charitable Trust ,
a registered trust with registration
no E/3092/Thane dated 30/4/03
presents an awareness program on
Oral Cancer and named it
Oral Cancer Awareness.org

2. Dr Suwas
Darvekar
As a social obligation we started a charitable
organization namely Sangeeta Darvekar
Charitable Trust and as a dentist I used to see
a lot of patients with complications arising
out of habits like gutka eating, keeping
tobacco Quid in mouth and smoking. So we
thought of this awareness campaign.

3. Dr Suwas
Darvekar
So we started an Awareness program and called it
“Oral cancer awareness.org”
as we have a website with the same name.
Dr Suwas Darvekar is the force behind this
campaign.
He is helped by Mr. Vincent Nazareth of
‘Crusade Against Tobacco’

4. Dr Suwas
Darvekar
This program won’t have been possible
without the help from TATA
MEMORIAL HOSPITAL.

5. Dr Suwas
Darvekar
Oral cancer is the most common cancer
in India and according to Dr Geoff Craig
“People are dying of oral cancer because
of ignorance”.

6. Dr Suwas
Darvekar
So Sangeeta Darvekar
Charitable Trust thought of a
mass awareness program
about oral cancer, its causes,
its treatment and resultant
problems and the way of
preventing this cancer.

7. Dr Suwas
Darvekar
So we approached Dr Surendra Shastri head of
preventive oncology at TATA MEMORIAL HOSPITAL and
he gave us a stunning information that ”There are
about 7,00,000 new cases of cancers diagnosed
every year in India out of which tobacco related
cancers are about 3,00,000, cancer of uteri are
1,00,000 and 80,000 breast cancer. Cost of
treatment of oral cancer is about 3.5 lakh. This
can be completely prevented by simple changes in
lifestyle and regular screening and even have
health benefits that reach beyond cancer. About
2000 deaths a day in India is tobacco related.”

8. Dr Suwas
Darvekar
On receiving this stunning news we thought
of enquiring for the reason of such high
incidence of oral cancer. We found that
the reason for such high prevalence of
oral cancer in India was primarily because
of the most common form of tobacco
consumption is keeping the tobacco in
mouth. Be it in the form of Gutka,tobacco
Quid and Mava,betel leaf with
tobacco(Pan), snuff or misri and so on.

9. Dr Suwas
Darvekar
Tobacco when kept in mouth
leaches out carcinogens, which
act on oral mucosa causing
neoplastic changes. Habit of
smoking is also equally
dangerous.

10. Dr Suwas
Darvekar
Tobacco contains potent carcinogens
including Nitrosamines (nicotine),
polycyclic aromatic hydrocarbons,
Nitrosodiethanolamine,
Nitrosoproline, and polonium.
Tobacco smoke contains carbon
monoxide, Thiocyanate, hydrogen
cyanide, nicotine and metabolites of
these constituents.

11. Dr Suwas
Darvekar
Tobacco in India most commonly
consumed in the form of gutka, quid
pan or smoking in the form of bidi
of cigarette.

12. Dr Suwas
Darvekar
Gutka is a flavored tobacco
mixture with betel nut lime, and
harmful additives like magnesium
carbonate. It is extremely
addictive and is apparently
targeted at youngsters.
Quid is the mixture of tobacco
and lime and extensively
consumed in India.

13. Dr Suwas
Darvekar

14. Dr Suwas
Darvekar
According to the B.B.C ‘4 in 10 of all
cancers in India are oral cancers’.
And this because of extensive use of
tobacco and betel quid.

15. Dr Suwas
Darvekar
Precancerous lesions
There are three most common precancerous lesions seen in the mouth and they
are
1. Oral leucoplakia
It is characterized by white patch on
the buccal mucosa or any place in the
mouth and is adjacent to the place
where the tobacco quid is kept. The
less likely place is floor of the mouth
and tongue although 93% of leucoplakia
at this sites turn malignant.

16. Dr Suwas
Darvekar
ORAL LEUCOPLAKIA PATCH

17. Dr Suwas
Darvekar

18. Dr Suwas
Darvekar
2. Erythroplakia
This is characterized by red velvety patch
which is not associated with any trauma
or inflammation. It may present with or
without leucoplakia. This lesion is easily
missed out but is considered to have
great malignancy potential.

