Oral Cancer in Teenagers: An Oral Pathologist’s View

During the teenage phase, most teenagers are worried about their exams, school projects, etc, but a few face something unimaginable. Do you imagine what it is? It’s an oral cancer diagnosis that is usually seen in adults over 40. It’s rare, but such cases are now documented in medical literature. This raises critical questions: why is oral cancer occurring at such a young age, and how can early diagnosis help improve outcomes?  

What is a cancer?

The uncontrolled growth of abnormal cells defines cancer and spreads to the nearby area.¹ Here, there are abnormal cells, which means they grow and divide uncontrollably, and their shape, size, and function may look different under a microscope compared to normal cells.  Oral cancer is the sixth most common cancer globally. Among them, one-third of the cases are seen in India.² Oral squamous cell carcinoma is one of the most common types of oral cancer.³ Tobacco chewing, betel nut, gutka, and areca nut are associated with Oral squamous cell carcinoma. Oral squamous cell carcinoma mostly occurs in individuals above 40 years of age, but now it’s seen in the teenage group.

To understand this unusual phenomenon, I interviewed Dr. Noopur Gajjar, MDS in Oral and Maxillofacial Pathology. She has personally observed oral cancer cases in teenagers for around 15 years.

Through her professional insights, this article explains the clinical features, risk factors, treatment challenges, and preventive measures relevant to oral cancer in young patients.

Could you please share your educational background and specialization in oral pathology?

I have done a Bachelor’s of Dental Surgery and Master of Dental Surgery in Oral and Maxillofacial Pathology from Government Dental College and Hospital, Ahmedabad, and now working as a Dental surgeon at General Hospital, Godhra, Panchamahal, Gujarat.

 

When did you first encounter a case of oral cancer in such a young patient, around 15 years old?

During my graduation while doing an Internship, I have encountered many cases of Oral Cancer in various age groups, where the majority of cases are after the age of 50. But I was shocked while diagnosing such a case in a 15-year-old male patient.

 

What types of oral cancers have you personally observed in younger patients?

I observed oral squamous cell carcinoma (OSCC) to be the most common one in various young Patients at different oral sites.

 

Are there specific oral sites more commonly affected in these young cases?

In my observation, the Buccal mucosa is the most common site for oral squamous cell carcinoma, whereas the tongue is second.

 

What are the main risk factors for oral cancer in adolescents?

The major risk factor is betel nut and areca nut chewing, tobacco chewing. But risk for occurrence of cancer also depends on frequent intake of these compounds, time duration in mouth (longer time in mouth = high risk of OSCC), patient’s diet (less in nutrients and oxidants = high risk of OSCC), stress (more stress = high risk of OSCC).

 

How do symptoms in young patients differ from those in older patients?

Symptoms are the same in both young and old patients. Clinically, an unhealing ulcer is the most commonly observed feature, followed by proliferative growth, induration, and swelling.

But before the occurrence of cancer, there are various potentially malignant lesions, like oral submucous fibrosis (OSMF), speckled leukoplakia, and oral lichen planus, from which we can diagnose the risk of cancer early.

In most cases, OSCC in younger patients involves OSMF followed by OSCC. So if we treat OSMF early, we can reduce the risk of OSCC.

In OSMF, clinical features are reduced mouth opening, thick fibrous buccal mucosa, and blanching of buccal mucosa, accompanied by burning sensation in some cases, with the most common one being reduced mouth opening. The patient says that he or she cannot eat spicy and hot food.

The clinical findings of oral lichen planus are whitish and reddish lesions.

In leukoplakia, it is a mixed reddish white lesion, but most cases of leukoplakia are associated with tobacco consumption or smoking habit, whereas OSMF is associated with a majority of areca nut and betel nut chewing.

 

Do families accept the diagnosis easily, or is there often denial because of the patient’s age?

First, there is a denial that it can happen at this age, then they accept once the ulcer becomes a proliferative growth and is not healing with medications.

 

What diagnostic tools are most useful in detecting oral cancer in young patients?

Biopsy is the Gold standard in diagnosing oral cancer and almost all types of cancer.

 

How does the treatment approach differ for adolescent patients compared to adults?

Adolescent patients have habits due to peer pressure as he/she don’t know the health hazards of bad habits. Sometimes they don’t even know about what cancer is and what can happen if left untreated or if the habit is not addressed.

So it is a challenge to approach them for treatment. So I would consider consulting with a Psychiatrist or Psychologist to understand the results of bad habits.

 

What preventive measures or awareness programs should be emphasized for teenagers?

In India, the government is conducting different programmes under NCD Non-communicable diseases, and also there is the National Tobacco Control Program (NTCP) launched in 2007-08, which aims to increase awareness, reduce tobacco supply and production, and facilitate cessation.

For prevention, Govt. should open Tobacco cessation centres, there should be frontline health workers at every health centre in the state or country, specially recruited for Tobacco cessation and to prevent areca and betel nut consumption.

The government should conduct various programmes in every school & educate students about the harmful effects of tobacco, betel nut, areca nut, and other cancer-causing products.

As a government employee, I also conduct a school health programme.

In this digital era, the government should be aware of teenagers by conducting programs through various social media handles.

The government should stop advertising these cancer-causing products.

 

Closing Thoughts

Dr. Noopur Gajjar’s insights remind us that oral cancer not only occurs in adults but can also appear in young people. It is causing alarm among both families and doctors. Her experience shows that awareness programs, school-level education, and early dental checkups can play a big role in preventing problems on time. It’s also important to stop risky habits like smoking and using areca nuts at a young age.

To build a stronger response, India needs a combination of skilled specialists, advanced diagnostic tools, and active government health programs. By taking these actions collectively, we can reduce the impact of oral cancer on future generations.

References

1. Brown JS, Amend SR, Austin RH, Gatenby RA, Hammarlund EU, Pienta KJ. Updating the definition of cancer. Mol Cancer Res. 2023 Nov 1;21(11):1142–7. Link

2. Akashanand et al. Burden of oral cancer and associated risk factors at national and state levels: A systematic analysis from the global burden of disease in India, 1990–2021. Oral Oncol. 2024 Dec;159:107063. Link

3. Singh MP, Kumar V, Agarwal A, Kumar R, Bhatt MLB, Misra S. Clinico-epidemiological study of oral squamous cell carcinoma: A tertiary care centre study in North India. J Oral Biol Craniofac Res. 2016;6(1):31–4. Link

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