Best Oral Cancer Therapies in India: Comprehensive Treatment Options

Oral Cancer Therapies and Surgery in India: Overview

In India, the treatment of oral cancer encompasses a variety of advanced therapies and surgical interventions aimed at effectively managing the disease. Surgery is often the first line of treatment, particularly for early-stage cancers, and includes procedures such as tumor resection, mandibulectomy, maxillectomy, glossectomy, and neck dissection, often followed by reconstructive surgery to restore function and appearance. Radiation therapy, including external beam radiation therapy (EBRT) and brachytherapy, is widely used to target cancer cells.

Chemotherapy, either as systemic treatment or in combination with radiation (chemoradiation), is another cornerstone of treatment, particularly for more advanced stages. Targeted therapies, such as EGFR inhibitors and monoclonal antibodies, specifically target cancer cell growth mechanisms. Immunotherapy, including checkpoint inhibitors like pembrolizumab and nivolumab, is an emerging field that leverages the body’s immune system to combat cancer.

Cryosurgical ablation (CSA), a minimally invasive procedure that uses freezing cycles to destroy cancer cells, is gaining traction due to its precision and reduced recovery time. Rehabilitation services, including speech therapy, nutritional support, and physical therapy, are integral to the treatment plan, helping patients regain their quality of life post-treatment. India's healthcare system combines modern medical technology with skilled oncologists, emphasizing early detection and a multidisciplinary approach to improve treatment outcomes and patient quality of life.

Radiation Therapy in India

Radiation therapy (RT) uses high-energy radiation from sources such as x-rays, photons, and electrons to kill cancer cells and shrink tumors. RT may be used as the main treatment to cure cancer (curative treatment), or as supportive care or palliative care to help ease pain or discomfort caused by advanced cancer.

Radiation is typically delivered from outside the body by a computerized device, which can shape the treatment to closely fit your body. Treatment is given in small daily doses, typically over 6 to 7 weeks on workdays, with weekends off. In special circumstances, particularly for palliative treatment, your course of therapy may be shorter. A device resembling a hockey goalie mask may be used to keep you still during treatment. If you get uncomfortable in tight spaces, please talk to your radiation oncologist for ways to help keep you comfortable and calm.

You will see your radiation oncologist at least weekly to review your progress and to help with side effects, such as sunburn-like rash, mouth soreness, lack of taste, dry mouth, or thick saliva. Ask your care team which radiation option(s) are best for your situation, if RT will be combined with chemotherapy, and what side effects to expect. RT puts you at a small risk of developing another cancer in the future.

Panoramic dental x-ray is part of a pre-radiation therapy dental evaluation. It is needed to check the health of your jaw and teeth to see if you need any dental work before starting RT. It is important to tell your dentist about your oral cancer and to have regular dental cleanings and checkups.

External Beam Radiation

External beam radiation therapy (EBRT) uses a machine outside the body to aim radiation at the tumor(s) or areas of the body. Common types of EBRT that may be used to treat oral cancer include:

• Three-dimensional conformal radiation therapy (3D-CRT) uses computer software and CT images to aim beams that match the shape of the tumor.
• Intensity-modulated radiation therapy (IMRT) uses small beams of different strengths to match the shape of the tumor, limiting the amount of radiation to normal tissue.
• Stereotactic body radiation therapy (SBRT) uses high-energy proton or photon beams to kill or ablate the tumor. SBRT is very precise, reducing the chance of damage to nearby tissues.
• Proton beam therapy (PBT) uses proton beams to kill or ablate the tumor. It might be used for lesions near critical structures like the skull base, brain stem, optical nerve, or spinal cord.

Either IMRT (preferred) or 3D-CRT is recommended for mouth cancer to minimize radiation dose to critical structures.

Internal Radiation

Internal radiation (brachytherapy) involves placing one or more small tubes into the tumor area. A small radioactive seed travels into the tube(s) and delivers radiation to the tumor area from inside the body.

Systemic Therapy in India

Systemic therapy works throughout the body and includes chemotherapy, targeted therapy, and immunotherapy. Systemic therapy might be used alone or with other therapies. Goals of systemic therapy may be curative or palliative and should be discussed before starting treatment. The choice of systemic therapy will be based on your individual needs. Your wishes about treatment are important. Make your wishes known.

For systemic therapy examples, see Guide 3.

• When systemic therapy is given before surgery or chemoradiation, it is called neoadjuvant or induction therapy.
• When systemic therapy, chemoradiation, or radiation therapy is given after surgery, it is called adjuvant or postoperative therapy.
• When systemic therapy is given for noncurable advanced or metastatic disease, it is called palliative therapy.

Chemotherapy

Chemotherapy kills fast-dividing cells throughout the body, including cancer cells and some normal cells. Sometimes, chemotherapies are combined together, or are combined with a checkpoint inhibitor therapy or targeted therapy. This is called multiagent chemotherapy. Chemotherapy might be followed by radiation therapy or chemoradiation.

