Dr. Dilip Murarka Onco Surgeon

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Dr. Dilip MurarkaOnco Surgeon
Towards a tobacco free World

• Consultant
• KOHINOOR HOSPITALS
• Kohinoor City, Kirol Road, Opp LBS marg, Kurla ,
  Mumbai-70
• Tel- 67556755/30553055

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One third of all cancers in India are tobacco
related, 2 lacs cases per year. 14.2 cr man
7.2 cr women above the age 15 consumes tobacco in
India The government spends 1000 Cr. Of Rs on
the treatment of tobacco related cancers every 5
years
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Tobacco is smoked- in cigarettes, beedis, chutta,
dhumti, clay pipes Hokas.Tobacco is chewed- in
paans with or Without lime betel nutsTobacco
is used for the teeth- as masheri tobacco
toothpasteTobacco is used as a snuff in paan
masalasAll these forms of Intake are harmful
causes an Increase incidence of tobacco related
cancers
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DO YOU KNOW?
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DO YOU KNOW?
Atmaram has more chances of developing cancer
and other diseases in comparison to Sakharam.
Why is this so?

• SAKHARAM
• Does not use tobacco in any form
• Keeps his mouth clean

• ATMARAM
• Smokes Beedi since 18 yrs of age
• Chews Gutkha since the last 5 years

Nearly 40 of cancers detected in India are
because of tobacco use. Tobacco contains Nicotine
which is an addictive agent. This addiction makes
the user a slave to tobacco
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COMMON CAUSES OF HEAD AND NECK CANCERS
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COMMON CAUSES OF HEAD AND NECK CANCERS

• There are a number of reasons why these
• cancers occur. The most common cause is use
• of tobacco in any form. Tobacco contains over
• a 1000 chemicals many of which play a role in
• the initiation of cancer. Tobacco can be used as
• Cigarette Smoking
• b. Beedi Smoking

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COMMON CAUSES OF HEAD AND NECK CANCERS
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COMMON CAUSES OF HEAD AND NECK CANCERS
c. Hookah Cut, shredded tobacco moistened with
molasses is kept in the bowl and is burnt with
charcoal. The smoke is drawn through the water,
which cools and filters it. This form of smoking
is common in North India. d. Paan Consists of
betel leaf, catechu, slaked lime and betel nut.
It may not contain tobacco. Pan chewing is a
socially accepted habit in our country especially
in the northern and eastern parts. Unfortunately
each of the ingredients used in paan affect oral
health
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Two thirds of the smoke from burning cigarette
does not reach the smokers lung but instead goes
directly into the air. The effects of this smoke
are similar to tobacco smoke inhaled by active
smokers. An increased the risk of lung cancer has
been shown in wives of husbands who smoke.
Inhaling of air containing tobacco smoke is
called passive smoking.
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The risk of passive smoking does not stop with
cancer. There is increase incidence of heart
disease in a passive smokers. Children of parents
who smoke has an increase incidence of cough,
bronchitis, ear infection pneumonia. Children
exposed to their parent cigarette smoke have six
times the number of respiratory infection. If a
pregnant women chew or smoke tobacco it will have
an adverse effect on foetus.
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COMMON CAUSES OF HEAD AND NECK CANCERS
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COMMON CAUSES OF HEAD AND NECK CANCERS
e. Pan Masala is a commercial preparation
containing areca nut, slaked lime, catechu. Many
brands of pan masala contains tobacco (Gutkha).
Pan masala has all the ingredients of a paan but
it is not perishable. The Indian market is being
flooded by this form and it is becoming very
popular due to aggressive advertising. f. Mava
is sold as a mixture containing areca, tobacco
Lime.
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COMMON CAUSES OF HEAD AND NECK CANCERS
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COMMON CAUSES OF HEAD AND NECK CANCERS
g. Khaini contains dried tobacco and slaked
lime. These are carried separately in a metal
container. When required, a little bit of tobacco
an lime are taken in the palm and mixed
thoroughly and then placed in the mouth. h.
Creamy snuff is a tobacco paste marketed in
toothpaste like tubes.
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COMMON CAUSES OF HEAD AND NECK CANCERS
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COMMON CAUSES OF HEAD AND NECK CANCERS

• Masheri is prepared by roasting tobacco on a hot
  metal plate till it is uniformly black. It is
  then powdered before using for brushing teeth.
  This is very common in Maharashtra, especially in
  women.
• Alcohol Besides tobacco another important
  cause of head and neck cancers is alcohol.

