Tongue Cancer

Tongue cancer is a type of cancer that develops from the surface lining cells of the tongue (squamous cells). It most often appears on the front part of the tongue that lies within the mouth, particularly along the side edges; cancers arising at the back of the tongue (base of tongue) are considered among the pharyngeal cancers. Because it begins in a visible area, it can be noticed at an early stage.¹

What is tongue cancer?

The tongue is a muscular organ in constant motion for speaking, tasting and swallowing. Tongue cancer begins in the thin tissue layer covering this organ (mucosa) and may over time advance into the muscle of the tongue. At a later stage it may spread to the lymph nodes (lymph glands) in the neck; for this reason the neck is assessed alongside the tongue when diagnosis and treatment are planned.²

The main risk factors for tongue cancer are cigarettes and tobacco products, alcohol use and infection with human papillomavirus (HPV). Long-term irritation of the lining of the mouth, for example by ill-fitting dentures, has also been suggested as a risk factor, but many studies have found no increased risk in denture wearers. Tongue cancer can also develop without any of these factors.^1,3

Symptoms

• A sore or lump on the edge of the tongue that does not heal within a few weeks¹
• White (leukoplakia) or red (erythroplakia) patches on the tongue
• Pain on touching or eating, easy bleeding
• Firmness, thickening or restricted movement of the tongue
• Pain radiating to the ear, difficulty swallowing, a change in speech
• A palpable swelling in the neck

In the early period these symptoms may be mild or may be mistaken for a simple sore such as an aphthous ulcer. A symptom that does not go away is the most important warning sign.

Diagnosis

Diagnosis begins with a careful examination of the tongue and the whole of the mouth. Taking a small tissue sample from the suspicious area (biopsy) establishes the definitive diagnosis. To see the depth of the disease and the state of the lymph nodes in the neck, ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) may be requested. On the basis of these assessments the stage of the disease (stage I–⁠IV) is determined and treatment is planned accordingly.¹

Treatment

The main treatment for tongue cancer is surgery. The tumour is removed together with a margin of healthy tissue around it; this procedure is called partial removal of the tongue (partial glossectomy). In early-stage tumours the procedure is usually performed through the mouth and most of the tongue is preserved. In larger tumours, the removed tissue may need to be replaced with tissue taken from another part of the body (reconstruction).^2,4

If there is a possibility of spread to the lymph nodes in the neck, the lymph nodes of the neck are also removed in the same operation (neck dissection). After surgery, depending on the pathology result, radiation therapy (radiotherapy) or drug treatment (chemotherapy) may need to be added. The treatment plan is drawn up for each person, taking into account the location, size and stage of the cancer.^2,4

What to expect after surgery

Depending on the extent of the operation, speech and swallowing may be affected for a time. After small resections these functions usually recover within a short period, while after extensive reconstructions speech and swallowing therapy supports the process. The tongue is an organ with a high capacity to adapt; returning over time to intelligible speech and eating by mouth is possible in most cases. Recovery after tongue and oral cavity surgery is described on a separate page.⁴

When should you see a doctor?

If you have a sore on your tongue that has not healed for several weeks, a patch that does not go away, a firm area or unexplained pain, you are advised to see an ear, nose and throat specialist. Tongue cancers noticed at an early stage can usually be treated with a smaller operation, and the function of the tongue can be better preserved.