Tongue Cancer

Tongue cancer is one of the most common types of cancer of the oral cavity. According to the World Health Organisation, oral cancers rank as the 13th most prevalent cancers worldwide. The incidence rate in men is higher than that of women but there is a growing trend in women due to the increase incidence of human papilloma virus (HPV) infection. The age of onset is mostly concentrated in those aged 60 or above. Tongue cancer can be treated through surgical resection in its early stages. If you have any suspicious symptoms, you should consult your doctor immediately. 

Tongue cancer symptoms   

The tongue is an easily accessible organ and presenting symptoms of tongue cancer or pre-cancerous lesions can often straightforwardly be detected. Many patients can find the following symptoms in the early or middle stages of tongue cancer: 

• Localised pain is the most common presenting symptom 
• Red spots (erythroplakia), white spots (leukoplakia) or red and white spots (erythroleukoplakia) on the tongue that persist and change over time (increase in size, multiply, ulcerate or bleed),  
• Chronic (long-standing) ulcers that worsen and easily bleed  
• Difficult or painful tongue and jaw movement 
• Difficulty speaking 
• Difficulty or pain in swallowing 
• Enlarged lymph nodes in the head and neck (possible spread of cancer cells) 

Advanced stages of tongue cancer may spread to other areas of the mouth and lymph nodes of the head and neck, but rarely involve other parts of the body and organs (distant metastases). 

Causes of Tongue Cancer    

The following habits or triggers may lead to tongue cancer: 

• Habitual consumption of alcohol and tobacco 
• Chewing betel nut 

• Infection with HPV virus 
• Repeated injury and inflammation of the same part of the tongue 
• Even if you do not have the above high-risk factors, it does not mean that the chance of developing tongue cancer is zero. Self-awareness and knowing the presenting symptoms and signs of tongue (and oral cavity) cancers are key to early detection and curative intervention.  

Diagnostic modalities for tongue cancer    

A full medical, personal, family history and comprehensive physical evaluation with special focus on the head and neck is the mandatory first step in the diagnosis. If a lesion is found, a tissue biopsy can be performed right away. Endoscopic evaluation is also done especially if there is suspicion at the base of the tongue and other locations that are not easily accessible. If the diagnosis of tongue cancer is confirmed, the next step is the staging of the cancer using the TNM (Tumor-lymph Node-Metastasis) classification. Adjuncts to staging (to look for local invasion, loco-regional spread or distant metastases) may include the following: - 

• CT Scan 
• Magnetic Resonance (MRI) 
• Ultrasound PET Scan  
• Stage Grouping of Oral Cavity Tumors (including Tongue cancers) - utilising the T-N-M classification, is designated from Stages 0, I, II, III, and IV, with the earliest, non-invasive as Stage 0 (in-situ) and the most advanced as Stage IV (invasive cancer with nodal and distant spread/metastases) 

Based on the staging of the cancer, the treatment strategies can now be planned and discussed with the patient. 

Tongue Cancer Treatment    

The cure rate for early-stage tongue cancer is as high as 90%, but for late-stage tongue cancer, it drops to 10% to 20%. Depending on the stage of tongue cancer, doctors will adopt different treatment methods: 

Early stage (Stage 0, I or II) ) 

• Surgery

Advanced stage (Stage III or IV with limited nodal and no distant spread) 

• Radiation therapy

Metastatic disease (Stage IV with distant spread) 

• Chemotherapy, radiation therapy and immunotherapy 

If tongue cancer has significantly affected the lymph nodes or spread to other regions of the head or neck, the patient will need radiation, chemotherapy, chemoradiation and newer medications like cetuximab (immunothrapeutics). Chemotherapy and immunotherapy uses medications targeting the tumor itself or tumor-promoting chemicals to destroy the cancerous cells and prevent further spread. These also form part of palliative therapy for management of stages far too advanced for a cure and may also include hospice care. 

How to prevent tongue cancer     

Regarding the various causes of tongue cancer, you can refer to the following methods to maintain oral hygiene and prevent tongue ulcers and cancer: 

• Quit smoking and excessive consumption of alcoholic beverages  
• Avoid chewing tobacco and betel nut 
• Practice safe sex to prevent HPV infection  
• Vaccination against HPV 
• Eating a balanced diet that is rich in soluble fibers and antioxidants such as fresh fruits, nuts and vegetables 

OT&P Medical Advice     

The symptoms of tongue cancer (such as persistent ulcers and troublesome white or red spots) are easily noticeable, and the cure rate of tongue cancer in its early stages is very high. If you have had a tongue ulcer for more than a few weeks, or if you have any concerns about the condition of your tongue, it is recommended that you seek medical advice as soon as possible. Early treatment increases the chance of a complete cure and full recovery. 

References

1. Mayo Clinic. Tongue cancer. 20 Dec 2023 Retrieved from https://www.mayoclinic.org/diseases-conditions/tongue-cancer/symptoms-causes/syc-20378428  
2. Cancer Research UK. What is tongue cancer? 20 Dec 2023 Retrieved from https://www.cancerresearchuk.org/about-cancer/mouth-cancer/stages-types-grades/tongue-cancer/about  
3. WebMD. Tongue Cancer: Facts That You Need to Know. 20 Dec 2023 Retrieved from https://www.webmd.com/cancer/tongue-cancer-facts  
4. Medical News Today. What are the early signs of tongue cancer? 20 Dec 2023 Retrieved from https://www.medicalnewstoday.com/articles/322519  
5. The International Agency for Research on Cancer (IARC), World Health Organization (WHO). Oral Cancer Prevention, IARC Handbooks of Cancer Prevention Volume 19, 29 November 2023. Retrieved from https://publications.iarc.who.int/617, on 22 February 2024.