From Surgery To Immunotherapy: Doctor Explains Advances In Oral Cancer Treatment

Oral cancer, medically known as oral squamous cell carcinoma, remains a major health concern, particularly in India where tobacco use, alcohol consumption, and delayed diagnosis continue to drive high incidence rates. Despite improvements in care, overall survival still hovers around 50 to 60 per cent. However, the treatment landscape is now undergoing a significant shift, offering new hope to patients. According to a study in journal Oral Oncology, in India, oral cancer contributes significantly to the global burden, with an estimated 77,000 new cases and 52,000 deaths reported annually representing nearly one-fourth of worldwide incidences.

Why Oral Cancer Remains A Concern In India

India carries one of the highest burdens of oral cancer globally. Lifestyle factors such as chewing tobacco, smoking, and alcohol use are among the leading causes. Adding to the challenge is late detection, with many patients presenting at advanced stages when treatment becomes more complex. Early diagnosis can make a life-changing difference. When detected in Stage I or II, oral cancer is often highly treatable.

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Is Surgery Still The Foundation Of Treatment

"For patients diagnosed early, surgery alone can be highly effective, with cure rates of 70 to 80 per cent," says Dr Imran Khan, Consultant, Medical Oncology, Fortis Escorts, Okhla, Delhi. Surgical removal of the tumour remains the cornerstone of treatment. In many cases, it is followed by radiation therapy or chemotherapy to reduce the risk of recurrence, especially in patients with high-risk features. However, these traditional treatments are not without challenges. Patients may experience side effects such as painful mouth sores, stiffness in the jaw, and long-term difficulties in speaking or swallowing, which can significantly impact quality of life.

The Rise Of Immunotherapy

One of the most promising advances in oral cancer treatment is immunotherapy. Unlike chemotherapy, which directly targets cancer cells, immunotherapy works by strengthening the body's own immune system to recognise and attack cancer.

"Immunotherapy has already shown encouraging results in advanced oral cancer, improving both survival and quality of life," explains Dr Khan. This approach is particularly valuable because it offers more durable responses in some patients and is often better tolerated than conventional treatments.

Treating Cancer Even Before Surgery

A major shift in recent years is the use of immunotherapy earlier in the treatment process, even before surgery. This is known as neoadjuvant immunotherapy. Traditionally, systemic treatments like chemotherapy or targeted therapy were introduced after surgery or when the disease returned. Now, oncologists are exploring the benefits of starting treatment at the time of diagnosis.

"Using immunotherapy before surgery helps the immune system recognise the tumour while it is still present," says Dr Khan. "It can also target microscopic cancer cells that may have already spread but are not yet visible on scans." This approach offers multiple advantages:

• It may shrink tumours, making surgery less extensive
• It can improve surgical outcomes
• It activates the immune system early, potentially reducing recurrence

In some cases, even one or two doses before surgery can trigger a meaningful immune response.

Better Outcomes, Fewer Side Effects

Research increasingly shows that immunotherapy can lead to longer-lasting responses compared to traditional treatments. Patients may also experience fewer and less severe side effects, although careful monitoring is still required. Importantly, immunotherapy is not a replacement for surgery in most cases but rather a powerful addition to the treatment strategy.

The Challenge Of Cost And Access

While these advances are promising, affordability remains a key concern, especially in a country like India where access to advanced cancer care can vary widely. "Cost can be a barrier, but newer and more affordable versions of these medicines are becoming available," notes Dr Khan. Government initiatives, local drug manufacturing, and patient assistance programmes are gradually improving access, making cutting-edge treatments more widely available.

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A More Personalised Approach To Care

The future of oral cancer treatment lies in personalisation. Doctors are increasingly tailoring treatment plans based on tumour biology, stage of disease, and patient-specific factors. This means combining surgery, radiation, chemotherapy, and immunotherapy in ways that maximise effectiveness while minimising side effects.

Oral cancer treatment is evolving rapidly. While surgery remains a key pillar, it is no longer the only or always the first step. The integration of immunotherapy, particularly in earlier stages of treatment, marks a significant breakthrough.

As Dr Khan puts it, "Starting systemic therapy early is changing how we approach oral cancer. It is helping patients live longer and with a better quality of life." For patients and families, this shift offers renewed hope. With greater awareness, earlier diagnosis, and access to newer therapies, the outlook for oral cancer is steadily improving.

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