It all started during a routine dental visit when Joseph Letiang’s dentist noticed a white patch in his mouth.
“I was not aware of any changes in my mouth. Although I drank occasionally, I have never smoked in my life and always thought my mouth was healthy. However, my dentist recommended that I see a specialist oral surgeon who examined my mouth and took samples from the inside of my jaw and gums,” says the 55-year-old father of three.
On his return visit, it was confirmed that he had cancerous cells in his right jaw and lower right gum.
“It’s now four years since I was first diagnosed as a ‘head and neck’ cancer patient,” says Mr Letiang, who is the lucky one and back to work.
Emma Wainaina, a dental surgeon at a private facility in Nairobi, shares a case of a patient who was diagnosed with oral cancer but faced challenges in accepting the diagnosis despite undergoing multiple tests, including sending lab samples abroad for confirmation. Regrettably, the patient eventually died due to the disease.
“It is painful that we are losing many patients due to late diagnosis. It is hard to talk about it. We can only hope for better days,” says Shem Rakewa, a resident in oral and maxillofacial surgery at Eldoret-based Moi Teaching and Referral Hospital.
While discussions on the disease have traditionally focused on breast, cervical, and throat cancers, the impact of other types is growing and requires prompt medical attention.
Head and neck cancer, of which oral cancer is about 90 percent, is sending thousands of Kenyans to early graves.
Dr Rakewa defines oral cancer as a disease that causes the mouth cells to grow uncontrollably and spread to other parts of the body.
“Oral cancers develop on the tongue, the jaw bones, the lips, the tissue lining the mouth and gums, under the tongue, at the base of the tongue, and the throat at the back of the mouth. They can be painless ulcers or swellings, which sometimes hurt when slightly irritated,” he says.
Oral cancer is often detected at an advanced stage when it has already spread to other parts of the body, especially the lymph nodes. This is due to low awareness of the disease.
Dr Rakewa says diagnosis of oral cancer in time could save a patient’s life and prevent further spread.
Depending on the type of cancer, it affects men more than women, and most cases occur between the ages of 40 and 50.
“Men have poor oral hygiene, which makes them common victims. It is not prevalent in children because they are not into the habits that cause the disease,” says Dr Wainaina.
The data the World Health Organisation published in 2020 shows the number of deaths due to oral cancer in Kenya was 1,842, ranking 13th globally.
Dr Rakewa says oral and maxillofacial surgeons see an average of at least 10 cases of oral cancer each week in varying stages of the disease.
In contrast, Dr Wainaina, who works in a private facility, believes that the statistics may be biased due to several factors, such as the high cost of treatment, the facility’s location in a less populated area, and the preference of many people to visit public hospitals.
However, she says there has been an increase in reported cases of oral cancer.
Dr Wainaina said the cause of cancer is currently unknown, but for oral cancer, the tongue is one of the most difficult places to have it due to its high blood supply, which causes cancerous cells to spread rapidly.
“Common causes of oral cancer include viruses such as herpes, HIV, and syphilis,” says Dr Wainaina.
“Drug abusers such as nicotine and miraa are at higher risk of contracting oral cancer. Miraa irritates the lining of the mouth, which then can cause oral cancer," says Dr Wainaina.
She advises one should be careful where they get their foodstuffs from since some contain aflatoxins, which are associated with oral cancer.
Dr Rakewa also notes that being infected with human papillomavirus (HPV) increases the risk of oral cancers.
“HPV is associated with warts in children. The symptoms are almost similar in children and adults,” he says.
“Using tobacco, excessive alcohol consumption, radiation including sun rays, and the presence HPV (mainly type 16) increase the occurrence of oral cancers.”
Studies have shown that Tobacco is estimated to increase the risk of oral cancer by 3.4–6.8 and is responsible for approximately 40 percent of all oral cancers.
Epidemiological evidence indicates that alcohol consumption is strongly associated with oral cancer, accounting for 20 percent of global oral cancer cases in 2020.
“There is more risk when both alcohol and tobacco are used by one person. It gets worse with poor oral hygiene,” says Dr Rakewa.
Symptoms, he says, vary in every person.
“In the mouth, it most commonly starts as a painless white patch that thickens, develops red patches, an ulcer, and continues to grow. When on the lips, it commonly looks like a crusting ulcer that does not heal, and slowly grows. In the jaw bone, it can be a small hard swelling that grows,” says Dr Rakewa.
The common symptoms of oral cancer he says include a lump on the neck or throat, as well as a red or white patch in the mouth that lasts for more than three weeks.
Other symptoms may include difficulty chewing, swallowing, speaking, or moving your tongue or jaw, swelling in the jaws or mouth, unexplained weight loss, bleeding in the mouth, and shaking or loosened teeth. It's important to note that oral cancers are rare in children.
“Oral cancer also presents as a non-healing wound which is migratory itch; sometimes on the right side of the cheek, then on the left, comes back on the right, an itch that doesn’t end,” adds Dr Wainaina.
Stages of oral cancer
Oral cancer staging is a way to describe or classify cancer based on its extent when it is first diagnosed. The staging helps in planning treatment and predicting outcomes.
“Oral cancer has five stages ranging from stage zero to stages one to four. Generally, the higher the stage number, the more the cancer has spread," says Dr Rakewa.
“The local stage means that the cancer is only in the mouth and has not spread to other parts of the body. Regional means the cancer has spread to the lymph nodes in the neck region while distant means in a part of the body farther from the mouth like the lungs,” he adds.
Treatment options and cost of oral cancer
When a patient presents to the primary doctor or dentist for a comprehensive oral examination, the treatment process begins. The examiner checks the mouth for any ulcers, swellings or changes in the mouth lining.
Subsequently, a series of painless investigations are performed. Dr Rakewa mentions that they always begin with ultrasounds, plain X-rays, CT scans, or MRI scans before conducting a biopsy. Biopsies help confirm a diagnosis made using imaging or clinical examination.
“The three standard treatments available in Kenya are surgery, chemotherapy which uses drugs to stop cancer cells growth, by killing the cells or stopping cell division, and radiation therapy which uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing," he says.
When diagnosed early, Dr Rakewa says the outcomes are very good with full resolution of the oral cancer. However, late diagnosis and initiation of treatment need a combination of surgery and chemotherapy or radiotherapy.
“On the costs of treatment; the earlier the diagnosis is made, the lower the cost of treatment. Some unfortunate cancer patients present so late that no treatment is beneficial,” he says.
So how can oral cancer be prevented?
“This question cannot be answered until we know what mainly causes oral cancers,” says Dr Rakewa.
He however suggests that people avoid the risk factors associated with oral cancers.
According to research, the relative risk for oral cavity and pharynx cancer is 1.13 for light, 1.83 for moderate, and 5.13 for heavy drinking.
Additionally, he recommends a firmer stance on the use of 'shisha' due to its high dosage of tobacco, which can be harmful to consumers.
"Most importantly, we must visit qualified dental professionals for early diagnosis and treatment of oral cancers. More awareness needs to be made on oral cancers,” says Dr Rakewa.
Untreated cancer
"Left untreated, oral cancer can spread to other areas of the body, making it difficult to manage and ultimately leading to death," says Dr Wainaina.
