Head and Neck Cancer in North India: Why We Still Meet It Too Late

Most mornings in my outpatient clinic in Hisar begin the same way. The man I describe here is a composite of many patients, not one person. A man in his fifties sits down, opens his mouth, and shows me an ulcer he has lived with for four or five months. He has tried mouthwashes, a few courses of tablets from the local chemist, and a home remedy suggested by a relative. By the time he reaches an ENT surgeon, the ulcer has become a cancer that has reached the lymph nodes in his neck.

This is not a rare story. India recorded about 1.44 lakh new cases of lip and oral cavity cancer and nearly 80,000 deaths from it in 2022, according to an analysis of GLOBOCAN 2022 data [1]. At Tata Memorial Hospital, Mumbai, half of the oral cancer patients in one large series were already at stage IV when first seen [2]. Add cancers of the throat and voice box, and head and neck cancer becomes one of the largest cancer burdens among Indian men.

The tragedy is that this is one of the most visible cancers there is. It does not hide deep inside the body. A white or red patch, a non-healing ulcer, a lump in the neck or a voice that stays hoarse can be seen or felt months before the disease becomes difficult to treat.

01Why patients arrive late

In tier-2 and tier-3 towns, I see four reasons again and again.

Tobacco is normal. Gutka, khaini, bidi and hookah are part of daily life for many men, and a sore mouth is seen as the cost of the habit, not a warning.

Pain comes late. Early oral cancer often does not hurt. Patients wait for pain, and by then the disease has spread.

The first contact is not a specialist. Patients go first to a chemist, a general practitioner or a dentist, often several times. Each visit adds weeks.

Fear and cost. Many believe a biopsy spreads cancer, or that treatment means travelling to a metro city they cannot afford.

02What would change the picture

A simple three-week rule, said everywhere. Any mouth ulcer, white or red patch, neck lump or hoarse voice that lasts more than three weeks needs an ENT or head and neck examination. This one sentence, printed in every chemist shop and primary health centre, could save lives.

Train the first contact. Chemists, general practitioners and dentists see these patients first. A short structured training on red flags, with a clear referral number, costs little.

Bring screening to where people are. Visual oral examination is quick and needs no machine. Camps at mandis, factories, transport hubs and village health days reach exactly the men most at risk.

Treat closer to home. Patients delay when the nearest surgeon is far away. A hub-and-spoke model, where district clinics screen and refer and a regional centre operates, keeps patients in the system instead of losing them.

Correct the biopsy myth. A biopsy does not spread cancer. It tells us exactly what we are treating, and it is the first step to a cure, not the cause of harm.

03Early is smaller

The difference early diagnosis makes is not abstract. A small tongue or cheek cancer can often be removed with a limited operation and good function. The same disease found late may need extensive surgery, reconstruction, radiation and chemotherapy, and the outcome is less certain.

As head and neck surgeons, we are trained for the difficult operations. But the most important work happens before the patient ever reaches us: when someone notices an ulcer that will not heal, and is told clearly, without fear, that it needs to be seen now.

If you or someone you know has had a mouth ulcer, neck lump or hoarse voice for more than three weeks, please do not wait for pain. See an ENT specialist.

References

1. Francis DL, Pape Reddy SS. Oral cancer burden and mortality in India: a GLOBOCAN 2022 analysis with regional comparison. ecancer. 2026;20:2162. https://doi.org/10.3332/ecancer.2026.2162
2. Lokhande M, Kannusamy S, Oak A, et al. A hospital-based study of survival in oral cancer patients of Tata Memorial Hospital, Mumbai. ecancer. 2024;18:1669. https://doi.org/10.3332/ecancer.2024.1669

Dr Bhushan Kathuria is an ENT, Head & Neck Cancer and Skull Base Surgeon at Santosh Advance ENT Healthcare, Hisar, Haryana, with fellowship training in head and neck oncology (Malabar Cancer Centre) and endoscopic skull base surgery (Weill Cornell Medicine). Reg. No. HN-017323, Haryana Medical Council. Disclosure: the author is involved in developing a hub-and-spoke ENT service in Haryana.