Over the generations, people around the world have developed many habits and some of them are addictions. These addictions can cause severe damage to human body and can even be fatal, if not controlled. Use of tobacco and its products can be named as one of the top addictions.  On world no tobacco day, let us get some deep insight into this dark world of tobacco and pledge for NO TOBACCO USE!

About Tobacco:

It is the product available across the globe and is prepared from the leaves of tobacco plant. The common variants used in commercial production are N.Rustica and N.tabacum.

Tobacco contains alkaloid nicotine which is a stimulant that causes the release of dopamine in the pleasure and motivation areas of the brain.

It has been observed that use of tobacco is a leading cause of cancer and deaths from cancer. People who use tobacco products or who are regularly around the environment where tobacco is consumed in excess, also called tobacco smoke or second-hand smoke, have an increased risk of cancer. People who may not be directly consuming tobacco smoke but they usually stand or sit near others who smoke are exposed to secondhand smoke, either coming from the burning end of the tobacco product or exhaled by the person who is smoking.

Effects of Secondhand smoke:

Secondhand smoke exposure can also lead to lung cancer and heart disease. It can cause health problems in both adults and children, such as coughing, phlegm, reduced lung function, pneumonia, and bronchitis. Children exposed to secondhand smoke are at an increased risk of ear infections, severe asthma, lung infections, and death from sudden infant death syndrome.

Tobacco and Cancer:

Lung cancer is the most common form that occurs due to smoking tobacco products. It causes cancer by damaging the cells that line the lungs. When you inhale cigarette smoke, which is full of cancer-causing substances (carcinogens), changes in the lung tissue begin almost immediately. At first your body may be able to repair this damage but with prolonged use, this ability to repair vanishes and lung suffers permanent tissue damage.

Tobacco smoke contains chemicals that cause cancer, also known as carcinogens. These chemicals get into your bloodstream and are carried to all parts of your body. Many of these chemicals can damage your DNA, which controls how your body makes new cells and directs each kind of cell to do what it is made for. Damaged DNA can make cells grow differently from how they are supposed to. These unusual cell growth or malignant cells can turn into cancer.

Type of cancer caused by Tobacco:

Tobacco use causes many types of cancer that includes cancer of the lung, larynx (voice box), mouth, oesophagus, throat, bladder, kidney, liver, stomach, pancreas, colon and rectum, and cervix, as well as acute myeloid leukaemia. People who use smokeless tobacco (snuff or chewing tobacco) have increased risks of cancers of the mouth, oesophagus, and pancreas.

There is no safe level of tobacco use. People who use any type of tobacco product are strongly urged to quit.  People who quit smoking, regardless of their age, have substantial gains in life expectancy compared with those who continue to smoke. Also, quitting smoking at the time of a cancer diagnosis reduces the risk of death.

Tobacco is the prominent cancer causing ingredient for many types of cancer but the most common form that occurs due to tobacco smoking is Oral cancer and Lung Cancer.

ORAL CANCER:

It is most commonly known as mouth cancer and is among the top three types of cancers prevalent in India causing 1 million deaths (approx.) every year. Over 5 people in India die every hour every day due to oral cancer and these statistics are shocking.

About Oral cancer:

Oral cancer, also known as mouth cancer is a type of head and neck cancer recognised by any cancerous tissue growth located in the oral cavity. It occurs where a tumour develops in the lining of the mouth. It may be on the surface of the tongue, the insides of the cheeks, the roof of the mouth (palate), or the lips or gums.

Tumours can also develop in the glands that produce saliva, the tonsils at the back of the mouth, and the part of the throat connecting your mouth to your windpipe (pharynx).

Symptoms of mouth cancer:

  • Xerostomia (Dry Mouth)
  • Recurrent ulcers that don’t heal within several weeks
  • Pain in the ear or deafness
  • Nasal intonation of voice
  • Restriction of the movement of the soft palate
  • A budlike shrunken uvula
  • Thinning and stiffening of the lips
  • Pigmentation of the oral mucosa with white or red patches
  • Burning sensation
  • Decreased mouth opening and tongue protrusion
  • persistent lumps in the neck that don’t go away
  • changes in speech, such as a lisp

 

Types of mouth cancer

This type of cancer most commonly involves the tongue, the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth). Most oral cancers look very similar under the microscope and the common is Squamous cell carcinoma.

