We are witnessing a sharp increase in number of cancers in our Kashmir valley. As a specialist of Ear-Nose-Throat, it is my moral duty to appraise my community about these dreaded cancers arising in head and neck area of our body.
Head and Neck cancers are those cancers which originate from the lining of mouth, tongue, gums , nose, throat, tonsils and upper end of food pipe. Couple of years back I was given a project to study the cancers of head and neck prevalent in our valley. As a postgraduate doctor, department of ENT Government Medical College, Srinagar I formulated the study plan which was approved & supervised by then Head of department & former principal Prof Rafiq Ahmad Pampori.
Excerpts from the study:
Almost more than 100 patients suffering from Head and Neck cancers reported to our department which excludes those going to SKIMS or outside state for treatment. In just one year (2015), the number itself speaks a lot; It was alarming to us all. These 100 cases were examined in detail and routine investigations needed were performed – CT scans, Biopsies and endoscopies etc.
The most common cancer of head and neck region was of throat (larynx) which comprised almost 60% of all head and neck cancers. This observation was in contrast to what is found in other parts of India, where mouth cancers (tongue, gingivobuccal sulcus, gums, lips) are the most common sites of head and neck. The reason being they chew tobacco and pan masala, which is strongly cancerous for these sites. In Kashmir this tobacco chewing is not in vogue, so the cancers of mouth are very less compared to rest of the India. Most of the cases were above 40 years of age which is quite young age indeed. These throat cancers were more common in men (3 times than women) and rural population was mostly involved than our urban population.
• The throat symptoms present in these patients were:
• Hoarse voice or any change in normal voice.
• Feeling of lump in throat.
• Pain in ear (usually referred pain from supraglottic tumors)
• Pain during swallowing (odynophagia in supraglottic tumors)
• Sound/noise on breathing (stridor in subglottic tumors)
Of tumors more than 60% were already in their advanced stage (stage 3 & 4). Most of these throat tumors had to be operated which consisted removal of sound box (laryngectomy) along with surrounding tissue (neck dissection). The disadvantages of the operation is that patient loses his/her normal speech and there is a permanent hole (stoma) in throat where from patient has to breathe.
The reasons for any cancer are multiple; ranging from genetic to familial to environmental factors. Many questions arise: what were the environmental factors causing these tumors? Why more men were involved than women, and that too more rural population than urban one? Why the cancers were already gone to advanced stage.
The explanation for that is smoking. Men smoke heavily in Kashmir, women usually don’t, except in our remote areas where hukka – Jajeer – by women folk is still a custom. “The state’s monthly spending on smoking tobacco far outstrips the national monthly expenditure averages. While nationally, smokers aged 15 and above spend Rs 399.20 a month on cigarettes and Rs 93.40 on bidis, those in J-K spend Rs 513.60 and Rs 134.20, respectively, on these tobacco forms,” reveals the Global Adult Tobacco Survey, (GATS).
The smoking products ranging from hukka, to biddis to cigarettes were common abusive/drug history in our patients. We found that “this smoking menace” has direct hand in causing throat cancer in our population. Because almost more than 70% of patients were active smokers and had been smoking from decades.
So it is imperative for us to stop smoking to get rid of this cancer and prevent others from becoming vulnerable by passive smoking .
The reason for high stage/advanced stage of disease at the beginning lies in the fact that our people don’t take throat symptoms seriously and seek specialist /health care providers’ opinion only when the disease has reached high stage. Any throat symptom especially in smokers should be taken very seriously and medical attention should be sought as early as possible. There is a recommendation that any change of voice (begaur awaz) of more than 3 weeks should be examined by ENT specialist.
Our study got published in one of the reputed national cancer journal. Interested readers can log on to http://www.jhnps.org on Tuesday, September 19, 2017, IP: 14.139.58.50.
Dr Shahid Rasool Biloo ENT specialist currently working at HIMSR New Delhi.
drshahid_gmc@yahoo.com