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Below, week by week, is what OnCo's record of Buccal mucosa and gingivobuccal cancer (oral cancer in India) says about the first two months: the order is typical, the timing is yours to ask about. Cancer of the cheek lining and gums is India's commonest cancer in men, caused by chewing tobacco and areca nut. Surgery with reconstruction is the mainstay, and trials from Tata Memorial in Mumbai have shown that removing the neck nodes up front, cheap oral chemotherapy, tiny doses of immunotherapy and visual screening by health workers all save lives at low cost. Sections appear only where the record has something to say. Orientation, not medical advice.
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Visual oral examination by trained health workers for tobacco and alcohol users (Kerala trial); treatment of leukoplakia and management of oral submucous fibrosis.
Smokeless tobacco and areca nut cessation, gutka bans, and oral screening in high-risk people.
Wide excision with marginal or segmental mandibulectomy as needed, elective or therapeutic neck dissection (Tata Memorial trial), and free-flap reconstruction.
Induction docetaxel-cisplatin-fluorouracil to shrink technically unresectable tumours, then surgery in responders (Tata Memorial practice); chemoradiation otherwise.
Postoperative radiotherapy for advanced stage, perineural invasion or nodes; cisplatin chemoradiation for extranodal extension or positive margins.
Oral metronomic methotrexate with celecoxib; low-dose nivolumab added where affordable; metronomic tablets with paclitaxel-carboplatin (METRO PLUS); pembrolizumab where available.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
Every term links to the glossary.