What is tongue cancer
Tongue cancer is a tumor formed by malignant proliferation of tongue mucosal epithelial cells. The tongue consists of muscle and mucosa, divided into the anterior two-thirds, or oral tongue, and posterior one-third, or tongue base. These belong to the oral cavity and oropharynx respectively.
The global situation regarding tongue cancer
Tongue cancer ranks among the most common oral malignancies, accounting for 37% to 53% of oral squamous cell carcinomas. It is more common in men and usually occurs at ages 40-60.
Consult a doctor regarding cancer-related issues
Anyone with a persistent tongue ulcer, a lump on the tongue border, tongue pain radiating to the ear, or difficulty swallowing or speaking should promptly consult an oral and maxillofacial surgeon, especially those who smoke, drink, or chew betel nuts.
Main types of tongue cancer
1. Oral tongue squamous cell carcinoma
Arising in the anterior two-thirds of the tongue, this is the most common type. It is closely associated with sharp tooth cusp irritation, smoking, and drinking and readily spreads early to cervical lymph nodes.
2. Tongue base squamous cell carcinoma
Arising in the posterior third of the tongue, it is classified as oropharyngeal cancer by the UICC. Early symptoms are subtle, most cases are advanced at diagnosis, and prognosis is poorer than for oral tongue cancer.
3. Verrucous carcinoma
This well-differentiated squamous cell carcinoma has exophytic verrucous growth and strong local invasiveness but a low metastatic rate. It must be distinguished from benign lesions.
4. Carcinoma in situ
Cancer cells are confined to the epithelium without crossing the basement membrane. This is the earliest stage, and timely removal can achieve good disease control.
5. Minor salivary gland carcinoma
Arising from minor salivary glands in the tongue, these tumors include various pathological types such as adenoid cystic and mucoepidermoid carcinoma and account for a small proportion of tongue cancers.
Typical symptoms and signs of tongue cancer
1. Tongue ulcers
An ulcer on the lateral or ventral tongue that does not heal within two weeks, with raised edges, an uneven base, and easy bleeding on contact, is the most typical early manifestation.
2. Tongue lump
A relatively hard lump or induration develops on the tongue, with a cauliflower-like or ulcerative surface. Enlargement impairs tongue movement.
3. Tongue pain
Persistent tongue pain worsens during eating and speaking and may radiate to the ear and temple, affecting eating and speech.
4. Restricted tongue movement
Invasion of tongue muscles impairs movement, causes deviation on protrusion and unclear speech, and may eventually fix the tongue completely.
5. Difficulty swallowing
Tumor enlargement or tongue fixation impairs swallowing, causing painful and difficult swallowing, drooling, and progressively worsening malnutrition.
6. Neck lump
Tongue cancer can spread early to cervical lymph nodes, producing palpable hard, enlarged nodes below the mandibular angle or in the neck.
How is tongue cancer diagnosed
1. Oral examination
The doctor visually examines and palpates the tongue mucosa, observing ulcer or lump shape, size, and location and assessing tongue mobility and cervical lymph nodes.
2. Pathological biopsy
Pathological examination of sampled lesion tissue is the gold standard for diagnosing tongue cancer, determining pathological type and differentiation to guide treatment planning.
3. Contrast-enhanced CT or MRI
Contrast-enhanced head and neck CT or MRI assesses tumor invasion depth, its relationship to the mandible, and cervical lymph node metastasis.
4. Neck ultrasound
Ultrasound assesses cervical lymph node size, shape, and internal structure, and ultrasound-guided needle biopsy can confirm metastasis.
5. Chest CT scan
Chest CT is used to rule out pulmonary metastasis and is an essential component of routine preoperative staging examinations.
6. Panoramic dental radiograph
A panoramic dental radiograph assesses the tumor's relationship to the jaw and whether mandibular bone invasion is present.
What treatments are available for tongue cancer
1. Surgical treatment
Partial glossectomy, hemiglossectomy, or total glossectomy is the main treatment, requiring adequate safe margins and concurrent neck dissection.
2. Repair and reconstruction
Removal of half or more of the tongue requires free-flap reconstruction. Forearm or anterolateral thigh flaps can restore tongue shape and some function.
3. Radiotherapy
Early tongue cancer may be treated with radiotherapy alone. Postoperative adjuvant radiotherapy for intermediate and advanced disease reduces local recurrence and preserves organ function.
4. Chemotherapy
Chemotherapy is mainly used for palliation in advanced disease or as part of preoperative neoadjuvant treatment and concurrent chemoradiotherapy.
5. Concurrent chemoradiotherapy
Concurrent chemoradiotherapy is suitable for unresectable locally advanced disease or as adjuvant treatment for high-risk postoperative patients.
6. Targeted therapy
Anti-EGFR targeted drugs such as cetuximab can treat advanced tongue cancer and improve efficacy when combined with chemotherapy.
7. Functional exercises
Postoperative swallowing and speech training helps improve oral intake and communication.
8. Follow-up monitoring
Regular oral examination and neck palpation after treatment monitor local recurrence and lymph node metastasis. Long-term follow-up is essential.
Conclusion
Tongue cancer is the most common oral cancer, mainly presenting with tongue ulcers and lumps. Giving up harmful habits, promptly seeking care for oral abnormalities, and early detection followed by surgery help achieve a better prognosis.
