Hope And Courage As Survival Fuel

Presently, cancer is the second leading cause of death worldwide and globally, about 10 million people die from cancer each year.The global cancer epidemic is behemothic and is set to increase if left unchecked. Head and neck cancers make up 30% of cancer cases in India and are often detected late. These cancers disrupt eating, speaking, breathing – yet early signs often go unnoticed. Consumption of tobacco, alcohol, betel quid and infection with viruses like HPV and EBV are major risk factors. High sugar-sweetened beverage intake is another risk factor for Oral cavity cancers. Cancer causes substantial socioeconomic burden due to treatment costs, loss of earnings and premature deaths. The burden can only be reduced by a multi-sectoral response involving Governments, NGOs, academic organizations, physicians, civil society, patients, industry and the media.

Head and neck cancer (HNC) include cancers of the mouth (such as lip, gum, palate andtongue), the pharynx (throat), the larynx (voice box), nose and paranasal sinuses, ear, thyroidgland, parotid and other salivary glands. The development of HNC is the result of theinteraction of both environmental factors and genetic inheritance and is multifactorial.Alcohol and tobacco use and Human papillomavirus (HPV) exposure are the major riskfactors. Areca nut (Betel nut) often taken along with tobacco is a significant risk factor fororal cancer. It is associated with the development of disorders with high potential formalignant transformation like oral lichen planus, oral leukoplakia and oral submucosalfibrosis. Other risk factors include poor oral hygiene, radiation exposure, poor nutrition,Epstein-Barr virus infection, environmental or occupational inhalants (asbestos, wood dust,paint fumes) and prolonged sun exposure (especially linked to lip cancer).Immunosuppression, as in case of post kidney transplant and AIDS, may predispose to anenhanced risk for oral cancers. 

HNC is more common among men than women.HNC typically produces symptoms referable to the upper aerodigestive tract - alterations indeglutition, phonation, hearing, and respiration. In particular, patients may develop difficultyduring swallowing, pain during swallowing, globus (lump) sensation in throat, red or whitepatch or ulcer in the mouth, hoarseness, epistaxis (bleeding from inside nose), epiphora(watering eyes), otalgia (ear pain), hemoptysis (coughing up blood), stuffiness of the ears,and trismus (lock jaw). Anypatient with symptoms referable to the upper aerodigestive tractthat have lasted for 3 weeks or with an asymptomatic neck mass should undergo a thoroughexamination. Besides some may present with only unexplained significant weight loss over ashort period of time or fatigue.

A thorough history followed by physical examination is the initial step for detecting lesionsof the upper aerodigestive tract. Due to the frequent occurrence of multiple primary tumors inpatients with a HNC, careful evaluation of the entire upper aerodigestive tract is necessary atthe time of diagnosis. The need for expeditious diagnosis cannot be overemphasized, as earlydiagnosis can lead to a reduction in mortality. For confirmation of nature of the lesion(cancerous or benign) an endoscopy (a procedure in which a tiny camera is fed into the mouththrough a tube), a biopsy of any suspicious lesions, and imaging like a computed tomography(CT) scan or magnetic resonance imaging (MRI) may be needed.

The treatment depends on the location and the stage of the cancer, the person’s age andgeneral health. It may include surgery, radiation therapy, chemotherapy, targeted therapy,immunotherapy or a combination of some or all of these. Once active treatment has finishedpatients need follow-up care. This includes regular physical examinations, medical tests, orboth. Cancer rehabilitation is a major part of follow-up care after HNC treatment. It helpspatients regain control over many aspects of their lives and remain as independent aspossible. They may receive physiotherapy to maintain movement and range of movement, aswell as speech and swallowing therapy to regain skills like talking and eating. Supportivecare or palliative care to manage symptoms and maintain nutrition after treatment may berecommended. Some patients may need to learn new ways to eat or prepare foods differently.Many patients especially young adults experience anxiety and depression both during andafter completion of treatment. Fear of recurrence is common. Many feel disconnected fromtheir life before cancer. Support from family and friends, other cancer survivors and healthprofessionals can help to mitigate the distress.

Cancer diagnosis can affect people in manyways. The word cancer itself brings fear and anxiety in the minds of the people. It is veryimportant that people have the right information and can make informed decisions.A healthy diet, regular exercise, avoiding tobacco and alcohol, maintaining good oralhygiene, managing stress, HPV vaccination etc helps reduce the chances of developing HNC. A plant-based diet that includes a variety of vegetables, fruits and wholegrains while cutting down on meat, fast food, packaged food and drinking plenty of watermay reduce the risk. Precancerous lesions as well as early stages of oral cancer can bedetected by a simple visual examination by trained caregivers under adequate light. It isextremely cost-effective in a resource-limited setting. One can self-screen at home in front ofmirror. HNC awareness should be done in schools and colleges as children and young adultsare getting addicted to tobacco and alcohol. Routine dental visits should be encouraged.

Cancer is scary no doubt, but it can be conquered using hope and courage as survival fuel. Theperson should have the courage to endure the treatment and hope for a positive outcome.Both courage and hope during cancer treatment are incredible acts of self-control. Both aresincere attempts to be resilient and adaptable throughout the treatment and beyond. Hope andcourage are both highly contagious and hence the role of care giver including medicalpersonnel as also family and friends in helping cancer patients harbour these attitudes isimportant. The government can provide free of cost, dedicated support workers to individuals and families, affected by cancer. Acceptance of the physical changes, establishing a new daily routine, joining asupport group with other cancer survivors and keeping busy helps to overcome the fearduring and after treatment. Life after cancer diagnosis may be different and difficult, but it canalso be inspiring and purposeful

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