By Ng Wan Ching

THE ulcer under his tongue that was the size of a green bean turned out to be a major life changer for Mr Liew Shyh Shiun.

It was actually a cancerous tumour.

After doctors cut it out, he stopped drinking alcohol completely and drastically cut his intake of meat.

Said Mr Liew, 47, a contractor and father of three: 'I had already given up smoking about three years before the ulcer formed. But I was still drinking alcohol.

'Now I am a changed man. I don't drink a drop of alcohol and I'm almost vegetarian.'

According to doctors, the combination of drinking and smoking increases one's risk of oral cancer by 24 times.

Said Assistant Professor Victor Fan, Consultant with the Department of Oral and Maxillofacial Surgery at the National University Hospital: 'If you smoke, it increases your risk by six times. But if you smoke and drink, the risk, as you can see, goes up a lot more.'

For someone to have his risk drop to normal levels, he needs to have stopped smoking for 10 years.

'It takes a long time for your body to recover from the effects of smoking,' he said.

Now Assoc Prof Fan wants to educate the public not only on the risks of smoking, but also on a do-it-yourself (DIY) screening system (see graphic) with which someone can check for anything untoward in his or her mouth.

'This system was started by an Indian doctor because the rates of oral cancer are higher in the Indian population, possibly because of the chewing of betul nut and smoking,' said Assoc Prof Fan.

This self-examination technique was devised by Dr Moni Kuriakose, an oral and maxillofacial surgeon at the Amrita Head and Neck Institute in Kochi, India.

He and his team had conducted successful projects in the early detection of oral cancer in high-risk populations in the rural areas of India.

Incidentally spotted

Most people find out about mouth cancers only when they go for their dental check-ups on a yearly or half-yearly basis, where mouth cancers are incidentally spotted.

Like Mr Liew.

'I had gone to a family doctor to get some ulcer cream for my ulcer. I never thought to go to a dentist,' he said.

He lived with his ulcer for half a year.

'It was very painful when touched,' he said.

Then he developed a toothache, which probably saved his life.

'I went to see a dentist to pull out the tooth. After the treatment, I told the dentist about the ulcer,' he said.

The dentist referred him to another dental surgeon.

'This second dentist told me he would take out a bit of my ulcer, to check what it is first, before deciding on what to do next,' said Mr Liew.

When he went to get his results, he had a shock - the ulcer was a cancerous tumour.

He was referred to Assoc Prof Fan for surgery.

(Page 1 of 2)'The tumour which was removed was about the size of a peanut. I was very lucky, it had not spread,' said Mr Liew.

It was considered to be early stage cancer. He did not need chemotherapy or radio-therapy.

'All I needed was a once monthly check-up immediately after the operation. Now it's once every three months,' he said.

But in between, he also does his own checks using the DIY screening method.

'I had the operation in 2006 and I need to go for five years cancer free before I can breath easy again,' he said.

Too late

But more often than not, the detection of oral cancers comes too late.

Said Assoc Prof Fan: 'The incidence of mouth cancer is low, about 200 to 300 new cases a year. But it is within the top 10 cancers in Singapore for the Indian population. Up to 50 per cent of people with mouth cancers here die within the first 5 years.'

That is because for many of them, the disease is detected at a late stage.

Chances of recovery are high if the cancer is detected early for treatment.

Up to 85 per cent of early oral cancer patients survive the disease for the first five years while only 20 per cent of late oral cancer patients will survive the first five years.

'Late-stage oral cancer patients will need major surgeries, radiotherapy and/or chemotherapy to battle the cancer.

'Such surgeries may also lead to face disfigurement,' said Assoc Prof Fan.

He also wants people to know that most mouth ulcers should go away within two weeks.

'If it does not go away, seek medical help, because it may be something more serious,' said Assoc Prof Fan.

This is something that Mr Liew is now very aware of.

'I should not have waited so long before going to a dental surgeon,' said the man who has changed all his old habits.

This story was first published in The New Paper on Nov 28, 2008.

Related:

DIY oral check