Cancer of the floor of the mouth develops in the tissues under the tongue, in the horseshoe-shaped area near the lower jawbone. This type of cancer most frequently starts in the thin, flat cells, known as squamous cells, that line the inside of the mouth.
Signs and Symptoms of Early Under Tongue Cancer
The initial presentation of cancer under the tongue can be subtle and is sometimes mistaken for a common canker sore. One of the most frequent early signs is a sore or ulcer in the mouth that does not heal. This lesion might appear as a small, painless ulcer that grows larger and persists over time.
Another visual indicator involves changes in the color and texture of the tissue under the tongue. The appearance of white or red patches, medically referred to as leukoplakia or erythroplakia, can be a warning sign. These patches are not easily scraped off, and a person may also notice a lump under the tongue.
Physical symptoms can also manifest, such as unexplained and persistent pain in the mouth or tongue that sometimes radiates to the ear. Some individuals may experience numbness in the tongue, unexplained bleeding, or difficulty or pain when moving the tongue, speaking, or swallowing.
Causes and Associated Risk Factors
The development of cancer on the floor of the mouth is strongly linked to tobacco and alcohol use, the most significant risk factors. All forms of tobacco, including cigarettes, cigars, pipes, and smokeless tobacco, significantly increase the risk. Smokeless tobacco is a specific concern because the substance is held in direct contact with the mouth’s tissues. Heavy alcohol consumption also independently raises the risk.
A synergistic effect occurs when tobacco and alcohol are used together, meaning their combined impact is much greater than the sum of their individual risks. The cells in the floor of the mouth are exposed to carcinogens from both substances, accelerating the DNA changes that can lead to cancer. These changes disrupt the normal cell life cycle, causing cells to grow and divide uncontrollably.
The Human Papillomavirus (HPV), particularly the HPV-16 strain, is a contributing cause of oral cancers, including those under the tongue. While more commonly associated with cancers in the back of the throat, HPV can infect cells in the floor of the mouth. Other risk factors include being male and having a weakened immune system, such as from an HIV infection or immunosuppressant drugs taken after an organ transplant.
The Diagnostic Process
The first step in diagnosis is a thorough physical examination of the mouth. A healthcare provider will carefully inspect the floor of the mouth, tongue, and surrounding tissues, often using a tongue depressor to get a clear view. They will assess the size, location, and appearance of any suspicious areas.
If a suspicious lesion is found, the definitive method for diagnosis is a biopsy. This procedure involves taking a small sample of the abnormal tissue from the floor of the mouth. The tissue is then sent to a laboratory where a pathologist examines it under a microscope to check for the presence of cancer cells. A fine-needle aspiration biopsy, where cells are drawn out through a thin needle, may also be performed to check for spread to lymph nodes in the neck.
Should the biopsy confirm cancer, further tests are required to determine the stage of the disease. Staging is the process of finding out how large the tumor is and if it has spread. Imaging tests such as CT (computed tomography) scans or MRI (magnetic resonance imaging) scans are used to get detailed pictures of the head and neck area. These images help doctors understand the tumor’s extent and plan the most appropriate treatment.
Treatment for Early-Stage Cancer
For cancers of the floor of the mouth that are detected at an early stage (commonly Stage I or II), the primary goal of treatment is to completely remove the cancer while preserving as much function as possible. Surgery is the most common treatment for these early-stage tumors. The procedure involves removing the cancerous tumor along with a small margin of the surrounding healthy tissue to ensure all cancer cells have been excised.
In some situations, radiation therapy may be used as the main treatment, particularly if the tumor is small or if surgery would be complex. Radiation uses high-energy beams to destroy cancer cells or stop them from growing. It can also be used after surgery as an adjuvant therapy to eliminate any remaining cancer cells and reduce the chance of the cancer returning. The decision between surgery and radiation depends on various factors, including the tumor’s specific location and size.
Following the completion of initial treatment, regular follow-up appointments are an important part of the care plan. These check-ups allow the medical team to monitor the patient’s recovery and watch for any signs of recurrence. Early detection of a new or recurring cancer provides the best opportunity for successful subsequent treatment.