Cancer can affect any part of the body and devastate the mental, physical, and emotional well-being of the affected. The global cancer burden, although considerable, has been reduced over the years thanks to scientific advancements and technological innovations that enable early detection, prompt treatment, a better prognosis, and improved survival.
Cancer, a formidable enemy, has plagued humanity for centuries and continues to pose significant challenges to health and healthcare systems. A cancer diagnosis turns an individual’s world upside down, mentally, emotionally, financially, and physically, instilling a fear of death the moment it is diagnosed, given that cancer is the second leading cause of death worldwide.
Cancer (or tumour) refers to the uncontrollable, uncoordinated, and excessive growth of cells that may damage normal body tissues and spread to neighbouring tissues by local extension (benign tumours) or metastasize to distant parts of the body through lymph nodes or blood (malignant tumours). Causes include genetic mutations, ageing, family history, tobacco consumption, smoking, sedentary lifestyles, dietary choices, and exposure to the sun (ultraviolet radiation), and the human papillomavirus (HPV).
The warning signs and symptoms of cancer include a persistent sore, a change in the size or shape of moles, new lumps or masses, persistent indigestion or altered bowel habits, unexplained or abnormal bleeding from any openings in the body, blood in vomit or urine, a persistent cough or hoarseness in voice, persistent and unexplained muscle and joint pain or fever, and unexplained weight loss.
Cancer diagnosis included biopsy, tumour markers, and positron emission tomography-computed tomography (PET-CT) scans, in addition to medical history and the clinical presentation of the disease. While biopsy provides histopathological data, tumour markers indicate cancer risks, types, and chances of metastasis, and PET-CT provides vital information on the extent of tumour involvement and metastasis. Screening tests for particular cancers include the Pap test (cervical cancer), mammography (breast cancer), and colonoscopy (colon cancer).
Treatments depend on tumour size, stage, grade, and the patient’s age and includes surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy, or hormonal therapy. Surgery involves tumour removal by operation, whereas radiation therapy employs the use of high-energy X-rays to kill cancer cells and shrink tumours. Chemotherapy kills cancer cells with medication, and hormonal therapy is administered to slow down or stop cancer growth.
The earlier cancer is detected, the sooner and better it can be cured. The stage of cancer indicates the extent of cancer’s spread, guides the choice of treatment, assesses treatment response, and ascertains prognosis and recurrence risks. As the stage advances, the prognosis becomes worse. Oncologists follow the TNM staging system for cancer, with T representing the tumour size, N representing lymph node involvement, and M representing metastasis.
Tumour grade denotes its degree of resemblance (or differentiation) with healthy cells. A tumour that does not resemble healthy tissues is poorly differentiated or high-grade, spreads rapidly, has a poor prognosis, and is therefore increasingly difficult to treat.
Amid the challenges and heartache, there is a ray of hope as advancements in cancer care pave the way for a better future. The relentless pursuit of innovative treatments, comprehensive support systems, and personalised therapies has transformed the cancer care landscape, offering renewed optimism to cancer patients and their families.
Advancements in radiation therapy such as intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), 3D-conformal radiation therapy, proton-beam therapy, brachytherapy, and image-guided radiation therapy (IGRT) have improved treatment outcomes by delivering high radiation doses to cancerous tissues while reducing harm to neighbouring healthy tissues.
Advancements in surgical options include laser surgery, robotic surgery, laparoscopy, and endoscopy. Surgeries not involving tissue cuts include cryosurgery, photodynamic therapy, hyperthermia, and laser. The emergence of non-invasive treatment has reduced recovery times, improved patient compliance, improved tumour response to other therapies, and decreased tissue loss, catering to the fear that accompanies conventional surgeries. Cancer care includes managing pain, nausea, and other side effects experienced by patients (palliative care) to improve their quality of life.
A remarkable breakthrough is the use of precision medicine, based on genes, to determine treatment and predict recurrence risks. While some genes protect against cancer, i.e., tumour suppressor genes or deoxyribonucleic acid (DNA) repair genes, such as p53, BRCA-1 and 2, oncogenes (such as RAS and HER2), or mutated genes (such as p53 mutations), promote cancer formation.
Conventional treatments often employ a one-size-fits-all approach, whereas precision medicine recognises that every patient's tumour is unique and needs tailored therapies. By analysing individual genetic profiles, particular mutations driving the tumour’s growth can be identified, enabling targeted treatments that attack tumour cells while minimising damage to healthy tissues.
Targeted therapies such as smallmolecule inhibitors, immunotherapies, and monoclonal antibodies act against particular genes and proteins that enable cancers to grow and survive and prevent the formation of new blood vessels. Precision medicine also includes the study of genetic responses to drugs (pharmacogenomics) to determine the choice of drug and assess its safety.
Immunotherapy involves the use of immune checkpoint inhibitors, T-cell transfers, treatment vaccines, and immune system modulators to strengthen the immune system to fight cancer. The treatments have demonstrated success in various types of cancer, such as breast cancer, lung cancer, and melanoma. They increase overall survival, prevent tumour recurrence, and improve quality of life with minimal side effects in comparison to conventional chemotherapy.
Early detection and prompt treatment are critical to the successful treatment of cancer. Over time, significant strides have been made in diagnostic techniques, leading to more accurate and efficient detection methods. Advanced imaging techniques, such as magnetic resonance imaging (MRI), PET-CT), and molecular imaging, facilitate the early detection of tumours.
