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Confronting An Overlooked Health Concern: Oral Cancer Among Malaysians

Oral cancer arises from a complex interplay of genetic, environmental, and lifestyle factors, with significant contributions from both HPV-related and non-HPV-related causes.

Abstaining from tobacco and betel quid, maintaining oral hygiene, and regular dental check-ups can considerably lower the risk of oral cancer. (Picture courtesy of Sunway Medical Centre)

KUALA LUMPUR, April 29 – In Malaysia, oral cancer, a potentially deadly disease characterised by silent progression and often late-stage diagnosis, has emerged as a significant public health concern.

However, studies reveal that the survival rate for oral cancer among Malaysians is nearly 50 per cent after treatment with surgery and radiotherapy, which is much lower than in most developed countries.

According to Cancer Research Malaysia, in 2020, 377,713 individuals were diagnosed with oral cancer globally, and 177,757 succumbed to the disease.

Dr Shailendra Sivalingam, consultant in otorhinolaryngology (ENT), ontology, neurotology, head and neck, and skull base surgery at Sunway Medical Centre, offers in-depth insights into oral cancer among Malaysians, emphasising the necessity of early diagnosis and treatment.  

Unveiling The Causes And Lifestyle Factors Of Oral Cancer 

“Oral cancer, which often affects the gums, cheeks, tongue, and tonsils, can present as white patches or ulcers.

“Depending on the cancer’s location, it can quickly spread to the throat or lymph nodes due to the oral cavity’s rich lymphatic drainage system, enabling tumour cells to disseminate early,” explained Dr Shailendra.

The disease arises from a complex interplay of genetic, environmental, and lifestyle factors, with significant contributions from both HPV-related and non-HPV-related causes.

Human Papilloma Virus (HPV), especially high-risk types like HPV-16, is strongly linked to oropharyngeal cancers, demonstrating a strong causal relationship, particularly in tonsil-related cancers. 

“Risks for oral cancer include HPV infection, excessive or prolonged smoking, excessive alcohol consumption, and poor dental hygiene, which introduce carcinogens to the oral cavity, causing genetic mutations that may lead to the development of cancerous cells,” noted Dr Shailendra.

Among the South Asian population, betel nut chewing also contributes to oral cancer. Furthermore, the World Health Organization (WHO) classifies betel nut or areca as a carcinogenic ingredient and warns of its impact on cancer.

“The betel nut’s strong acidic nature, containing arecoline and lime, stays in the mouth for extended periods, causing lesions and alters the mouth’s microbiome and oral mucosa, leading to cancer,” added Dr Shailendra. 

Symptoms, Diagnosis, And The Journey To Treatment

Dr. Shailendra advises on recognising oral abnormalities to aid early detection of oral cancer.

“Symptoms like long-lasting ulcers or unusual bleeding in the oral cavity, cheek, or throat can be easy to overlook.

“It’s often not until the symptoms become impossible to ignore, such as changes in voice, difficulty eating, or noticeable weight loss, that intervention occurs. By then, it might be stage three, a much more difficult situation to treat,” said Dr Shailendra.

“If something in your mouth doesn’t feel right and persists for more than a week, it’s essential to get it checked. Early detection can significantly improve the chances of successful treatment and recovery,” he added.

Treatment And Impact Of Oral Cancer 

“Diagnosing oral cancer is a detailed process, from biopsy to determining the cancer’s stage, illustrating the disease’s difficulty in early detection,” Dr Shailendra continued.

Treatment may range from surgery in early stages to a combination of surgery, chemotherapy, and radiation in more advanced cases.

Despite advances in targeted therapy and immunotherapy, accessing these treatments can be challenging.

The impact of treatment often involves significant surgical interventions, potentially affecting the patient’s quality of life.

This includes the possibility of disfigurement and difficulties in speaking and swallowing due to the tumour or cancer removal in the tongue, cheek, lip, or even tonsil area. 

Reducing Risk And Importance Of Early Detection For Oral Cancer 

Beyond the medical interventions, Dr Shailendra speaks about the critical role of lifestyle changes and preventive measures, advising, “Abstaining from tobacco and betel quid, maintaining oral hygiene, and regular dental check-ups can considerably lower the risk”. 

With an observed increase in oral cancer among young adults, research underscores the effectiveness of HPV vaccines in preventing oral cancer, provided they are administered early.

“HPV vaccines are an effective protection against oral, head, neck, and cervical cancers. However, they do not work if you already have cancer or are already infected. Therefore, the earlier the vaccine is administered, the better,” he added. 

He underscores the importance of early detection and treatment: “If you notice an area in your mouth that has not healed after one week, get it checked. Early diagnosis can make a significant difference in treatment outcome and post-treatment quality of life.”

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