19. Dr Suwas
Darvekar
Erythroplakia

20. Dr Suwas
Darvekar
3.Oral sub mucous fibrosis.
This condition is characterized by
limited opening of mouth and burning
sensation on eating of spicy food.
This is a progressive lesion in
which the opening of the mouth
becomes progressively limited, and
later on even normal eating becomes
difficult.
It occurs almost exclusively in
Indians and Indian communities
living abroad.

21. Dr Suwas
Darvekar
Oral Sub Mucous Fibrosis

22. Dr Suwas
Darvekar
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

23. Dr Suwas
Darvekar
Smf is equally common in gutka eating ladies

24. Dr Suwas
Darvekar

25. Dr Suwas
Darvekar
Professor Newell Johnson an
expert oral surgeon said, ”we
know this condition, oral sub
mucous fibrosis has highest
rate of transferring to
malignancy of any of the so
called pre-malignant lesions
in the mouth. It is a very
serious condition.”

26. Dr Suwas
Darvekar
The next stage after the
precancerous lesion is the
Cancerous lesions.

27. Dr Suwas
Darvekar
The most common form of cancer is
Squamous cell carcinoma.

28. Dr Suwas
Darvekar
It normally starts from any of the
precancerous lesion in the mouth.

29. Dr Suwas
Darvekar
Common sites of oral cancer
The most common sites of the oral
cancer is the tongue and the floor of the
mouth. The other common sites are
buccal vestibule, buccal mucosa, gingiva
and rarely hard and soft palate. Cancer
of bucco-pharyngeal mucosa is common
in smokers.

30. Dr Suwas
Darvekar
Diagnosis
Initially oral cancer may be asymptomatic but a check up of a
small ulcerative lesion from a professional is recommended.
But patients normally presents when pain and discomfort is
predominant and then the prognosis becomes poor.
Diagnosis is established by many ways like applying dyes
like toluidine blue which may give false positive results in
inflammatory lesion but never false negative, using X rays
and scans to see the extension of the lesion and the bony
involvement and the most confirmatory test is biopsy of the
lesion and its histo-pathological examination

31. Dr Suwas
Darvekar
It may start as a small ulcer, usually on the lateral
border of the anterior two third of the tongue. It may
have varied presentation like a small papillary exophytic
lesion, a flat nodule, ulceration within a pre existing
fissure or may occur in the absence of frank ulceration in
an atrophic tongue. Once ulceration has occurred, the
lesion becomes painful, making speech and swallowing
difficult. Tongue cancer rapidly extends to involve the
floor of the mouth and lower alveolus, which makes
treatment difficult.
Carcinoma of the Tongue

32. Dr Suwas
Darvekar
Cancer of Tongue following tobacco consumption

33. Dr Suwas
Darvekar
Cancer of Tongue

34. Dr Suwas
Darvekar

35. Dr Suwas
Darvekar

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Darvekar

37. Dr Suwas
Darvekar
The lesion is usually painless in early stages and only
when it becomes ulcerated and secondarily infected or
invades adjacent nerve, pain is the noticeable feature.
The tumor is usually at the level of the occlusal plane or
below it. They may be proliferative warty exophytic growth
with little fixation or deeply ulcerative invasive lesion.
The proliferative lesion though it looks dangerous is
easily treatable and long-term prognosis is good as the
metastasis to the local lymph nodes is relatively late.
Whereas the ulcerative lesion is not so easily noticeable
in the early stages but is more dangerous because of their
invasive nature and the metastasis to the local lymph
nodes is very early
Cancer of Gingiva and Buccal mucosa