Chemoradiation

Treatment that combines chemotherapy with radiation therapy is called chemoradiation. Chemotherapy may improve how well radiation works; that is why they are sometimes used together. For locally advanced disease, cisplatin is often the preferred chemotherapy drug given with radiation therapy (RT). Chemoradiation is often used to cure your cancer. Chemoradiation may also be used to control symptoms caused by a tumor even if a cure is not possible.

Targeted Therapy

Targeted therapy focuses on specific or unique features of cancer cells. Targeted therapies seek out how cancer cells grow, divide, and move in the body. These drugs stop or inhibit the action of molecules that help cancer cells grow and/or survive. If your tumor has certain mutations, targeted therapy might be used.

Immunotherapy

Immunotherapy is a type of systemic treatment that tries to reactivate the immune system against tumor cells. The immune system has many on and off switches. Tumors take advantage of turning on the "off switches." If your tumor has a high number of mutations, immunotherapy might be given. Immunotherapy can be given alone or with chemotherapy or targeted therapy.

Oral or Mouth Cancer Surgery in India

Surgery involves removing cancer from the body. For head and neck cancer, consult an experienced otolaryngologist, head and neck surgeon, or surgical oncologist. Hospitals that perform many such surgeries usually achieve better results. Consider a referral to a specialized hospital or cancer center.

Approach to Surgery

The approach to surgery depends on the tumor's size, location, and involvement with surrounding tissues. Surgery aims to remove cancer in the safest way possible. Discuss potential impacts on breathing, swallowing, speaking, chewing, and appearance. Nerves and lymph nodes might need to be cut or removed. Inquire about post-surgery appearance and facial reconstruction options.

Tumor Resection

Tumor resection involves removing the entire tumor. The ability to remove the whole tumor depends on its location, involvement with vital structures, depth of invasion, and impact on functions. Lymph node surgery (neck dissection) is often necessary as the risk of metastasis increases with tumor invasion.

Reconstruction After Tumor Removal

If planning reconstruction surgery after tumor resection, ask questions early. A multidisciplinary team (MDT) is essential for high-quality reconstruction. Inquire about the MDT members, tissue removal for reconstruction, surgery duration, and recovery time. You might stay in a specialized nursing unit post-surgery for safe recovery.

Neck Lymph Nodes

Lymph nodes filter infections and harmful substances. The head and neck have over 300 lymph nodes, often involved in cancer spread. Mouth cancer frequently spreads to nearby lymph nodes. The neck has six levels of lymph node groups, with levels I, II, and III at higher risk for metastasis.

• 1A – Submental nodes
• 1B – Submandibular nodes
• Separated by the front part of a neck muscle (digastric muscle)

• 2A – Upper Jugular nodes
• 2B – Upper Jugular nodes
• Separated by the spinal accessory nerve

The middle neck

The lower neck

• 5A – Posterior Triangle nodes (superior half, toward the head)
• 5B – Posterior Triangle nodes (inferior half, away from the head)

Near the windpipe

Lymph Node Surgery in India

Lymph node removal, or nodal dissection, is often part of tumor resection. The extent of removal depends on the tumor's location and pre-surgery staging. Types of neck dissections include:

• Selective Neck Dissection (SND): Removes some regional lymph nodes.
• Comprehensive Neck Dissection: Removes all lymph nodes in a group or level.
• Radical Neck Dissection: Removes all lymph nodes, possibly including veins, arteries, nerves, or muscles.
• Sentinel Lymph Node Biopsy: Identifies and removes the first lymph node(s) cancer is likely to spread to for testing.

Cost of Lymph Node Surgery in India

• Selective Neck Dissection (SND): INR 80,000 - 2,00,000
• Comprehensive Neck Dissection: INR 1,50,000 - 3,50,000
• Radical Neck Dissection: INR 2,00,000 - 5,00,000
• Sentinel Lymph Node Biopsy: INR 50,000 - 1,50,000

Sentinel Lymph Node Biopsy

The sentinel lymph node (SLN) is the first node to which cancer cells are likely to spread. During surgery, sentinel lymph nodes are removed and tested for cancer cells. This involves injecting a radioactive material and dye near the tumor, which travels to the lymph nodes. The nodes containing the dye are removed and examined. If cancer is found, further treatment may be needed.

Discover the Best Oncologists and Cancer Hospitals in India

When it comes to cancer treatment, finding the right specialist and hospital can make a significant difference in the outcome. In this blog, we have compiled a list of the top oncologists and cancer hospitals across major cities in India, ensuring that you have access to the best care available.

Top Oncologists in Major Cities

For those seeking expert oncologists, we have identified the best specialists in key cities:

• Best Oncologist in Delhi
• Best Oncologist in Mumbai
• Best Oncologist In India

Leading Cancer Hospitals

In addition to finding the right specialist, choosing the right hospital is crucial for comprehensive cancer care. Here are the top hospitals in major cities:

• Top 5 Cancer Hospitals in Mumbai
• Top 5 Cancer Hospitals in Delhi
• Top 10 Cancer Hospitals in India

Conclusion

Finding the right oncologist and hospital is the first step in your cancer treatment journey. Explore the links above to learn more about the top specialists and hospitals in your area.