Squamous cell carcinoma: It is the most common type of mouth cancer, accounting for 9 out of 10 cases.Squamous cells are found in many places around the body, including the inside of the mouth and the skin. It mainly affects oral cavity.

The oral cavity includes the following:

  • The front two thirds of the tongue.
  • The gingiva or gums.
  • The buccal mucosa (the lining of the inside of the cheeks).
  • The floor (bottom) of the mouth under the tongue.
  • The hard palate (the roof of the mouth).
  • The small area behind the wisdom teeth. .

 

Occurrence:

It may arise as a primary lesion originating in any of the tissues in the mouth, by metastasis from a distant site of origin, or by extension from a neighbouring anatomic structure, such as the nasal cavity. Alternatively, the oral cancers may originate in any of the tissues of the mouth, and may be of varied histologic types: teratoma, adenocarcinoma derived from a major or minor salivary gland, lymphoma from tonsillar or other lymphoid tissue, or melanoma from the pigment-producing cells of the oral mucosa. Oral or mouth cancer most commonly involves the tongue. It may also occur on the floor of the mouth, cheek lining, gingiva (gums), lips, or palate (roof of the mouth). Not all tumors in the mouth are cancer. Some are benign (not cancer), and some are precancerous, meaning they may become cancer.

 

LUNG CANCER:

Lung cancer is a type of cancer that begins in the lungs. Our lungs are two spongy organs in our chest that take in oxygen when you inhale and release carbon dioxide when you exhale.

Lung cancer is the leading cause of cancer deaths in India, among both men and women. People who smoke have the greatest risk of lung cancer, though lung cancer can also occur in people who have never smoked.

SIGNS AND SYMPTOMS

Lung cancer typically doesn’t cause signs and symptoms in its earliest stages. Signs and symptoms of lung cancer typically occur when the disease gets in advanced stage.

  • A new cough that doesn’t go away
  • Coughing up blood, even a small amount
  • Shortness of breath
  • Chest pain
  • Hoarseness
  • Losing weight without trying
  • Bone pain
  • Headache

CAUSES

Smoking is the major cause of lung cancers in India and every year majority of youngsters as well as elderly people get affected from it.

How Smoking can cause lung cancer:

Doctors believe that smoking causes lung cancer by damaging the cells that line the lungs. When you inhale cigarette smoke, which is full of cancer-causing substances (carcinogens), changes in the lung tissue begin almost immediately.

At first your body may be able to repair this damage. But with each repeated exposure, normal cells that line your lungs are increasingly damaged. Over time, the damage causes cells to act abnormally and eventually cancer may develop.

Types of lung cancer:

The two general types of lung cancer include:

Small cell lung cancer (oat cell cancer):  Small cell lung cancer occurs almost exclusively in heavy smokers and is less common than non-small cell lung cancer.

The lungs are a pair of cone-shaped breathing organs that are found in the chest. The lungs bring oxygen into the body when you breathe in and take out carbon dioxide when you breathe out. Each lung has sections called lobes. The left lung has two lobes. The right lung, which is slightly larger, has three. A thin membrane called the pleura surrounds the lungs. Two tubes called bronchi lead from the trachea (windpipe) to the right and left lungs. The bronchi are sometimes also affected by lung cancer. Small tubes called bronchioles and tiny air sacs called alveoli make up the inside of the lungs. Small cell lung cancer is a disease in which malignant (cancer) cells form in the tissues of the lung.

Non-small cell lung cancer:  Non-small cell lung cancer is generally an umbrella term for several types of lung cancers.  Non-small cell lung cancers include squamous cell carcinoma, adenocarcinoma and large cell carcinoma. The types of non-small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look under a microscope:

Squamous cell carcinoma: Cancer that forms in the thin, flat cells lining the inside of the lungs. This is also called epidermoid carcinoma.