38. Dr Suwas
Darvekar
CANCER LESION COMING OUTSIDE
THE MOUTH
Cancer Of Cheek after tobacco quid habit

39. Dr Suwas
Darvekar
SAME PATIENT WITH THE CANCER LESION COMING EXTRA
ORALLY

40. Dr Suwas
Darvekar
Cancer of buccal mucosa after tobacco habit going
extra-orally

41. Dr Suwas
Darvekar
CANCER STARTING FROM BUCCAL VESTIBULE
FOLLOWING HABIT OF PAN WITH TOBACCO

42. Dr Suwas
Darvekar
Cancer of Buccal mucosa invading extra-oral tissues
following tobacco quid habit

43. Dr Suwas
Darvekar
Cancer of labial mucosa invading extra-oral tissues
following tobacco quid habit

44. Dr Suwas
Darvekar
CANCER OF CHEEK FOLLOWING EATING OF GUTKA

45. Dr Suwas
Darvekar
Cancer of labial mucosa after tobacco quid habit

46. Dr Suwas
Darvekar
Same patient with Cancer Of Gums

47. Dr Suwas
Darvekar
CANCER OF GUMS FOLLOWING EATING OF GUTKA

48. Dr Suwas
Darvekar
Carcinoma of the lip usually starts at the vermilion border of
the lower lip. 95% of lip cancer affects the lower lip. It is in
the form of a nodule, which ulcerates and forms a small scab,
which fail to heal completely. It is often misdiagnosed as a cold
sore. Eventually the margins of the lesions become proliferative
and an extensive exophytic lesion with central ulceration
develops.
Carcinoma of the lip

49. Dr Suwas
Darvekar
CANCER OF LOWER LIP

50. Dr Suwas
Darvekar
Cancer of palate
It is usually an ulcerative lesion and may spread
extensively before involving underlying bone.

51. Dr Suwas
Darvekar
Cancer of Palate after habit of smoking

52. Dr Suwas
Darvekar
Cancer of Palate after habit of smoking

53. Dr Suwas
Darvekar
CANCER OF MAXILA AFTER SMOKING HABIT

54. Dr Suwas
Darvekar
CANCER OF PALATE

55. Dr Suwas
Darvekar
Alveolar carcinoma is common in mandible that
maxilla. The lesion is warty nodular and
proliferative, although it may rarely present as
erosive lesion. Unfortunately it mimics apical or
periodontal disease and their diagnosis is often
delayed. Often the neoplastic nature is
recognized when socket fails to heal following
dental extraction for a supposedly periodontal
abscess.
Alveolar carcinoma

56. Dr Suwas
Darvekar
Alveolar cancer after tobacco quid habit

57. Dr Suwas
Darvekar
Alveolar cancer after tobacco quid habit

58. Dr Suwas
Darvekar
Relapse case
He was operated for cancer of lower jaw in oct
‘00

59. Dr Suwas
Darvekar
Relapsed cancer in upper jaw in July 04

60. Dr Suwas
Darvekar
This cancer is extremely malignant and even if
there is slight delay it spreads to lymph nodes
of the neck. Once it spreads the prognosis
becomes poor and death is inevitable and is
because of erosion of major blood vessels and
erosion of the base of the skull, Cachexia and
secondary infection of the respiratory tract.

61. Dr Suwas
Darvekar
The American joint committee on cancer has developed the Tumor (T), Node
(N), and Metastasis (M) system of cancer classification. The TNM
classification is basically a clinical description of the disease, but
can also involve imaging in classification. T is the size of the tumor
and T1 is <2 cm, T2 is >2 but < 4 cm, T3 is >4 cm and T4 is >4 cm with
invasion of adjacent structures.
N0 is no lymph node
N1 is single ipsilateral node < 3 cm
N2a single ipsilateral node > 3 cm but < 6 cm
N2b multiple ipsilateral node < 6 cm.
N2c bilateral or contra lateral nodes < 6 cm
N3a ipsilateral node > 6 cm
N3b bilateral nodes > 6 cm
M0 is no metastasis and M1 is metastasis present.
Staging
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0; any T1 T2 T3, N1 M0
Stage IV T4 ANY N, M0; any T, N2 or N3; ANY T OR N WITH M1
Cancer classification and Staging

62. Dr Suwas
Darvekar
Treatment available
Treatment is surgery, and in advanced cases surgery followed by
radiation therapy is performed. But even that is not always
successful as more than 70% of the cases after treatment leads to
relapse and the result is death.

63. Dr Suwas
Darvekar
The treatment is successful only if the lesion is
diagnosed early, but sadly many times, it is ignored
and the patient reports when the lesion has spread so
much that the treatment is impossible or even if done
the long term prognosis is poor.

