Tongue Cancer

Several types of cancer grow in the tongue but squamous cell carcinoma is the most common. Squamous cells are thin, flat cells that line the mouth and other organs.

There are two types of tongue cancer: 

  • Cancer of the oral tongue. The front two-thirds of the tongue that you can "stick out" is called the oral tongue. 
  • Cancer of the base of tongue. The base is the back one-third of the tongue that extends down the throat.

Symptoms

Oral Tongue Cancer
  • A lump on the side of the tongue that touches the teeth (lateral side)
  • The lump often looks like an ulcer and is grayish-pink to red in color
  • The lump bleeds easily if bitten or touched


Base of Tongue Cancer

  • The tumor is often difficult to see in the early stages so it is usually diagnosed when it is larger
  • There are few symptoms in the early stages
  • In later stages, the cancer may cause pain, a sense of fullness in the throat, difficulty swallowing, the feeling of a lump in the neck or throat, voice changes or ear pain


Causes and Risk Factors

Some people develop cancer of the tongue with no risk factors. The cancer is more common in older age groups, age 40 and up, although it may be found in young people. It is twice as common in men. Other risk factors are:

  • Smoking and drinking alcohol. Smokers are five times more likely to develop tongue cancer than nonsmokers.
  • Human papillomavirus (HPV), a sexually transmitted disease. HPV 16 and HPV 18 increase the risk of tongue cancer
  • African-American men are at greater risk than Caucasians

Diagnosis

To make a diagnosis, the doctor will take a medical history and ask specific questions about symptoms. A patient's tongue and neck will be examined and a small, long-handed mirror will be used to look down the throat.

Several tests are used to aid in the diagnosis. These tests include:

  • X-rays of the mouth and throat, including CAT (computed tomography) scans (X-rays that show images in thin sections)
  • PET scans (positron emission tomography) which uses radioactive materials to identify excessive activity in an organ. This may indicate the tumor is growing
  • Biopsy, a small sample of tissue that is removed from a tumor to diagnose cancer. Tongue cancer usually requires a biopsy. After the surgeon removes the tissue, a pathologist will examine the cells under a microscope. There are different methods to obtain a biopsy:
    • Fine Need Aspiration (FNA) biopsy. A thin needle is inserted into the tumor mass and a sample is aspirated (drawn out by suction) into a syringe.
    • Incisional biopsy. A sample is removed with a scalpel (surgical knife)
    • Punch biopsy. A small circular blade removes a round area of tissue

Treatments

Surgery, chemotherapy and radiation therapy are used to treat tongue cancer.

Surgery

Oral Tongue
Surgical removal of the primary tumor might be the only treatment needed for small oral tongue cancers. If the tumor is large, it may have spread to lymph nodes in the neck. When this occurs the surgeon may recommend removal of the affected lymph nodes in the neck (called a neck dissection).

Most small cancers of the oral tongue leave little cosmetic or functional changes after they are removed.

Larger tumors can spread and cause swallowing difficulties. Surgery for large tumors also affects speech and swallowing. With the latest reconstuctive techniques, our doctors are able to restore most speech and swallowing problems.

Base of the Tongue
Tumors on the base of the tongue are usually larger when diagnosed because in the early stages the tumor is difficult to see. The only early symptom is ear pain. Voice changes and difficult swallowing occur later.

Because bases of the tongue cancer is diagnosed later, the cancer may have already spread to the neck. A neck dissection is frequently needed to remove the affected lymph nodes.


Radiation Therapy

Radiation therapy, including intensity modulated radiation therapy, stops cancer cells from dividing and slows the growth of the tumor. Radiotherapy also destroys cancer cells and can shrink or eliminate tumors. Intensity modulated radiation therapy allows the use of more effective radiation doses with fewer side effects than conventional radiotherapy techniques.

Radiation therapy involves 5-6 weeks of daily treatments.


Chemotherapy

Chemotherapy is prescribed for different reasons:

  • Together with radiotherapy as an alternative to surgery (called chemoradiation)
  • After surgery to decrease the risk of the cancer returning
  • To slow the growth of a tumor and control symptoms when the cancer cannot be cured (palliative treatment)