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Head and Neck cancer -1-Introduction, causes


(All the articles published in past are available at

Question: Dr. Chiragbhai, thank you very much for giving us a detailed review of Hemato-oncology in 58 parts, in a simplified manner. The next big topic that we need to discuss is Head and Neck Cancers. It seems like and epidemic now with so many patients around.
Ans: Yes, this cancer has grown rapidly in last couple of decades, and is likely to increase in much larger numbers. Sadly, we are now seeing many 25 years old and sometimes even younger patients with this cancer. Unfortunately, Gujarat is one of the largest producer and user of tobacco products. Change in pattern of tobacco use from smoking to chewing has led to increase in head and neck cancers. Since Gutkha and Pan masala are more easily available and cheap, they are used widely now by children as well. According to a study in 2008, over 50 lac children in India under age 15 chew tobacco. It may be double or more now. So you are right, this is an epidemic. If we do not stop this menace, these children and other users who have started chewing tobacco products recently, a large number will develop cancer in next 2-10 year, and that number is huge.

Que: But smoking has been around for so many decades. Tobacco chewing seems to be a bigger problem than that in such a short period. Why is that so?
Ans: You are right, and this is due to a combination of several factors:
1. Tobacco chewing seems more carcinogenic, due to it being combined with many other ingredients/chemicals in Gutkha and Pan masala. Due to this, now we are seeing cancers with much shorter use, even within 2 years, which for smoking used to be generally over a decade. Areca nut (supari) alone is also carcinogenic, and more closely tied to developing oral submucous fibrosis – OSF.
2. Children are also using these products, and their tender tissues are more susceptible, hence they develop cancer with shorter use.
3. Alcohol increases cancer risk by over 40 times, with history of tobacco use in same person.
4. Compared to smoking, chewing tobacco is socially more acceptable. Also these products are much more widely available, easy to use, and cheaper. Marketing is also aggressive unlike with cigarettes or bidi.
5. Nutrition: there is strong epidemiological data that poor nutrition combined with tobacco chewing may increase cancer risk. Chronic tobacco chewers frequently have poor nutrition, in addition to the general malnutrition in India, including several vitamin and mineral deficiencies. Vitamin A possibly protects epithelium against cancer.
6. Hygiene: poor hygiene increases risk of HPV infection, which is a known risk factor for oral cancers. Chronic tobacco chewers frequently have poor hygiene which may add to the risk.
7. Tobacco products chewing creates other serious health problems as well, such as OSF – oral submucous fibrosis. A serious debilitating and incurable condition with extreme restriction of mouth opening. Patients frequently have only one to two cm mouth opening, hence can take only liquids. A very pity sight seen in many young males in their 20s and 30s. Tobacco chewing also leads to poor appetite, sleep disturbance, loss of concentration and other health issues.
According to some reports, it may also cause cardiovascular, neurological, renal, liver, fertility related issues and effects on other body systems, hence much more than causing only cancers. It has also created serious cleanliness issues and very likely spread of other diseases, due to widespread spitting by tobacco chewers. I would like to appeal readers to understand the serious level of this epidemic, and to ensure that your loved ones, especially the young, do not fall prey to this monster, the slow poison. Your word also means a lot to your patients and their relatives. Do Spread the message. Many argue that not all tobacco chewers develop cancers. Yes, but a large number do, and out of all head and neck cancers, 80% patients are tobacco users. And a much larger number develop OSF and other health problems. So why take chance with this Priceless Life?

January 11th 2015.

Dr. Chirag A. Shah; M.D. Oncology/Hematology (USA), 079 26754001. Diplomate American Board of Oncology and Hematology. Ahmedabad. Shyam Hem-Onc Clinic. 402 Galaxy, Near Shivranjani, Opp Jhansi ki Rani BRTS, Ahmedabad.