64. Dr Suwas
Darvekar
The cost of the treatment is 3.5 lakh and in spite of
this cost there is no guarantee of sure cure.

65. Dr Suwas
Darvekar
Differences in genetics have not been identified
in relation to risk and survival.

66. Dr Suwas
Darvekar
Commando operation is resection of half of the mandible with floor
of the mouth and block desection of the neck to remove the entire
lymphatic drainage of the neck together with sterno-cleido mastoid
muscle and internal jugular vein.
In the following photographs you will see what a commando
operation looks like.

67. Dr Suwas
Darvekar
This is a patient who has undergone a commando
operation for oral cancer

68. Dr Suwas
Darvekar
INTRA ORAL VIEW OF POST SURGICAL
PATIENT

69. Dr Suwas
Darvekar
EXTRA ORAL VIEW OF THE SAME PATIENT

70. Dr Suwas
Darvekar
This is a patient who has undergone a commando
operation for oral cancer

71. Dr Suwas
Darvekar
This is a patient who has undergone an operation of his
palate, nose and right eye for cancer of palate extending to
nose and right eye.

72. Dr Suwas
Darvekar
This is a patient who has undergone a commando
operation for oral cancer

73. Dr Suwas
Darvekar
This is a patient who
has undergone a
commando operation
for oral cancer. Because
of the operation he has
lost control on his left
side of the mouth and
hence saliva is seen
drooling from left side
of the mouth.

74. Dr Suwas
Darvekar
Frequently Asked Question
1.How do I prevent oral cancer ?
2.Why is that not all people consuming tobacco have oral cancer ?
3.Who is more susceptible to oral cancer ?
4.I have a precancerous lesion in my mouth, would I get cancer ?
5.How is the diagnosis established ?
6.What is the treatment available ?
7.what is the approximate cost ?
8.I Occasionally chew tobacco/smoke, and keep tobacco only for very short tim
9.My friend has been told that he has oral cancer, but he does not believe it. wh
10.My dentist has recommended the biopsy of the premalignant lesion. What sh
11.I have oral cancer and I am taking ayurvedic medicine. Will that help?
12.My Friend had cancer after tooth extraction. Was the doctor negligent?

75. Dr Suwas
Darvekar
How do I prevent oral cancer ?
Stopping all the habits of tobacco consumption. Stopping means complete stop
to the habit. Reducing the consumption of tobacco does not reduce your risk of
cancer. But stopping certainly reduces the risk.
Is tobacco the only cause of oral cancer ?
Tobacco is the major cause of oral cancer but certainly not the only cause. Their
are other causes like poor oral hygiene, chronic trauma from sharp tooth or an ill
fitting dentures. Their are other agents like some viruses which are thought to
cause or expedite the effect of tobacco in causing oral cancer.
Why is that not all people consuming tobacco have oral cancer ?
Their are many factors like genetic make of the person, his diet and many
unknown factors that increases or decreases the susceptibility of person of
having oral cancer. But one thing is certain that tobacco consumption increases
your susceptibility by almost 8 times. That means a person consuming tobacco is
more prone to have oral cancer or other tobacco related problems.
Who is more susceptible to oral cancer ?
Anybody consuming tobacco is susceptible to oral cancer. Differences in genetics
have not been identified in relation to risk and survival. That means a Caucasian
or a mongoloid, Black race all are equally prone to oral cancer if they consume
tobacco.

76. Dr Suwas
Darvekar
I have a precancerous lesion in my mouth, would I get cancer ?
It depends on whether you continue your habit or not. If you stop your habit then
your chances of getting oral cancer decreases drastically. But it is always better
to get your precancerous lesion checked by a Dentist. He will suggest you the
best thing for you and may be he will take a biopsy sample of the lesion for histo-
pathological check up. Or he may apply some specific Dyes to the lesion so that
check its neoplastic potential.
How is the diagnosis established ?
Diagnosis is established by many ways like applying dyes like Toluidine blue
which may give false positive results in inflammatory lesion but never false
negative, using X rays and scans to see the extension of the lesion and the bony
involvement and the most confirmatory test is biopsy of the lesion and its histo-
pathological examination
What is the treatment available ?
Treatment is surgery, and in advanced cases surgery followed by radiation
therapy is done. But even that is not always successful as 70% of the cases after
treatment leads to relapse and the result is death. The treatment is successful
only if the lesion is diagnosed early, but sadly many times, it is ignored and the
patient reports when the lesion has spread so much that the treatment is
impossible or even if done the long term prognosis is poor

