Oral Cancer: जब मुँह में छुपा होता है ख़ामोश क़त्ल By Mr. Doctor

What is Oral Cancer? | ओरल कैंसर क्या है? Oral cancer refers to the malignant neoplasm (cancerous tumor) that arises in the tissues of the oral cavity. It can involve: • Lips • Buccal mucosa (गाल की अंदरूनी सतह) • Tongue (especially lateral borders) • Floor of mouth (जीभ के नीचे का हिस्सा) • Hard/Soft palate • Gingiva (मसूड़े) • Retromolar trigone यह Squamous Cell Carcinoma के रूप में सबसे ज़्यादा पाया जाता है – यानी इसका origin squamous epithelial cells से होता है। ⸻ Etiology: कारण क्या हैं? 1. Tobacco Use • Cigarette, bidi, cigar, hookah • Smokeless tobacco: Gutkha, khaini, zarda • Nitrosamines (present in tobacco) carcinogenic होते हैं 2. Alcohol Consumption • Ethanol mucosa को irritate करता है • Alcohol + Tobacco = Synergistic effect (risk 15x) 3. HPV (Human Papillomavirus) • Especially HPV-16, associated with oropharyngeal cancers • Sexual transmission through oral sex 4. Poor Oral Hygiene & Chronic Irritation • Sharp teeth, ill-fitting dentures • Continuous mucosal trauma can lead to dysplasia 5. Sun Exposure (Lip Cancer) • Particularly in field workers, UV rays damage lower lip epithelium 6. Genetic & Epigenetic Factors • TP53 mutation • Loss of p16, p21 (tumor suppressor genes) • Methylation of tumor suppressor gene promoters ⸻ Pathogenesis: कैसे बनता है कैंसर? 1. Initiation: Genetic mutation due to carcinogen (e.g., tobacco) 2. Promotion: Clonal expansion of mutated cells 3. Progression: Formation of carcinoma in situ → invasive carcinoma 4. Metastasis: Local lymph node involvement (e.g., submandibular, cervical nodes) Stage Symptoms Early Small painless ulcer, leukoplakia (white patch), erythroplakia (red patch) Mid Pain, bleeding, difficulty in speaking or swallowing Late Trismus, halitosis, weight loss, cervical lymphadenopathy Diagnosis: 1. Clinical Oral Examination – by ENT or oral pathologist 2. Toluidine Blue Staining – to detect dysplastic areas 3. Biopsy – Incisional biopsy for histopathological confirmation 4. Imaging – • CT/MRI: Tumor extent • PET-CT: Metastasis • Ultrasound-guided FNAC: Lymph nodes ⸻ Histopathological Grading (Broder’s classification): • Well-differentiated SCC • Moderately differentiated SCC • Poorly differentiated SCC (You can relate this with your thesis topic on “Histopathological grading and staging of OSCC”) TNM Staging (AJCC 8th Edition):Component Description T (Tumor size) T1-T4 N (Nodes) N0-N3 M (Metastasis) M0-M1 Prognosis: • 5-year survival rate: • Localized: ~85% • With nodal involvement: ~50–60% • Distant metastasis: ~30% ⸻ Prevention: • Avoid tobacco & alcohol • Oral HPV vaccination • Regular oral screening (especially for tobacco users) • Early treatment of leukoplakia & erythroplakia • Public awareness & dental camps ⸻ Conclusion: Oral cancer ek slow killer है, लेकिन यह 100% preventable और treatable है अगर समय रहते पकड़ा जाए। Medical students और doctors को चाहिए कि वो oral screening को daily practice का हिस्सा बनाएं।