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COMMON SITES FOR HEAD AND NECK CANCERS
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COMMON SITES FOR HEAD AND NECK CANCERS

• Oral cavity cancer refers to cancer of the lips,
  floor of the mouth, gums, tongue, cheeks and
  palate.
• Use of tobacco in any form can cause cancer of
  the oral cavity, voice box, food pipe, lungs and
  many other organs.

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PRECANCER CHANGES IN ORAL CAVITY
RED PATCH
WHITE PATCH
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PRECANCER CHANGES IN ORAL CAVITY

• Luckily for us, before oral cancer
  develops, the body will give certain warning
  signals. These are also known as precancer
  lesions. Most oral cancers develop from these
  precancer lesions. Therefore it is important to
  look for these signs.
• Leucoplakia/ white patch in mouth This white
  patch normally develops at the site where the
  person places the tobacco in the mouth. However
  it may be seen in non tobacco users also.
• Erythroplakia/ red patch in mouth This red patch
  can develop anywhere in the oral cavity. These
  colour changes of white/ red/ black patches are
  seen usually on the tongue, gums, angle of the
  mouth, cheeks and floor of the mouth.

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PRECANCER CHANGES IN ORAL CAVITY
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PRECANCER CHANGES IN ORAL CAVITY

• c. Submucous fibrosis there is a uniform
  whitish discolouration of the oral cavity with
• Difficulty in opening mouth fully
• There is intolerance to spicy food
• It is usually seen with chewing tobacco/ Pan
  masala
• d. Non- healing ulcer This ulcer is usually
  painless, keeps increasing in size, does not show
  signs of healing.

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OTHER HARMFUL EFFECTS OF TOBACCO
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OTHER HARMFUL EFFECTS OF TOBACCO

• Unfortunately, besides cancer, tobacco use causes
  a number of other diseases also.
• Chronic Bronchitis This is infection of the
  lining of the breathing tubes in the lungs.
  Infection occurs because of damage to delicate
  cells. The damage results from prolonged exposure
  to irritants from cigarette smoke.
• Peripheral vascular diseases There is narrowing
  of blood vessels that carry blood to the leg and
  arm muscles. This is dangerous because if a blood
  clot blocks a narrow artery, it can result in
  damage or loss of the limb. Smoking is a major
  risk factor for this disease.

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OTHER HARMFUL EFFECTS OF TOBACCO
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OTHER HARMFUL EFFECTS OF TOBACCO
c. Heart attack Cigarette smoke, high blood
pressure, high cholesterol levels and physical
inactivity are the four major risk factors for
heart attack. The more cigarettes a person smokes
the greater the risk of a heart attack. d.
Babies born to mothers who smoke can be more
sickly. Smoking can cause a pregnant woman to
lose her baby and children of parents who smoke
have more health problems than children of
non-smokers.
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Early stages of almost all tobacco related
cancers can be cured with 80 success. Advanced
stages however required extensive treatment, at
times with disfiguring surgery. Ignoring the sign
and symptoms in the belief that they will go away
can be a fatal mistake. The sooner cancer is
diagnosed, the earlier the treatment can be
gained and with the favorable outcome.
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INVESTIGATIONS TO HELP DIAGNOSE HEAD NECK
CANCERS
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INVESTIGATIONS TO HELP DIAGNOSE HEAD NECK
CANCERS

• A number of investigations help in diagnosing
  cancer of head and neck region. Some of the
  routine investigations used are as follows.
• Biopsy Here the doctor collects a small sample
  of the suspected tumor and this specimen is then
  examined under a microscope to confirm the
  presence of cancer cells.
• b. Indirect laryngoscopy Here the doctor use
  the laryngeal mirror to examine for cancer in the
  voice box. The mirror resembles the dentists
  mirror and has a long handle. If the cancer is
  suspected then further investigations can be
  done.

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INVESTIGATIONS TO HELP DIAGNOSE HEAD NECK
CANCERS
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INVESTIGATIONS TO HELP DIAGNOSE HEAD NECK
CANCERS
c. Chest X- Ray Chest X- Rays are important in
detecting lung cancer. Besides this there are a
number of other procedures which can be used for
diagnosing lung cancer. d. Barium Sallow
Barium Sulphate is a radio opaque dye used for
taking special X- Rays where the patient swallows
the dye and X- Ray is taken. This helps in
identifying any lesion in the food pipe.
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TREATMENT OF HEAD AND NECK CANCERS
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TREATMENT OF HEAD AND NECK CANCERS