77. Dr Suwas
Darvekar
What is the approximate cost ?
Cost involved is approximately Rs 350,000/- . The cost may vary because of many
things like the extent of the lesion, any metastasis and many other factors.
I Occasionally chew tobacco/smoke, and keep tobacco only for very short time.
Am I susceptible for cancer ?
Tobacco has many chemicals which can cause cancer and lower intake doesn't
mean less susceptibility. If a person is genetically more predisposed then even
little consumption can trigger malignancy.
My friend has been told that he has oral cancer, but he does not believe it. what to
do?
Cancer is very well treated with fewer complication in early stages. So if a doctor
has said that your friend has cancer than don't neglect it. If you don't believe get it
checked from an authority. Remember time is an essence here. Even if their is
slight delay the prognosis rapidly goes from good to bad to worse.
My dentist has recommended the biopsy of the premalignant lesion. What should I
do?
Biopsy is the only confirmatory test of whether you have oral cancer or not. If
your Dentist has recommended a biopsy he has given you the right advise. Go
ahead and do it at once without any delay.

78. Dr Suwas
Darvekar
I have oral cancer and I am taking ayurvedic medicine. Will that help?
I am not an authority on ayurvedic medicine. But it has been generally noted that
ayurvedic medicines don't work once you have oral cancer and you have to
undergo surgery. So don't wait, get the surgery done at once. May be if the lesion
has not progressed you will have a excellent prognosis.
My Friend had cancer after tooth extraction. Was the doctor negligent?
No! You can never have oral cancer with any dental procedure performed by your
Dentist. The predominant sign of alveolar and gingival carcinoma is mobile
tooth/teeth, and only after extraction when the socket doesn't heal and their is
some growth, you find out that the tooth/teeth were mobile because of cancer.
This is a case of misdiagnosis and not wrong treatment. This type of diagnosis
can be missed even by the best of Dentist. Usually such cases give a history of
tobacco consumption.

79. Dr Suwas
Darvekar
So friends if you want to save
money, lead a healthy life style
don’t want to suffer from cancer and
its associated problems, stay away
from tobacco in any form be it
Gutka, tobacco Quid,pan,snuff,Mava
Misri, Smoking and so on.

80. Dr Suwas
Darvekar
Wish you a healthy life
without tobacco and oral
cancer.

81. Dr Suwas
Darvekar
This is Dr Suwas Darvekar who has been the force
behind this awareness campaign.

82. Dr Suwas
Darvekar
This presentation can be freely copied and shown
without alteration to your friends, relatives and
any audience. An awareness campaign is not
possible with few individuals so we want maximum
people to cooperate in this effort as this is one
cancer which is completely preventable.
Any one who needs a CD of this presentation can
obtain by sending Rs 50/- only or copy it free of
cost from www.oralcancerawareness.org
Please remember no alteration is permissible in
this presentation as it would lead to copyright
infringement and therefore a punishable offence.

83. Dr Suwas
Darvekar
We want to convert this presentation into a Video and plan
to add the interviews of leading doctors on oral cancer
and interviews of the patients as to how they got this
cancer. All the written matter in this presentation will be
converted into dialogues with a professional Voice. The
whole presentation will then be converted into a VCD of
leading local languages initially and later on in all the
vernacular languages and will be circulated throughout
India and possibly world over. This requires strong
financial capabilities which we are lacking. Therefore we
request all the like minded peoples and organizations to
help us for this noble cause.

84. Dr Suwas
Darvekar
You can contact us at
Sangeeta Darvekar Charitable Trust
602/A, Sealand Tower, Jesal Park, Bhayandar
East, Dist Thane 401105
Phones: 28149233, 28162440, 9869368937
Email: sndarvekar@rediffmail.com
Website: www.oralcancerawareness.org

85. Dr Suwas
Darvekar
Contributed by Dr Suwas Darvekar.
Copyright © 2003 [Sangeeta Darvekar Charitable Trust]. All rights reserved.
Revised:July 19, 2014