On 22 June 2024, Seniors Today hosted Dr Prathamesh Pai on Health Live@Seniors Today weekly webinar. The Senior Oncologist, spoke on and answered questions about Early Detection and Prevention of Head and Neck Cancers.
Dr Prathamesh Pai, a highly accomplished professional with 24 years of experience, boasts an impressive array of qualifications, including MS (ENT), DNB, DORL, MNAMS, FACS, and EPGDHA. His specialised expertise lies in the field of Head and Neck Surgical Oncology. Dr Pai’s illustrious career includes a significant tenure at the Tata Memorial Hospital, where he served as a Professor and MCh teacher in Head and Neck Surgical Oncology. His areas of keen interest and exceptional proficiency encompass Head and Neck Surgical Oncology, Oral and Transoral Laryngeal Surgery, Laser Surgery, as well as skull base procedures with a specific focus on minimal access techniques.
The Head and Neck Cancer Institute of India is the Punyashlok Ahiylyabai Holkar Head and Neck Cancer Institute of India, situated at Mazgaon, Mumbai. It is the newest edition to the head and neck cancer treatment facilities in the country. It was started by Dr Sultan Pradhan who is the chairman of the CanCare Trust. This hospital was started with the sole idea to provide a new resource for the country.
Head and Neck cancer is a very prevalent cancer in the country. It is one of the largest cancer burdens in the country. And we do not have adequate infrastructure. So this facility, which is a 100 bed facility is a comprehensive cancer treatment for Head and Neck Cancers. Trying to provide best quality care at affordable rates.
This institute has all facilities available such as surgery, medical oncology- which includes chemotherapy, radiation therapy, PET CT Scan.
Any patient that comes here, gets comprehensive care and treatment under one roof.
Cancer is more common as we age.
What we are seeing in the population is that the number of people over the age of 60 outnumber the children below 5 years of age. More than 80% of older people will now be living in countries such as ours.
By the year 2050, people who are over the age of 60 will double.
A third of all these people can have cancer.
Cancers are on the rise and what is predicted is that by the year 2045, we will be seeing almost doubling of all the cancers that we are seeing today.
When we look at India, Head and Neck cancer is the most common cancer in the male population. It forms around 30%of the cancers in our country. In the year 2022, Dr Prathamesh Rai says that they registered over 12,00 new cases of Head and Neck cancer at the Data Memorial Cancer Hospital. And over 2.5 thousand major surgeries were performed and about a third of them required reconstructive surgery. And this is a mere drop in the ocean.
We need to fight tobacco and alcohol consumption, since they are the most important causes for Head and Neck cancers today.
Betel nut is a class 1 carcinogen which is very predominantly used in social circumstances as well as routine consumption in our country which might expose our population to cancer formation.
Chronic irritation in the oral cavity is also a cause for oral cancers in patients who are non habitual tobacco or alcohol consumers.
Hence, we need to be extremely careful when we are placing dentures or dental implants.
We are having more and more patients who have a possibility of cancer in patients who have been using dentures for a long period of time.
Dentures used can be either removable or fixed
What happens in a denture usage is, more commonly seen with fixed implants, since they require the assistance of a dentist to remove the dentures, there can be collection of food particles between the teeth, gums leading to chronic irritation, it can also lead to easy and early bacterial infections which can also lead to changes in the mucosa and chronic irritation.
Tobacco takes about 10-15 years before it manifests as cancer
Chronic irritation and ulcers can take about 3-6 months to develop into a lesion. And a chronic lesion, over a few years can lead to cancer.
Early detection of cancers is important, as a majority of patients who present to the hospital/ clinic are already in the advanced stages- stages III/ IV, wherein the survival drops by 50% in spite of the best treatment modalities available.
If the cancers are detected early, more than 60% of the cancer patients/ cases can be cured. Whilst, if present in the advanced stages, less than 40% will survive.
The failures that we have are due to:
- Lack of suspicion
- Lacunae in paying attention to the symptoms and signs
- Not undergoing proper diagnostic intervention/ treatment
Various sites involved in Head and Neck Cancer
- Oral cavity- organs and stem involved include tongue, cheek, lips. There might be white patches on the tongue, gums, angle of the mouth and some lesions in the vicinity of the teeth
- Tumours in the voice box- can present as changes in the voice
- Tumours of the oesophagus/ food pipe- presents as difficulty in eating and swallowing
- Tumours in the tonsil, palate, thyroid and parathyroid gland
- Lesions occurring in the salivary glands- parotid and submandibular gland
- Tumours occurring in the nose and paranasal sinuses
- Tumour growths in the skull/ close to your skull
Symptoms that should raise suspicion for a Head and Neck Cancer:
- persistent oral lesions
- Change in voice
- Altered swallowing
- Swelling in the neck
- Nasal obstruction
And all the above symptoms do not subside despite the best of treatments, that is when you should suspect cancer and consult with your doctor.
These are the symptoms which if not diagnosed early can grow
You should consult with either an ENT Surgeon or a Dental surgeon who’ll be able to pick up these lesions early on.
The diagnostic modalities generally used are:
- Complete clinical examination
- Documentation of the symptoms and examination
It does not take a lot of technologically advanced investigations to make the diagnosis. A simple examination of the oral cavity can give you an idea as to what might be the scenario.
There are 3 treatment modalities that are available for treatment of cancer:
- Surgery- wherein we try to remove the cancer
- Chemotherapy- uses drugs to fight the cancer by killing the DNA of the cells and then destroying the cancer
- Radiation therapy- this induces a cell- kill by killing the DNA
The new modality which has come in over the last 10 years is immunotherapy. It helps the body build its immunity and use that immunity to kill the cancer. It does so by making the body aware that there is cancer and that the cancer cells are foreign body.
It uses the body’s resources for the treatment of cancer.
It is seen to be beneficial and effective for 1 in every 5 cancer patients. which is growing.
