Low survival rate for oral cancer in Malaysia raises alarm

KUALA LUMPUR - Oral cancer, a potentially deadly disease characterised by silent progression and often late-stage diagnosis, has emerged as a significant public health concern.

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

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

Sunway Medical Centre Consultant Otorhinolaryngology (ENT), Otology, Neurotology, Head & Neck, and Skull Base Surgery Dr Shailendra Sivalingam said the disease arises from a complex interplay of genetic, environmental and lifestyle factors, with significant contributions from both Human Papilloma Virus (HPV)-related and non-HPV-related causes.

He said 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,” he added.

Dr Shailendra said oral cancer which often affects the gums, cheeks, tongue, and tonsils, could 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 tumor cells to disseminate early,” he said.

He said the habit of betel nut chewing among the South Asian population also contributes to oral cancer, as it is classified as a carcinogenic ingredient by the World Health Organisation (WHO).

"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,” he added.

Dr Shailendra emphasised the importance of being vigilant for any oral abnormalities such as long-lasting ulcers or unusual bleeding in the oral cavity, cheek, or throat that could be easily overlooked.

"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.

"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 said adding that diagnosing oral cancer is a detailed process, illustrating the disease's difficulty in early detection.

In treating oral cancer, he said treatment may range from surgery in the early stages to a combination of surgery, chemotherapy and radiation in more advanced cases.

The impact of treatment often involves significant surgical interventions, potentially affecting the patient’s quality of life including the possibility of disfigurement and difficulties in speaking and swallowing due to the tumor or cancer removal in the tongue, cheek, lip or even tonsil.

Dr Shailendra also advised the public to abstain 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, the research stresses 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,” Dr Shailendra said. - BERNAMA