Tongue cancer is a form of head and neck cancer involving the uncontrolled growth of abnormal cells on the tongue. Most of these cancers are squamous cell carcinomas, which originate in the thin, flat cells lining the mouth’s surface. The location of the cancer on the tongue influences symptoms and treatment, and awareness of the initial signs is a significant factor in achieving a favorable outcome.
Identifying Early Signs and Symptoms
The first indication of tongue cancer is often a sore or lump on the side of the tongue that does not heal and may bleed easily if touched. This lesion might appear as a red patch, known as erythroplakia, a white patch, called leukoplakia, or a grayish-pink ulcer. Unlike a common canker sore, these abnormalities persist for more than a couple of weeks.
Pain in the tongue, jaw, or ear can also signal a persistent issue. Some individuals may experience numbness in the mouth or a burning sensation on their tongue. As a tumor grows, it can lead to difficulty or pain when chewing, swallowing, or moving the tongue or jaw. A change in voice or a constant feeling that something is caught in the throat are also potential symptoms.
While these symptoms can arise from less serious conditions, their persistence for more than two weeks should prompt a visit to a doctor or dentist. Cancer on the oral tongue (the visible front two-thirds) is often detected earlier because the signs are more visible. Cancer at the base of the tongue may not produce noticeable symptoms until it is more advanced, sometimes first being detected as a lump in the neck when cancer cells have spread.
Key Risk Factors
The development of tongue cancer is strongly associated with tobacco and alcohol use. People who smoke are about five times more likely to develop tongue cancer than nonsmokers. The risk escalates significantly for individuals who both smoke heavily and consume large amounts of alcohol, increasing the risk for head and neck cancers by as much as 30 times.
Another major risk factor, particularly for cancers at the base of the tongue, is infection with the human papillomavirus (HPV). HPV, specifically HPV 16, is a sexually transmitted virus that can cause cells to become cancerous.
Other contributing factors include poor oral hygiene and a family history of head and neck cancers. Age is also a consideration, as tongue cancer is more common in people over 40. Additionally, men are twice as likely as women to be diagnosed.
The Diagnostic Journey
A diagnosis often begins during a routine check-up with a dentist or primary care physician who notices an abnormality. If you present with persistent symptoms, a doctor will conduct a physical examination of your mouth, throat, and neck, checking for lumps or sores. They may use a small mirror or a flexible tube with a camera, called an endoscope, to view the base of the tongue and throat.
If examination findings are suspicious, a biopsy is the definitive step. This procedure involves removing a small sample of the suspicious tissue, which is then analyzed by a pathologist to identify cancerous cells. For lesions on the front of the tongue, this can be done in the clinic under local anesthesia, while a biopsy of the base of the tongue might require general anesthesia.
Once a cancer diagnosis is confirmed, imaging tests are used to determine the tumor’s size and to see if it has spread. These tests can include CT (computed tomography) scans, MRI (magnetic resonance imaging) scans, or PET (positron emission tomography) scans. The information gathered helps doctors stage the cancer, which is a system used to describe the extent of the cancer and guide treatment decisions.
Treatment Approaches for Early Stages
For early-stage tongue cancers, the goal of treatment is to completely remove the tumor while preserving as much tongue function for speech and swallowing as possible. The main treatment options are surgery and radiation therapy, which may be used alone or in combination. The specific approach depends on the tumor’s size, location, and stage.
Surgery is the most common treatment for early cancers of the oral tongue. A procedure called a partial glossectomy involves removing the cancerous part of the tongue along with a margin of healthy tissue around it. In some cases, the surgeon may also remove lymph nodes from the neck in a procedure called a neck dissection to check if the cancer has spread.
Radiation therapy uses high-energy rays to destroy cancer cells and may be used as the main treatment, especially for cancers at the base of the tongue or if a patient is not a good candidate for surgery. It can also be used after surgery to eliminate any remaining cancer cells and reduce the chance of recurrence. A multidisciplinary team, including surgeons and radiation oncologists, collaborates to create a personalized treatment plan.