TONGUE CANCERS

What is tongue cancer?

Tongue cancer is a type of head and neck cancer occurring either on the oral tongue (freely mobile anterior two-thirds of the tongue) or on the base of the tongue (posterior third of the tongue). The anterior tongue is subdivided into the tip, dorsum, lateral borders and ventral surface. Most tumours occur in the middle third of the tongue, commonly on the lateral aspect.

Oral tongue cancer is usually diagnosed in an early stage whereas cancer at the base of tongue is diagnosed at an advanced stage when the tumour is larger and spread to the lymph nodes.

Stages of tongue cancer

Staging of the tongue cancer tells the extent of the cancer and also helps in the planning the appropriate treatment.

There are five stages of tongue cancer:

Stage 0: known as Carcinoma in-situ. This describes the presence of abnormal cells in the surface lining and having high potential to invade the deeper layers.

Stage I: The size of the tumour is less than or equal to 2 centimetres and the cancer cells did not spread to the lymph nodes.

Stage II: The size of the tumour is between 2 and 4 centimetres and the cancer cells did not spread to the lymph nodes.

Stage III: The tumour is larger than 4cm and without spreading to lymph nodes, or is of any size and had spread to only a single lymph node(less than 3cm).

Stage IV: It is the most advanced stage. The tumour may be of any size, but it has spread to:

  • Adjacent tissue, skin or bone
  • Single lymph node (more than 3cm) or multiple lymph nodes.
  • Distant body parts like lungs etc.

The rate of recurrence is high for the cancers in stage III and IV.

Symptoms of tongue cancer

Patients may present with several symptoms which include:

  • Ulceration or lump on the tongue
  • Reddish or White patches on the tongue
  • Pain and difficulty in swallowing
  • Difficulty in speaking
  • Difficulty in mastication
  • Lump in the neck
  • Bleeding and numbness
  • Sore throat

Causes and risk factors of tongue cancer

Consumption of tobacco products and drinking alcohol are the most common causative factors.

Risk factors include:
  • Tobacco:

    It includes smoking tobacco by cigarettes, cigars & pipes and consuming smokeless tobacco by snuffing and chewing.

  • Excess consumption of Alcohol:

    Tobacco smoke and alcohol act synergistically in causing tongue cancer.

  • Infection with Human Papilloma Virus(HPV):

    Cancers at the base of the tongue are caused by Human papilloma virus.

  • Chronic irritation by dentures, teeth and poor dental hygiene
  • Diet low in vegetables, fruits, vitamins A, C and E.
  • Gender: mostly in males
  • Family history
  • Immunosuppression.

Diagnosing tongue cancer:

History & Examination:

Providing a detailed medical history and any history of tobacco & alcohol consumption will help in diagnosing tongue cancer.

Complete inspection of anterior and posterior thirds of the tongue to identify any abnormal tissue or growth.

Fiber optic examination:

The base of the tongue is examined for any growth or ulcer by using the fiber optic endoscope.

Biopsy:

A small amount of suspicious growth over the tongue will be sent to a pathologist for microscopic examination. This helps in confirmation of the tongue cancer.

- Different types of biopsy include:
  • Incisional biopsy: In this, a piece of the suspicious lesion is taken without removing it all.
  • Punch biopsy: This is a type of incisional biopsy using a ‘punch forcep’, which helps in removing a small tissue from the suspected area.
  • Excisional biopsy: In this technique, the whole area of concern is removed.
  • Brush biopsy: A few cells off the surface of a suspicious lesion are taken.
Neck Biopsy:

If needed, the lump in the neck is examined by a biopsy.

  • Fine needle aspiration cytology (FNAC): This is the most common and easiest way to do biopsy in which a tiny needle is placed into the lump over the neck and some cells are drawn out through a syringe. This will be sent to a pathologist for microscopic examination. If needed, FNAC will be done with USG or CT guidance.
  • Core biopsy: It is similar to FNAC, but a larger needle is used to remove a core of tissue from the lump.
  • Open neck biopsy: This is performed by placing an incision over the lump, and either a piece or the entire lump is taken out for the diagnosis.
Imaging:

Evaluation of the extent of tongue cancer requires the use of special x-rays like CT scans and MRI scans and Panorex. The invasion of the cancer into the tongue muscles will be evaluated using these specialised imaging techniques.

Treatment for tongue cancer:

  • The treatment goals of tongue cancer are to eradicate the cancer and restore the form and function of tongue.
  • The treatment modality for achieving these goals in tongue cancer is usually surgery. In case of advanced cancer, surgery should be followed by adjuvant radiotherapy and chemotherapy either alone or in combination.
  • The choice of treatment depends on the depth, extent and stage of the tongue cancer.
  • Surgery to remove a part of the tongue is known as partial glossectomy whereas advanced cases needed larger tissue removal.
  • People with large tissue removal may need a reconstructive surgery to restore the form and function.

Preventing tongue cancer?

Ways to reduce the risk of tongue cancer:
  • Refrain from smoking and consuming any tobacco products.
  • Avoid excess drinking of alcohol
  • Regular dental check-ups and maintaining good oral hygiene.
  • Take a balanced diet rich in fruits, vegetables, Vitamins A, C and E.