Oral Cancer: Symptoms and the Link with Paan, Gutka and Naswar

In Pakistan, a paan after lunch, a pinch of naswar under the lip or a packet of gutka or chalia during the day is an everyday habit for millions of people. It is also the main reason Pakistan has one of the highest rates of mouth cancer in the world. Oral cancer is often found late, because early signs look like harmless ulcers. But when it is caught early, it can often be treated successfully, and the best protection is simple: stop chewing and smoking tobacco and areca nut.

What is oral cancer?

Oral cancer starts in the lining of the mouth. It can appear on the lips, tongue, inner cheeks, gums, floor of the mouth, palate or throat. The most common type is squamous cell carcinoma. It often starts as a small patch or sore that slowly grows.

Oral cancer symptoms

• A mouth ulcer that does not heal within two to three weeks
• A white or red patch inside the mouth or on the tongue that does not rub off
• A lump, thickening or rough spot in the cheek, tongue or neck
• Pain, burning or numbness in the mouth or tongue
• Difficulty chewing, swallowing, speaking or moving the tongue
• Difficulty opening the mouth fully, with a tight, stiff feeling in the cheeks
• Loose teeth, or a denture that no longer fits
• Unexplained bleeding in the mouth, a persistent sore throat or a hoarse voice
• A swelling in the neck that does not go away

A normal mouth ulcer is painful and heals in about one to two weeks. A cancerous ulcer is often painless at the start and keeps growing.

What causes oral cancer?

• Chewing tobacco products: naswar, gutka, khaini, mawa and tobacco added to paan
• Areca (betel) nut, which is found in paan, chalia and gutka. Areca nut itself causes cancer and a condition called oral submucous fibrosis.
• Smoking cigarettes, bidis, hookah and shisha
• Alcohol, especially combined with tobacco
• Human papillomavirus (HPV) infection, mainly for cancers at the back of the throat
• A sharp tooth, broken tooth or ill-fitting denture that repeatedly irritates one spot, together with poor oral hygiene
• Long exposure to sun on the lips

The longer and more often you chew, the higher the risk. Holding the quid in the same spot in the cheek is particularly harmful.

Check your own mouth

Once a month, look in a mirror with good light. Check the lips and inside of the lips, the cheeks, gums, the top and underside of the tongue, the floor and roof of the mouth, and feel the neck for lumps. Any ulcer, patch or lump that lasts more than two weeks needs to be seen by a doctor or dentist. If you use tobacco or areca nut, ask for a mouth check at least once a year.

Diagnosis

A doctor or dentist examines the mouth, and if there is a suspicious area, takes a small tissue sample (biopsy) for testing. Scans such as CT or MRI show how far the disease has spread.

Treatment

Treatment is decided by a cancer team and depends on the size and place of the tumour and whether it has spread. Surgery is the main treatment for most oral cancers, sometimes followed by radiotherapy, with or without chemotherapy. Early cancers can often be removed with small operations and good results, while advanced cancers need larger surgery and rehabilitation of speech and swallowing. This is why early detection matters so much.

How to protect yourself

• Quit all forms of chewing tobacco, areca nut and smoking. Cancer risk starts falling after you quit, and it falls further every year.
• Ask your doctor for help to quit. Support, counselling and medicines can double your chances.
• Avoid alcohol, or keep it minimal.
• Brush twice a day, see a dentist regularly, and get sharp teeth and badly fitting dentures corrected.
• Eat plenty of fruit and vegetables.
• Protect your lips from strong sun, and talk to your doctor about HPV vaccination for teenagers.
• Keep children away from paan, gutka and chalia, because habits that start young are hard to stop.

When to see a doctor

• A mouth ulcer, white or red patch or lump lasting more than two to three weeks
• Unexplained bleeding, numbness or pain in the mouth
• Difficulty opening the mouth, chewing or swallowing
• A lump in the neck

Key takeaways

• Naswar, gutka, paan with tobacco, chalia and smoking are the main causes of oral cancer in Pakistan.
• A mouth ulcer or patch that does not heal in two to three weeks must be checked.
• Early oral cancer is very treatable, and quitting at any age lowers your risk.
• Monthly mouth self-checks and a yearly dental visit can save your life.

Related medicines on Medimart

Cancer treatment is decided by your oncologist. A commonly used supportive medicine during chemotherapy:

• Ondansetron: helps control nausea and vomiting from chemotherapy

Prescription medicines are supplied only against a valid prescription. Please take them only as advised by your doctor.

Browse cancer care medicines and supportive products on Medimart with delivery across Pakistan. Prescription medicines are supplied only against a valid prescription.

This guide is for general information and does not replace advice from a doctor or dentist. Any mouth sore that does not heal in two to three weeks should be examined.