Large cell carcinoma: Cancer that may begin in several types of large cells.

Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.

Risk factors for lung cancer include:

A number of factors may increase the risk of lung cancer. Some risk factors can be controlled by quitting smoking. And other factors can’t be controlled family history.

  1. Smoking: Your risk of lung cancer increases with the number of cigarettes you smoke each day and the number of years you have smoked. Quitting at any age can significantly lower your risk of developing lung cancer.
  2. Exposure to secondhand smoke: Even if you don’t smoke, your risk of lung cancer increases if you’re exposed to second-hand smoke.
  3. Exposure to radon gas: Radon is produced by the natural breakdown of uranium in soil, rock and water that eventually becomes part of the air you breathe. Unsafe levels of radon can accumulate in any building, including homes.
  4. Exposure to asbestos and other carcinogens: Workplace exposure to asbestos and other substances known to cause cancer — such as arsenic, chromium and nickel — also can increase your risk of developing lung cancer, especially if you’re a smoker.
  5. Family history of lung cancer: People with a parent, sibling or child suffering from lung cancer have an increased risk of the disease.

PRE CANCEROUS TUMOR

The most common precancerous conditions of the oral cavity are:

ORAL SUB MUCOUS FIBROSIS (OSF)

It is condition which affects people who chew tobacco like Gutka, Paan masala, Areca nut or Supari. It is characterised by inability to open the mouth completely. This happens due progressive fibrosis of submucosal tissues and juxta-epithelial inflammatory reactions. It means inner cheek lining which is usually red or pink and stretchable turns into thick white hard like a parchment and become un-stretchable. In advanced stages there are fibrotic bands are formed which does not allow the mouth to open.

In the initial phase of the disease, the mucosa feels leathery with palpable fibrotic bands. In the advanced stage the oral mucosa loses its resiliency and becomes blanched and stiff. The disease is believed to begin in the posterior part of the oral cavity and gradually spread outward.

DIAGNOSIS OF ORAL CANCER:

  1. Physical exam: Physical exam of the lips and oral cavity: An exam to check the lips and oral cavity for abnormal areas. The medical doctor or dentist will feel the entire inside of the mouth with a gloved finger and examine the oral cavity with a small long-handled mirror and lights. This will include checking the insides of the cheeks and lips; the gums; the roof and floor of the mouth; and the top, bottom, and sides of the tongue. The neck will be felt for swollen lymph nodes. A history of the patient’s health habits and past illnesses and medical and dental treatments will also be taken.
  1. Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  2. Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.
  3. Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist. If leukoplakia is found, cells taken from the patches are also checked under the microscope for signs of cancer.Fine-needle aspiration (FNA) biopsy of the lung is done in which there is removal of tissue or fluid from the lung using a thin needle. A CT scan, ultrasound, or other imaging procedure is used to locate the abnormal tissue or fluid in the lung. A small incision may be made in the skin where the biopsy needle is inserted into the abnormal tissue or fluid. A sample is removed with the needle and sent to the laboratory. A pathologist then views the sample under a microscope to look for cancer cells. A chest x-ray is done after the procedure to make sure no air is leaking from the lung into the chest.
  4. Bronchoscopy: It is a procedure to look inside the trachea and large airways in the lung for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
  5. Exfoliative cytology: A procedure to collect cells from the lip or oral cavity. A piece of cotton, a brush, or a small wooden stick is used to gently scrape cells from the lips, tongue, mouth, or throat. The cells are viewed under a microscope to find out if they are abnormal.
  6. MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  7. CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  8. Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.

PREVENTION IS BETTER THAN CURE!

It is a well-known fact and we should follow steps for getting a tobacco free lifestyle so than there is no need of treatment options mentioned above.

The theme of this year’s world no tobacco day is “Tobacco and lung health”.

The relation between Smoking and Respiratory Diseases is a well-established one and here are some facts:

  1. Smoking can cause lung disease by damaging your airways and the small air sacs (alveoli) found in your lungs.
  2. Lung diseases caused by smoking include COPD (chronic obstructive pulmonary disease), which includes emphysema and chronic bronchitis.
  3. Cigarette smoking causes most cases of lung cancer and every year almost 10 million people die in India sue to smoking.
  4. Asthmatic people can be worst affected by tobacco smoke which can trigger an attack or make an attack worse.

