The Indian Council of Medical Research (ICMR) has issued a 'consensus document' for the management of buccal mucosa cancer, which is one of the commonest oral cavity cancer in India.
Senior ICMR officials said that the document is the result of deliberations of a group of experts and is a consensus document based on the available evidence. The document is recommendatory in nature and not binding on a treating oncologist or a team of oncologists.
The need to develop consensus document for buccal mucosa cancer arose due to the fact that even though several international consensus guidelines are available for the management of oral cavity cancers, none of them addresses buccal mucosa cancers in particular. Therefore, formulating reliable guidelines based on western data is questionable given the fact that buccal mucosa tumours are quite rare in the developed countries, officials said.
There is obviously an urgent need to formulate consensus document for the management of carcinoma of buccal mucosa based on Indian data and experience which would not only incorporate the evidence available but would also be feasible to be practiced in the hospitals of India.
As per the data available from the National Cancer Registry Programme (Population Based Cancer Registries), of the ICMR, the males of Ahmedabad urban showed highest Age Adjusted Rate (AAR) for mouth cancer followed by Bhopal. However, for females, Bengaluru showed the highest AAR followed by Kamrup urban district. In the Hospital Based Cancer Registry report, cancer of the mouth is also ranked as the leading site in Mumbai in males and was within the first five leading sites in all registries in males.
In the developed countries, carcinoma buccal mucosa is relatively uncommon as compared to the Indian subcontinent. The high incidence of carcinoma of the buccal mucosa in India is attributable to the extensive use of tobacco in various forms and the locally advanced cancers account for about 70 per cent of the cases at the time of presentation.
The reported five-year survival rates for buccal mucosa cancers in India ranges from 80 per cent for stage I disease to five to 15 per cent for locally advanced disease. There is lack of consensus over the use of surgery, radiotherapy and chemotherapy in the treatment of advanced buccal mucosa cancers. This includes sequence/combination of the different modalities and the use of concurrent chemo radiotherapy. Recurrent disease after surgery and/or radiotherapy is difficult to salvage and therefore it is necessary to provide optimum, state-of-the-art, evidence based care to patients to improve cure rates with minimum morbidity and good quality of life.
So, providing treating doctors with uniform guidance for the management of buccal mucosa cancer appears to be an appropriate step forward in achieving this goal, ICMR officials said.