• Treatment Modalities
• Surgery
• Radiation
• Chemotherapy

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CORRECT YOUR MISCONCEPTIONS
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CORRECT YOUR MISCONCEPTIONS
a. Cigarette smoking is more harmful than
Beedi. No! Both cigarettes and beedi are
harmful to the body. Infact, one puff of a beedi
is as harmful as two puffs of a cigarette. b.
Smoking tobacco is harmful to the body but other
forms of tobacco are not so harmful. No!
Both smoking and smokeless tobacco are similarly
addictive and carcinogenic though the sites of
damage may differ. Infact in our country, the
habit of chewing tobacco is increasing in all
sections of the society. c. Some cigarettes are
less harmful than others No! There is no
such thing as a safe cigarette.
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CORRECT YOUR MISCONCEPTIONS
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CORRECT YOUR MISCONCEPTIONS
d. I can get cancer only if I am a heavy
smoker. No! the very fact that you use tobacco
increases your risk of getting cancer. The
quantity of tobacco smoked or chewed only
determines the degree of risk e. I am harming
only myself by smoking. No! Passive smoking is
exposure of non smokers to air polluted by
tobacco smoke. It can be considered as a form of
smoking because the non-smoker is exposed to many
of the harmful substances in this smoke. The
non-smoker inhales this polluted air as a part of
the necessary act of breathing. It is not by
choice.
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YOU CAN HELP YOURSELF AND YOUR LOVED ONES
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YOU CAN HELP YOURSELF AND YOUR LOVED ONES

• Its never too late to quit this addiction. No
  matter how long you have used tobacco but the
  body repairs much of the damage when you give up
  tobacco. Your circulation will improve and your
  lungs will begin to repair themselves. You will
  stop harming those you love and whats more, you
  can save all that money! So.
• Stop using tobacco in any form
• Select a quit day to put your Promise into
  Practice.
• Deep breathing makes you calm and helps you cope
  with the urge to use tobacco.

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YOU CAN HELP YOURSELF AND YOUR LOVED ONES
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YOU CAN HELP YOURSELF AND YOUR LOVED ONES

• Do something else when you feel the urge to
  smoke or chew tobacco. This will help you keep
  your mind off tobacco.
• Delay the act, Count to 100 and think pleasant
  thoughts because the urge to use tobacco will
  pass in 5-10 minutes whether you have tobacco or
  not.
• Collect the money saved from each pack of
  cigarette or Pan masala. You can buy a gift for
  your family with all that money.

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• It is not very simple but we can do it.
  Surprisingly 85 of tobacco users wish to give a
  try.
• Decide positively that you want to quit.Educate
  yourself to the harmful effect of tobacco.
• Stop tobacco use totally Gradual reduction in
  tobacco consumption usually fails
• Avoid Situation that increase your urge for
  tobacco
• Get health conscious walk, jog, exercise, swim
• Collect the money that you save as it multiplies
  you will realize what you have lost all these
  years.
• The urge to use tobacco is very strong in the
  first few days after stopping. Once you get past
  this the rest is easy STAY STOPPED!Even a simple
  cigarette/ paan can take you into the habit all
  over again

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• Avoid prolonged placement of the paan in your
  mouth.The longer the contact the greater is the
  risk.
• Maintain meticulous oral hygiene.
• Examine your mouth in a mirror at least once a
  month, look for cleanliness of your mouth,
  condition of your teeth and gums, any red and
  white patches on the tongue or cheeks. These are
  the warning signs should not be ignored.
• A change in once voice persistence cough,
  hoarseness, pain and difficulty in swallowing
  should look into it.
• A chronic smoker should undergo a periodical
  X_Ray chest and check up by competent doctor at
  least once in a year.

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1 cigarette loss of 2 breaths 1 beedi loss of
3 breaths 1 packet of gutka loss of 4 breaths
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One life- yours
Recipes of death - multiple

• Tobacco does not affect only your health, but
  also the health of people who love you and who
  you care about.
• Passive smoking harms your familys health
• Children elders follow their bad habits of
  tobacco use.

Do you want them to pay the price of love
by death?
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Save for a Better life or Spend to end your Life
Expenses Diseases
Pain Death
Savings Health Happiness Life
Choice is yours A Saving
of Rs 5 every day, amounts to Rs. 1825 every
year. Just think how much you save
in your life time?
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Live Life King Size
And died a slow painful death
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Its your Choice. Its your life
OR
Tobacco has many forms, but the end is one-
Disease and Death
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With friends like these who needs enemies?
Are they truly your friends?
Do they really care? If they care, then would
they give you tobacco, the ingredient of death?
Think about it?
When a loved one dies the heart
of a family bleeds. Dont make your family
suffer the consequences of your friendship
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Dr. Dilip Murarka
Thank
You