STEPS TAKEN TO START A TOBACCO FREE LIFE:

  1. Decide and prepare for a final quit day

Half battle is won once you decide to stop smoking and rest half is to be ready for a quit date. You need to pick a day that would be the final one for quitting, but gives you enough time to prepare will almost certainly feels the urge to smoke many times during your quit day, but it will pass. Follow these D’s for restricting yourself from breaking the rule of quitting:

  • Delay until the craving passes. The urge to smoke often comes and goes within 3 to 5 minutes.
  • Deep breathe mantra. Breathe in slowly through your nose for a count of three and exhale through your mouth for a count of three. Visualize your lungs filling with fresh air.
  • Drink water sip by sip to beat the craving.
  • Do something else to distract yourself. Perhaps go for a walk in a lush green field.
  • Avoid individuals who are smoking or get you into smoking.
  • Avoid situations wherein you have a strong urge to smoke.
  • Yoga is always helpful in peaceful and balanced lifestyle.
  1. NRT (nicotine replacement therapy)

NRT is one potent and reliable way of quitting as it can help relieve some of the physical withdrawal symptoms so that you can focus on the psychological (emotional) aspects of quitting. Many studies have shown that NRT can nearly double the chances of quitting smoking.

The U.S Food and Drug Administration (FDA) have approved five types of NRT:

  • skin patches
  • chewing gum
  • lozenges
  • nasal spray (prescription only)
  • inhaler (prescription only)

NRT can reduce the cravings and withdrawal symptoms you experience that may hinder your attempt to give up smoking. NRTs are designed to wean your body off cigarettes and supply you with a controlled dose of nicotine while sparing you from exposure to other chemicals found in tobacco.

In India, Glenmark Pharmaceuticals Ltd, a research-led global integrated pharmaceutical company announced the launch of Kwitz, a medically approved nicotine replacement therapy that helps smokers embark on a step by step journey towards a smoke-free life.

  1. E-cigarettes and Vaping devices:

Electronic cigarettes, also known as e-cigarettes, e-vaporizers, or electronic nicotine delivery systems, are battery-operated devices that are used by smokers to help in quitting smoking by replacing cigarettes with aerosol. You inhale an aerosol, which typically contains nicotine (though not always), flavourings, and other chemicals. They can resemble traditional tobacco cigarettes (cig-a-likes), cigars, or pipes, or even everyday items like pens or USB memory sticks.

Other devices, such as those with fillable tanks, may look different. Regardless of their design and appearance, these devices generally operate in a similar manner and are made of similar components. More than 460 different e-cigarette brands are currently on the market.

Some common nicknames for e-cigarettes are:

  • e-cigs
  • e-hookahs
  • hookah pens
  • vapes
  • vape pens
  • mods (customizable, more powerful vaporizers)

Working of e-cigarettes:

Most e-cigarettes are battery operated devices that consist of four different components, including:

  • a cartridge or reservoir, which holds a liquid solution (e-liquid or e-juice) containing varying amounts of nicotine, flavourings, and other chemicals
  • a heating element (atomizer)
  • a power source (usually a battery)
  • a mouthpiece that the person uses to inhale

In many e-cigarettes, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge. The person then inhales the resulting aerosol or vapour (called vaping).

Side effects of e-cigarettes and vaping:

According to recent studies and research on effects of e-cigarettes, it may be more dangerous for hearts, lungs, and brains.

  • There’s also a growing body of research suggesting that vaping can lead to smoking. Nicotine is the primary agent in both regular cigarettes and e-cigarettes, and it is highly addictive.
  • It causes you to crave a smoke and suffer withdrawal symptoms if you ignore the craving.
  • It raises your blood pressure and spikes your adrenaline, which increases your heart rate and the likelihood of having a heart attack.
  • E-cigarettes are also linked to poor heart and depression which is equally panicking like real smoking.