Tongue cancer begins in the cells of the tongue. It can develop on the front two-thirds (oral tongue) or the back one-third (base of the tongue). When detected early, tongue cancer is often curable. The likelihood of a successful outcome depends on several factors, which influence treatment and long-term outlook.
Factors Influencing Curability
The stage of the cancer significantly affects its curability. Cancer staging, often described using the TNM system (Tumor size, Nodal involvement, Metastasis), indicates how much the cancer has grown and whether it has spread. Earlier stages, such as Stage I or II, where the cancer is small and has not spread to lymph nodes or distant sites, typically have a much higher chance of cure compared to later stages, like Stage III or IV, where the cancer has grown larger or spread.
The tumor’s location on the tongue also plays a role in detection and prognosis. Cancers on the oral tongue are often noticed earlier due to their visibility and symptoms they cause, such as a persistent sore or lump. In contrast, cancers at the base of the tongue may grow larger before symptoms become apparent, making early diagnosis more challenging. Squamous cell carcinoma is the most common type of tongue cancer, originating from the flat cells lining the tongue’s surface.
A person’s overall health and the presence of other medical conditions can influence their ability to tolerate and recover from treatment. The human papillomavirus (HPV) status is another factor, particularly for cancers at the base of the tongue. HPV-positive oropharyngeal cancers, which can include those on the base of the tongue, sometimes have a more favorable prognosis and respond better to treatment compared to HPV-negative cancers.
Treatment Approaches
Treatment plans for tongue cancer are tailored to each individual, considering the cancer’s stage, location, and the patient’s overall health.
Surgery
Surgery is a common primary treatment, especially for early-stage tongue cancer. A glossectomy involves removing part or all of the tongue, with removal extent depending on tumor size and location. For larger tumors or if the cancer has spread, lymph nodes in the neck may also be removed, and reconstructive surgery might be performed to restore function and appearance.
Radiation Therapy
Radiation therapy uses high-energy beams to destroy cancer cells. It can be a standalone treatment for smaller cancers or used after surgery to eliminate remaining cancer cells and reduce recurrence. This can involve external beam radiation or brachytherapy, which places radioactive material directly into or near the tumor. Radiation treatments are typically given daily over several weeks.
Chemotherapy
Chemotherapy uses medicines that target and kill cancer cells. It is often used in combination with radiation therapy, especially for advanced stages, as it can enhance radiation’s effectiveness. Chemotherapy may also be used to shrink tumors before surgery or to treat cancer that has spread to distant parts of the body.
Targeted Therapy and Immunotherapy
Targeted therapy and immunotherapy are newer treatment options that work differently from traditional chemotherapy. Targeted therapies focus on specific molecules involved in cancer cell growth and survival, such as the epidermal growth factor receptor (EGFR). Immunotherapy helps the body’s own immune system recognize and attack cancer cells. These treatments may be used for recurrent or advanced disease, to improve outcomes.
Prognosis and Follow-up
The long-term outlook for tongue cancer is influenced by the stage at diagnosis.
Survival Rates
For localized tongue cancer, meaning it has not spread beyond the tongue, the five-year survival rate is approximately 85%. If the cancer has spread to nearby lymph nodes or structures, the five-year survival rate is about 70%. When the cancer has spread to distant parts of the body, the five-year survival rate decreases to around 40%. These figures represent averages, and individual outcomes can vary based on specific circumstances.
Follow-up and Recurrence
After treatment, there is a possibility of the cancer returning, known as recurrence. Regular follow-up appointments are important for monitoring. These appointments typically include physical examinations, imaging scans, and blood tests to check for recurrence or new cancers. This long-term monitoring helps ensure that any potential issues are identified and addressed promptly.
Life After Treatment
Life after treatment can involve adjustments. Depending on the extent of the cancer and the treatments received, individuals may experience changes in speech, swallowing, and eating. Rehabilitation services, such as speech therapy and nutritional support, can help manage these side effects and improve quality of life.
Prevention and Early Detection
Risk Factors
Risk factors for tongue cancer include:
Tobacco use (smoking and chewing tobacco)
Heavy and frequent alcohol consumption, especially when combined with tobacco
Infection with certain types of human papillomavirus (HPV), particularly for base of tongue cancers
Poor oral hygiene
Early Symptoms
Recognizing early symptoms can lead to earlier diagnosis and improved outcomes. Common signs include:
A persistent sore, lump, or ulcer on the tongue that does not heal
Red or white patches
Pain in the tongue or mouth
Difficulty swallowing
A sore throat that does not resolve
If these symptoms persist, seek medical attention.
Dental Check-ups
Regular dental check-ups are also valuable for early detection. Dentists often perform oral cancer screenings during routine examinations, identifying suspicious areas. Early detection significantly increases the chances of successful treatment and a positive prognosis.