In addition, liquid biopsies, which identify cancer cells or their deoxyribonucleic acid (DNA) in circulation, have emerged as non-invasive techniques to detect cancers in their initial stages and monitor their response to treatment. Screening programmes have become widespread for colorectal, cervical, and breast cancers, enabling early treatments and, therefore, better outcomes.
Cancer care is not limited to medical therapy. Recognising the social, psychological, and emotional challenges faced by patients and their loved ones, healthcare professionals have adopted a holistic approach to cancer care. Supportive programmes have integrated services like counselling, ain management, rehabilitation, and nutritional recommendations to address the multifaceted requirements of cancer patients.
Moreover, online communities, community programmes, and patient support groups have become invaluable resources, building connections between patients and providing a platform to share knowledge and experiences and gather emotional support. Educational workshops and relevant publications are available to improve cancer awareness.
Oral cancer, an insidious and devastating disease affecting the lips, tongue, floor of the mouth, cheeks, hard and soft palate, sinuses, or throat, profoundly impacts swallowing, eating, speech, and the overall health-associated quality of life.
Radiation therapy can cause dry mouth (xerostomia), salivary gland damage and decreased salivation, oral ulcers, severe tooth decay, periodontal disease, taste alterations, mucosal inflammation (mucositis), jaw stiffness, reduced mouth opening (trismus), and changes in the jaw bones, such as osteoradionecrosis. Chemotherapy may also result in oral bleeding, a burning tongue, and infections due to lower white blood cell counts and bone marrow suppression.
Therefore, oral cancer demands utmost attention, early detection, multidisciplinary treatment, and holistic care to improve the lives of those affected. Early detection is paramount in the battle against oral cancer, as it facilitates timely intervention and the use of lessinvasive and more effective treatment. However, oral cancer screening remains dishearteningly low. Thus, public health initiatives must prioritise educational campaigns and emphasise the need for routine oral examinations.
Risk factors for oral cancer include tobacco use, betel quid chewing, alcohol intake, nutritional deficiencies, HPV transmission during oral sex, sun exposure, age, and chronic irritation to the oral mucosa. Signs and symptoms include a white or red patch in the mouth; ulcers, lumps, or swelling in the mouth, jaw, or neck that persists beyond three weeks; pain when swallowing, chewing, speaking, or moving the jaw or tongue; numbness in the tongue or other areas of the mouth; hoarseness persisting beyond six weeks; unexplained loosening of teeth; and difficulty tolerating spicy foods.
Before initiating cancer treatment, any potential sources of dental infection must be identified and eliminated. Teeth with cavities must be restored with fillings, and those with severe infections must be extracted at least a week before initiating chemotherapy or radiation treatment to allow for healing. Thorough scaling and oral prophylaxis must be performed, and all sharp areas must be smoothed to prevent mucosal irritation. Fluoride gel applications could help prevent tooth decay.
During cancer treatment, soft brushes and fluoridated toothpaste must be used for toothbrushing, and dentures must be worn only during meals. Flossing may be avoided if it causes bleeding in the case of low platelet counts. Commercial alcohol-containing mouthwashes must also be avoided since alcohol may irritate the mucosa.
Daily warm water or baking soda and water rinses could help maintain oral health. Analgesics may be used to reduce pain; however, non-steroidal antiinflammatory drugs such as aspirin must be avoided since they may cause bleeding problems. Caffeinated beverages must be avoided due to potential oral dryness. Citrus fruits and tomato juice may irritate mouth sores.
Regular jaw exercises, artificial saliva substitutes, and medications that coat the oral mucosa to protect it while eating, along with topical anaesthetics, are also essential. Patients must use sugar-free gums or candies, hydrate,avoid hot, spicy, sharp, and crunchy foods that could irritate the mucosa, and refrain from tobacco and alcohol use. Lip moisturisers may prevent the lips from cracking.
After cancer treatment, good oral hygiene must be maintained with regular scaling and cleaning, and fluoride treatments must be continued. Dentures must be relined six months after treatment to adapt to changes in the mouth. Patients must adhere to low-sugar and nutritionally balanced diets, drink at least eight glasses of water daily, and continue to avoid caffeine, tobacco, and alcohol.
Beyond medical treatment, holistic patient care is important to promote the psychological, physical, and emotional well-being of oral cancer patients. Supportive measures must include pain management strategies, dental rehabilitation, speech and swallowing therapy, psychological counselling, and nutritional support to alleviate the burden and promote the health of patients.
The cancer care landscape has undergone an astounding transformation, offering new avenues for patients and their families. Precision medicine has revolutionised the approach to cancer therapy, allowing for tailored therapies that target the cause of cancer. Early detection techniques continue to advance, offering the assurance of detecting tumours in the initial stages and facilitating more effective treatment. The incorporation of comprehensive support systems into cancer care acknowledges the holistic requirements of patients, providing vital psychological and emotional support.
Challenges such as improving accessibility to cancer care facilities and overcoming health disparities remain; however, the progress attained in recent times fuels the hope of a future excluding the catastrophic impact of cancer. Continued investments in cancer research and advanced technology, coupled with an empathetic approach to cancer care, could pave the way for a cancer-free world.
