The Indian Council of Medical Research (ICMR) has issued a draft 'consensus document' for the management of tongue cancer where India shows high incidence rates of oral cavity cancers forming a major health burden.
According to senior ICMR officials, this document represents a consensus on the current principles of management for tongue cancers. It has been put together by a team of national experts in the field.
Officials said that there is no level 1 evidence for a number of issues on the subject and the expert committee has therefore taken into account published literature and institutional experience of members of the task force who are leaders in the field. These guidelines are meant to aid clinicians nationally and are nowhere binding.
The committee is appreciative of the fact that there is wide variation in the infrastructure amongst treating oncology centres. Taking into consideration peripheral oncology centres, regional cancer centres and tertiary cancer centres in major cities, the set of recommendations includes two categories -
Desirable/Ideal: Tests and treatments that may not be available at all centers but the centers should aspire to have them in the near future.
Essential: Bare minimum that should be offered to all the patients by all the centers treating cancer patients.
The need to develop a consensus document for tongue cancer arose due to the fact that a recent national representative survey of cancer mortality in India demonstrated oral cavity cancer as the leading cause of mortality in men which was responsible for cancer-related deaths in 22.9 per cent cases.
Oral cancer forms the 16th most common type of cancer worldwide with a crude incidence rate of 3.91. There are about 0.2 million new cases every year worldwide with 0.1 million deaths each year. On global comparison India shows high incidence rates of oral cavity cancers forming a major health burden. Age standardised incidence rate in India is 7.5 per 100,000 population while in western Europe and USA it is 4.6 and 3.8 per 100,000 population respectively.
Tobacco is the single most important risk factor for cancers of the oral cavity including tongue cancers. The use of both smoked as well as smokeless tobacco predisposes a person to cancer. Tobacco specific nitrosamines (TSNA) present in smokeless tobacco are the most harmful carcinogens which are also responsible for various precancerous lesions. Arecanut by itself is also a carcinogen.
Alcohol is a known group 1 carcinogen. It has a synergistic effect when used in combination with tobacco. Studies have reported several fold increased risk of cancer in the presence of excessive use of both the agents. The use of alcohol is important risk factor for carcinoma of oral tongue and floor of mouth.