Tongue squamous cell carcinoma is a cancer that begins in the flat, thin squamous cells lining the surface of the tongue. This condition is a significant form of oral cancer, affecting either the front two-thirds of the tongue (oral tongue) or the back one-third (base of tongue). While various cancers can affect the tongue, squamous cell carcinoma is the most common type encountered. Recognizing this disease early is highly beneficial for improving treatment results and overall patient outcomes.
Causes and Risk Factors
Several factors significantly increase the likelihood of developing tongue squamous cell carcinoma. Tobacco use, encompassing smoking cigarettes, cigars, pipes, and using smokeless tobacco such as chewing tobacco or snuff, is considered the most substantial risk factor. Consistent and heavy consumption of alcohol also contributes to an elevated risk. The combined use of both tobacco and alcohol dramatically escalates this risk.
Human papillomavirus (HPV) infection, particularly HPV-16, is another identified cause, especially for cancers located at the base of the tongue. While less common, HPV can also contribute to oral tongue cancer. A personal or family history of head and neck cancer, particularly squamous cell carcinoma, also increases an individual’s susceptibility. Additionally, chronic irritation from factors like ill-fitting dentures or sharp teeth can contribute to the development of these lesions. In some instances, however, tongue squamous cell carcinoma may develop without any clear identifiable risk factors.
Signs and Symptoms
The presence of tongue squamous cell carcinoma can manifest through several noticeable signs and symptoms. A persistent sore or lesion on the tongue that does not heal is a common indicator, often appearing as a lump that might bleed easily if bitten or touched. Red patches (erythroplakia) or white patches (leukoplakia) on the tongue or inside the mouth can also signal abnormal cell growth and are considered precancerous lesions in some cases.
Patients may experience a persistent sore throat that does not resolve, difficulty swallowing (dysphagia), or a feeling of something being caught in the throat. Numbness of the tongue or other areas of the mouth, unexplained bleeding from the tongue, or a burning sensation can also occur. A lump in the neck, resulting from swollen lymph nodes, may also be a presenting symptom, particularly with cancers at the base of the tongue that are harder to see in early stages. While these symptoms can be caused by less severe conditions, their persistence warrants prompt medical evaluation.
Diagnosis Methods
Diagnosing tongue squamous cell carcinoma typically begins with a physical examination by a doctor or dentist, which often includes a visual inspection of the oral cavity and palpation for any abnormalities. Dentists are frequently the first healthcare professionals to notice suspicious signs during routine check-ups. If a suspicious area is identified, further investigation is necessary.
The definitive diagnostic tool is a biopsy, where a small tissue sample is removed from the suspicious lesion for microscopic examination by a pathologist. This can be an incisional biopsy, removing part of the lesion, or an excisional biopsy, removing the entire lesion. Following a confirmed diagnosis, imaging tests like CT scans, MRI scans, or PET scans are often utilized to determine the cancer’s stage and assess for potential spread to nearby lymph nodes or distant body parts. CT scans are commonly used for local tumor staging and to detect nodal metastases, while MRI can assess spread to soft tissues.
Treatment Options
Treatment is highly individualized, taking into account the cancer’s stage, its precise location on the tongue, and the patient’s overall health. A multidisciplinary team of specialists, including surgeons, radiation oncologists, and medical oncologists, collaborates to develop the most suitable plan.
Surgery is a common treatment, often involving a glossectomy, which is the removal of part or all of the tongue, along with a margin of healthy tissue to ensure all cancer cells are excised. If the cancer has spread to nearby lymph nodes, a neck dissection may be performed to remove the affected nodes. For larger tumors, reconstructive surgery may follow to restore function and appearance.
Radiation therapy, which uses high-energy beams to destroy cancer cells, can be delivered externally or internally through brachytherapy. It may be used as the primary treatment, after surgery to eliminate remaining cancer cells, or in combination with chemotherapy. Chemotherapy employs powerful medicines to kill cancer cells and is often combined with radiation therapy, a process known as chemoradiotherapy, especially for advanced cancers.
Targeted therapy utilizes drugs like cetuximab that specifically attack certain chemicals within cancer cells, disrupting their growth. Immunotherapy, with drugs such as pembrolizumab and nivolumab, helps the body’s own immune system recognize and destroy cancer cells. These systemic therapies are particularly relevant for advanced or recurrent cases.
Prognosis and Prevention
The outlook for individuals with tongue squamous cell carcinoma is influenced by several factors, including the cancer’s stage at diagnosis, its specific location on the tongue, and the patient’s general health. Early detection and prompt treatment significantly improve the chances of a positive outcome and higher survival rates. For instance, the 5-year survival rate for tongue cancer is approximately 69.7%, with better outcomes for early-stage disease.
Preventative measures can substantially reduce the risk of developing this type of cancer. Avoiding all forms of tobacco use and limiting alcohol consumption are among the most effective strategies, as these are major risk factors. Quitting these habits, even after years of use, can still greatly lower the risk.
Receiving the HPV vaccine, if applicable, can also protect against HPV-related cancers, including some tongue cancers. Maintaining good oral hygiene and undergoing regular dental check-ups are also important, as dentists can often detect suspicious lesions in their early stages. Regular follow-up care is also advised for survivors to monitor for any recurrence.