New Delhi [India], May 28: Every year on 31st May, World No Tobacco Day reminds us about a disease that many patients never think will happen to them.
Cancer.
As a Head & Neck Surgical Oncologist, one statement I hear repeatedly in my OPD is:
“Doctor, I thought it was just a small ulcer.”
“Doctor, I thought it would heal on its own.”
“Doctor, there was no pain, so I ignored it.”
Unfortunately, oral cancer often begins quietly.
Many people expect cancer to create severe pain, dramatic symptoms, or obvious warning signs.
Real life is different.
Sometimes it starts with nothing more than a tiny mouth ulcer that refuses to disappear.
And by the time patients seek help, weeks or months may already have passed.
India carries one of the world’s highest burdens of oral cancer, and tobacco remains one of the biggest contributors. Oral cancers represent a substantial cancer burden in India, and tobacco exposure remains strongly linked with disease development.
As Dr. Bhavin Vadodariya, MS, DrNB Surgical Oncology, Lead Consultant Surgical Oncologist at SSO Cancer Centre Ahmedabad, I want to discuss warning signs people commonly ignore.
1. A Mouth Ulcer That Does Not Heal
This is perhaps the most common presentation.
People frequently assume:
Vitamin deficiency
Heat in the body
Stress ulcers
Food irritation
Tooth injury
Most ulcers heal within approximately two weeks.
If a lesion continues beyond that period, it deserves evaluation.
Not every persistent ulcer is cancer.
But every persistent ulcer deserves attention.
2. White Or Red Patches Inside The Mouth
Many patients discover these accidentally.
Some notice:
White patches on cheeks
White tongue lesions
Red irritated areas
Mixed red-white patches
They may be painless.
Because there is no discomfort, people ignore them.
These changes can sometimes represent potentially precancerous alterations requiring evaluation.
3. Difficulty Swallowing
Patients frequently explain:
“Food feels stuck.”
“Doctor, swallowing feels strange.”
“Maybe acidity.”
Persistent swallowing difficulty should never be ignored.
4. Reduced Mouth Opening
In India, gutkha and smokeless tobacco use remain major risk factors.
Repeated exposure may gradually lead to:
Tightness inside cheeks
Burning sensation
Difficulty opening mouth
Smokeless tobacco products, including gutkha and related products, remain important contributors to oral cancer burden.
5. Neck Swelling
Sometimes the first symptom is not inside the mouth.
The first complaint becomes:
“Doctor, there is a swelling in my neck.”
Cancer cells can occasionally spread into lymph nodes before patients notice the primary lesion.
Why Patients Delay Diagnosis
As doctors, we repeatedly observe common reasons:
Fear
Denial
Internet misinformation
No pain
People fear biopsy.
Many believe:
“This cannot happen to me.”
People attempt self-diagnosis.
Absence of pain creates false reassurance.
Unfortunately, oral cancer does not always announce itself loudly.
A Message To Tobacco Users
Many patients believe:
“I don’t smoke.”
“I only chew tobacco.”
“I use gutkha occasionally.”
The body does not distinguish between occasional and regular injury.
Tobacco in smoked and smokeless forms significantly increases cancer risk. Studies in Indian populations demonstrate increased risk across multiple cancer types, including head and neck cancers.
My Message On World No Tobacco Day
As surgeons, we operate.
We remove tumors.
We reconstruct tissues.
But prevention remains stronger than surgery.
Early-stage oral cancers may often be treated more effectively than advanced disease.
The greatest surgery is often the one that never becomes necessary.
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