Tongue Cancer, Symptoms, Causes and Treatment

Tongue Tumor

Tongue Cancer
The tongue is an organ made up of many mobile muscles that fill the mouth at rest. It has many roles including swallowing, speaking and cleaning the mouth, chewing, and tasting. It is an organ that performs very important tasks such as providing the movement of pushing back into the pharynx by shaping the food after chewing and shaping the words.

What is Tongue Cancer?

What is Tongue Cancer?

Tongue cancers are tumoral formations that occur due to effects such as chronic smoking and alcohol irritation that usually starts in the squamous cells covering the surface of the tongue. Two-thirds forms of anterior cancer of the tongue are classified as a type of oral cancer, while cancer of the posterior one-third of the tongue is considered oropharyngeal cancer.

What are the Symptoms of Tongue Cancer?

Symptoms of Tongue Cancer

The following symptoms can be seen in tongue cancers:
  • A red / white patch-like lesion on the tongue and this lesion grows over time or becomes swollen from the surface
  • The appearance of areas on the tongue that bleed during eating or spontaneously.
  • Pain when chewing or swallowing
  • An ulcerated wound on the tongue
  • Having a sore throat that does not decrease in the ear
  • Numbness in the tongue or mouth
  • Change in voice (may be due to reduced tongue movements or mass effect)
  • Stiff tongue
  • Bad breath
  • Difficulty opening the mouth
  • A mass in the neck area
  • Painless growth in neck lymph nodes
  • Unexplained weight loss
  • Intraoral prostheses, which are normally used to fit into the mouth, cannot be fully placed due to hitting a lump or protrusion in the mouth.
Although some of these symptoms can be seen in simple benign diseases, an ENT specialist should be consulted in the presence of these symptoms.

Diagnosis of Tongue Cancer?

Oral examination, head and neck examination, histopathological evaluation, head and neck magnetic resonance imaging, and computed tomography may be required in the diagnosis of tongue cancer.

PET-CT scanning

In patients with tongue cancer, the back of the tongue is rich in lymphatic vessels and a network of blood vessels. Advanced stage language cancers can be detected in patients who come with complaints such as simple sore throat or ear pain after a long period. Before surgery and other treatments, PET-CT scanning may be required for staging the disease and determining the disease level.

Risk Factors For Tongue Cancers

As in all head and neck cancers; Alcohol consumption and smoking are the main risk factors in tongue cancers. Alcohol and smoking are thought to play a role in more than 80% of squamous cell carcinoma (squamous cell cancer), especially in the head and neck region. The epithelial surfaces in the head and neck region, such as smoking and alcohol, can cause a series of changes, from chronic exposure to irritant factors, to hyperplasia, dysplasia, and cancer.

Risk Factors For Tongue Cancers
Unfortunately, when alcohol and cigarettes are consumed, a synergistic carcinogenic effect emerges. In other words, they cause risk shots like the risk multiplier of each other, not the total risk of each (roughly, if tongue cancer is 6 times more common in alcohol users and 6 times more common in smokers, the risk of tongue cancer in those who use alcohol and cigarettes together. 6x6 times, that is 36 times more visible ... is considered). The risk increases according to the duration of smoking and the amount of cigarette smoked.

People who smoke may be up to 25 times more likely to get head and neck cancer than non-smokers. Passive smoking (exposure to cigarette smoke), tobacco chewing and cigar smoking are also risk factors for the development of head and neck cancer.

Another factor that has been emphasized in recent years and increases the development of head and neck cancer is viral infections. In particular, it has been reported that the sexually transmitted Human Papilloma Virus increases the risk of tongue cancer.

HIV virus, exposure to asbestos and perchlorethylene, radiation, dietary factors (such as Betel Hazelnut chewed in India ...), genetic predisposition (problem with tumor suppressor genes) are other reported risk factors in head and neck cancers. Poor oral hygiene is also blamed for tongue cancer.

How Often and At What Age Are Tongue Cancers?

Tongue cancer incidence 

Tongue cancers constitute 3% of oral cavity cancers. Tongue cancer is the second most common type of oral cancer after lip cancer and its frequency increases with age. While it is rare under the age of 40; Tongue tumors tend to be seen at the age of 60-70. It is more common in men. The disease is more common in the Indian population than in other populations.

Treatment of Tongue Cancer 

In tongue cancer surgeries, complaints of decreased speech and swallowing skills may occur, depending on the amount of tissue excised. Localized T1-T2 disease (that is, the tumor is less than 4 cm in diameter and the disease is limited to the tongue) lesions are treated with surgery or radiotherapy for curative purposes.

The lesions on the sides of the tongue can be excised by preserving the safe surgical margin of 2 cm (partial glossectomy surgery). Radiotherapy treatment is also applied in more advanced stage cancers (in large tumors, tongue tumors with the possibility of cancer spillage (metastasis) to the lymph nodes in the neck). Combinations of surgery, radiotherapy and chemotherapy treatment are used in these patients. Chemotherapy treatment can also be used for temporary symptomatic benefit. Additional surgical procedures such as jawbone resection, temporary or permanent hole opening in the larynx (tracheotomy), neck dissection (removal of lymph nodes in the neck) are applied in large tongue tumors that spread into the mouth or involve the tongue root.

The patient with tongue cancer,
  • general condition
  • the size and location of the tumor
  • whether / not metastasis (spread of cancer to another tissue such as a lymph node)
  • the type of tumor
It is determined that it is the most suitable for the patient among surgical, radiotherapy and chemotherapy treatment options. The best results are obtained in patients who are caught in the early period, do not have metastases and have a good general condition.

Targeted drug therapies using monoclonal antibodies have been tried in recent years.

Diet, speech, swallowing, physical and occupational rehabilitation therapies can be applied after surgery, chemotherapy and radiotherapy treatments.

Tongue Cancer - Prognosis (Course of the Disease)

Tongue Cancer - Prognosis (Course of the Disease)
When detected early, tongue cancer is highly treatable. Tongue cancer is staged according to the size of the tumor and the presence or absence of metastasis. Early diagnosis and early treatment are the most important prognostic factors that increase treatment success in tongue cancer. It is approximately 70% of patients who are caught in the early stage, without a 5-year disease. Tongue tumors usually have a worse prognosis because they are diagnosed late and have a rich lymphatic structure.

I have not accepted patients for cancer treatment or cancer surgery for a long time because my mother and father died of cancer. I only wrote what is written on this page as information. May God help all cancer patients and their relatives.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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