Oral Cancer Treatment in Mumbai

Our Approach To Oral Cancer Management

Screen proactively. Biopsy promptly. Treat decisively.

The statistics surrounding oral cancer in India are sobering - it accounts for approximately 30% of all cancers diagnosed in the country, with five-year survival rates that remain unacceptably low because of the stage at which most patients are first seen. Yet the oral cavity is one of the most accessible parts of the body for clinical examination - every dental visit is an opportunity for trained eyes to detect changes that a patient themselves may not notice or may not know to be concerned about.

At Shree Hospitals, our approach to oral cancer screening and biopsy diagnosis in Mumbai integrates systematic oral mucosal screening into every dental consultation - because finding a suspicious lesion at three millimetres and biopsying it immediately is infinitely more effective than finding it at three centimetres when treatment options are far more limited and outcomes far less certain.

1. Systematic Oral Mucosal Examination

• Comprehensive soft tissue examination at every dental consultation - lips, buccal mucosa, tongue, floor of mouth, hard and soft palate, and oropharynx
• Risk factor documentation - tobacco, alcohol, betel nut, and HPV exposure history recorded and used to stratify examination urgency
• Identification of premalignant lesions requiring biopsy:
• Leukoplakia - white patch in mouth symptoms that cannot be wiped off and has no identifiable benign cause
• Erythroplakia - red velvety patches carrying significantly higher malignant transformation risk than white lesions
• Oral submucous fibrosis - restricted mouth opening with mucosal stiffness from betel nut chewing
• Oral lichen planus - particularly the erosive form requiring monitoring and biopsy if change occurs
  

2. Adjunctive Detection Technologies

• VELscope (Velvet Enhanced Lesion Scope) - fluorescence visualisation technology identifying abnormal tissue metabolism not visible under white light
• Toluidine blue vital staining - a dye that selectively concentrates in rapidly dividing cells, identifying areas within a lesion most likely to show dysplasia on biopsy
• Oral brush cytology for initial assessment of suspicious lesions as an adjunct to planned biopsy

3. Biopsy & Histopathological Diagnosis
    
   Definitive diagnosis requires tissue, not clinical impression:

• Incisional biopsy - sampling the most suspicious area of a larger lesion using a scalpel or punch technique under local anaesthesia
• Excisional biopsy - complete removal of small suspicious lesions for both diagnostic and therapeutic purposes
• Histopathological grading - distinguishing hyperkeratosis, dysplasia (mild/moderate/severe), carcinoma in situ, or invasive squamous cell carcinoma
• Immunohistochemistry and molecular markers for HPV status determination in oropharyngeal lesions
• Rapid turnaround reporting ensuring no delay between biopsy and treatment planning

4. Staging & Treatment Planning
    
   Once malignancy is confirmed:

• Clinical staging using TNM classification - tumour size, lymph node involvement, and distant metastasis assessment
• MRI of the primary site and neck - defining tumour extent and perineural invasion
• CT chest and abdominal imaging for nodal and metastatic staging
• PET-CT for selected cases where occult nodal or distant disease is suspected
• Multidisciplinary tumour board discussion - oral surgeon, radiation oncologist, medical oncologist, and reconstructive surgeon reviewing every case together

5. Surgical Management - Mouth Cancer Surgery
    
   Mouth cancer surgery and oncology care remains the primary curative modality for most oral cancers:

• Wide local excision with clear surgical margins - removing the tumour with a minimum of 1 to 1.5 cm of surrounding normal tissue
• Neck dissection (selective or modified radical) - removing regional lymph nodes at risk of occult metastatic spread
• Reconstruction - primary closure for small defects, local flaps for medium defects, free flap microvascular reconstruction (radial forearm, anterolateral thigh, fibula osteocutaneous flap) for large or composite defects
• Mandibulectomy (marginal or segmental) when bone is involved - with fibula flap reconstruction for composite jaw defects
• Intraoperative frozen sections - confirming clear margins during surgery before wound closure

6. Adjuvant Therapy & Rehabilitation

• Post-operative radiotherapy for high-risk pathological features - positive margins, nodal spread, or perineural invasion
• Concurrent chemoradiotherapy for locally advanced disease - cisplatin-based protocols as radiosensitiser
• Speech therapy - addressing post-surgical articulation changes
• Swallowing rehabilitation - particularly after tongue base or floor of mouth resection
• Dental rehabilitation - addressing post-radiation xerostomia, dental caries, and prosthodontic needs after treatment