Tongue Cancer or Cancer of the tongue is a malignant tumor that begins as a small lump, a firm white patch, or a sore (ulcer) on the tongue.
If untreated, the tumor may spread throughout the tongue to the floor of the mouth and to the gum (jaws).
As a tumor grows, it becomes more life threatening by spreading (metastasizing) to lymph nodes in the neck and later to the rest of the body.
There are two parts to the tongue, the oral tongue and the base of the tongue. Tongue cancer can develop in either part. The oral tongue is the part which is visible when someone ‘pokes the tongue out’ at someone. This is the front two thirds of the tongue. Cancers that develop in this part of the tongue come under a group of cancers called mouth (oral) cancer.
Tongue cancer can be defined as malignancy of the tongue or squamous cell carcinoma of the tongue. Risk factors include smoking tobacco, smokeless tobacco, heavy alcohol intake, and dentures. Tongue cancer usually occurs after the age of 40, with men affected more than women.
Three-quarters of these tumors are small and can be effectively treated by surgery or radiation. The risk of metastasis is quite small but if metastases do occur, usually to the neck, they require prompt therapy.
The prognosis (outlook) is generally good. The base of the tongue is the site of only one-third of all tongue cancers but these tumors tend to be far more advanced and aggressive than those on the front of the tongue.
Symptoms of tongue base tumors may be odynophagia (pain on swallowing food or fluid), otalgia (pain in the ear), or a mass in the neck. The mass is usually due to metastases that can be felt in three-quarters of cases at the time of the diagnosis.
Treatment may involve a combination of methods (surgery, radiation, chemotherapy) and may need to be aggressive. The prognosis is more guarded than with anterior tongue tumors.
Cause of Tongue Cancer
Tongue cancer is one of the more common and serious types of mouth cancer. It mainly occurs in people who smoke cigarettes, pipes, or cigars or use smokeless tobacco. People who drink large amounts of alcohol and use tobacco are especially at risk.
Tongue cancer is rare in people under age 40 and people who do not use tobacco or alcohol. It is most common after age 60.
The exact cause of tongue cancer, head and neck cancers is unknown. But several risk factors have been identified. Smoking tobacco (cigarettes, cigars and pipes) and drinking a lot of alcohol are the main risk factors for cancers of the head and neck in the western world. Chewing tobacco or betel quid with tobacco is very common in parts of Asia and is known to be a main cause of mouth (including tongue), gullet (esophageal) and throat (pharyngeal) cancers in these countries.
Other definite risk factors include:
- Poor diet
- Having a weakened immune system
- Being exposed to some chemicals
- Acid reflux
Tongue Cancer Symptoms or Sign of Tongue Cancer
Tongue cancer begins as a small lump or thick white patch. It may or may not be painful or tender. Over time this lump turns into an ulcer with a firm, raised rim and a center that bleeds easily.
The tongue cancer symptoms or sign of tongue cancer may include:
- A red or white patch on the tongue, that will not go away
- A sore throat that does not go away
- A sore spot on the tongue that does not go away
- Pain when swallowing
- Numbness in the mouth that will not go away
- Unexplained bleeding from the tongue (that is, not caused by biting your tongue or other injury)
- Pain in the ear (rare)
- Bad breath
- Drooling and trouble swallowing saliva
- Trouble breathing
- Difficulty in speaking
Tongue Cancer Treatment
Tongue cancer treatment is based on the stage (size and extent) of the disease when it is diagnosed.
The treatments recommended are radiation therapy, chemotherapy, and surgery. These treatments may be used in combination.
A speech therapist will usually be involved in helping patients improve speech function and swallowing capabilities following surgical or radiation treatments.
A nutritionist can also be very helpful to ensure optimal nutritional and caloric intake that is vital to recovery from tongue cancer and maintain overall good health.
Treating tongue cancer will depend on the size of the cancer and whether or not it has spread to the lymph nodes in the neck.
The best treatment for very small tongue cancers is surgery. For larger tumors that have spread to the lymph nodes in the neck, it is likely to have a combination of surgery and radiotherapy. This means having an operation to remove the cancer from the tongue and the lymph nodes in the neck. The patient may need to have all the nodes on one or both sides of the neck removed.
This operation is called radical neck dissection. It lowers the risk of the tongue cancer coming back in the future. Then a course of radiotherapy is given to help get rid of any cancer cells left behind.
If the cancer has grown so big that it affects most of the tongue, then surgery to remove the tongue (glossectomy) is done. This is a big operation and many doctors may suggest trying radiotherapy and chemotherapy to shrink the cancer first. If this works, surgery may not be done.
If this operation it done, it will permanently change the ability to speak and swallow.
Tongue Cancer Survival Rate
Overall tongue cancer survival rate ranges from 50-65%, with improved survival with early-stage disease. Even in the presence of advanced-stage disease, the mandible and larynx can be preserved in 80% of patients.
The overall survival and non-recurrence rates at 2 and 5 years were higher in cancer of oral tongue than in cancer of base of the tongue. Survival rates were better when neck nodes were clinically or histologically negatives and in early-stage carcinomas. Non-recurrence rates were better when nodes were clinically or histologically. The functional results were better in oral tongue cancer than in base of the tongue cancer.