Tongue Cancer

There are several types of cancer that can affect the tongue. However, tongue cancer most commonly arises from the thin, flat cells present on the surface of the tongue (called squamous cells). There are two types of tongue cancer:

• Oral tongue cancer: the oral part of the tongue is the front two-thirds part of the tongue and is visible upon opening the mouth. Cancer developing in this part of the tongue is part of a group of cancers called oral/mouth cancer. Oral tongue cancer is more likely to be observed and felt.
• Oropharyngeal cancer: This occurs in the back third of the tongue. Since this part of the tongue is very near to the pharynx (throat), cancer occurring here is termed oropharyngeal cancer. Cancer occurring here is typically identified in its advanced stages when the tumour has grown larger and cancer is spread to the lymph nodes in the neck.

Symptoms of tongue cancer especially the oral type are easily identified. The following are some of the symptoms:

• Ulcer in the tongue that bleeds easily and is not healing
• White, red or dark patches on the tongue
• Pain and stiffness in the tongue, jaw or throat (Read more: Jaw pain)
• Numbness in the mouth
• Problem while swallowing food or while chewing
• A persistent lump on the tongue
• A lasting sore throat
• Pain in the ear
• Voice changes

The above symptoms are common with other types of oral cancers and may also be present without any cancer.

In case tongue cancer is not detected early or metastasises to other parts of the body, it may lead to complications like:

• Difficulties in swallowing or eating
• Speech impediment
• Issues in breathing

For some people, tongue cancer develops from prevalent risk factors. However, there are specific risk factors that are found to increase the likelihood of developing this condition:

• Smoking and/or heavy drinking. People who smoke and drink excessively are at a fifteen times higher risk of developing oral cancer.
• Human Papillomavirus (HPV) is associated with the occurrence of oropharyngeal cancer. HPV is a sexually transmitted disease.
• Personal family history of cancer, especially other squamous cell cancer
• A diet which is high in red meat or processed foods and low in fruits and vegetables
• Men forty years and above are more likely to develop tongue cancer.
• Poor oral hygiene
• Chewing betel or gutkha
• Gastroesophageal Reflux Disease, which results in heartburn
• Exposure to certain chemicals such as asbestos, benzene, formaldehyde, etc.

While it is not possible to prevent the development of tongue cancer, there are certain lifestyle changes a person can implement to reduce the risk:

• Quitting smoking and stopping or limiting intake of alcohol
• Stop chewing betel or gutkha and other tobacco products
• Going through a full course of the HPV vaccine
• Practising safe sex, including oral sex
• Maintaining proper dental hygiene, including periodic visits to the dentist
• Including fruits and vegetables in the diet

The person should also be aware of the early signs of tongue cancer and in case of any suspicion, should reach out to a doctor.

For diagnosing tongue cancer, the doctor (usually an oncologist) starts with taking a medical history, including details about drinking, smoking, personal and family history of cancer, whether tested positive for HPV in the past, the onset of the symptoms, etc. A physical examination of the mouth is also carried out to check for visible signs of cancer – this may also consist of looking down the throat via a small, long-handled mirror (indirect laryngoscope). Nearby lymph nodes, such as in the neck, are also tested for any inflammation.

The following tests are also carried out to confirm the diagnosis and understand the spread of the disease:

• Biopsy: a sample of the suspected tissue is removed and sent to a lab for analysis. There are different methods of removing the tissue:
  • Incisional biopsy: under local anaesthesia, a small piece of the suspected cancerous cells is removed with a scalpel (surgical knife).
  • Brush biopsy: this is a newer type wherein a small brush is rolled over the suspected area. This involves slight bleeding and pain, compared to other types.
  • Fine needle aspiration biopsy: in this, a thin needle is inserted into the suspected tumour and the sample is drawn out into the syringe using suction. This is a minimally-invasive short procedure.
  • Punch biopsy: After applying local anaesthesia, a small round piece of tissue is removed using a small circular blade.
• Nasoendoscopy: In this procedure, the doctor passes a flexible tube called a nasendoscopy through the person’s nose. This tube has a camera and a bright light at its end to see any abnormal-looking areas. It is passed through the nose to look inside the mouth, at the back of the tongue and the throat and the larynx (voice box). This is done under local anaesthesia. When any abnormal area is observed, the doctor proceeds with a biopsy.
• X-rays of mouth and throat: special X-rays such as CT-scan or MRI or panorex (an x-ray of the full upper and lower jaw and the sinuses) are carried out to understand the extent of cancer.
• PET scan (positron emission tomography): this uses radioactive materials to detect excessive activity in an organ. It helps understand the spread of cancer and its stage.

Typically, the cancer is determined to be early-stage when the size of the affected area is less than 4 cm and is contained within the tongue. It is considered to be locally advanced when cancer has grown outside the tongue and affected nearby tissues and/or lymph nodes. In the case of spreading to other body parts, the cancer is considered to be in an advanced stage.

Post-diagnosis of the extent and depth of the tongue cancer and depending on its location, the doctor proceeds to prescribe the treatment plan, which may include one or more treatment modalities.

• Glossectomy: This is the surgical removal of the affected part of the tongue. It is prescribed where cancer has not spread to other parts of the body. When the cancer is diagnosed in its early stages, only a partial glossectomy may be required. This is then followed by reconstruction surgery to rebuild the tongue by using another piece of skin or tissue from another part of the body.
• Removal of lymph nodes: the affected lymph nodes are also removed surgically.
• Chemotherapy: This involves taking powerful drugs to destroy cancer cells. This can be prescribed in combination with radiation therapy or post-surgery to decrease the risk of recurrence or in case of cancer cannot be cured, the slowdown in the growth of the tumour and to control symptoms.
• Radiation Therapy: in this, high-energy beams of x-rays or other particles are used to destroy the cancer cells or shrink the tumours.
• Immunotherapy: This involves using medicines to help boost the body’s immune response in finding and destroying cancer cells.

Depending on the severity of the condition, a combination of the above may be required to ensure complete treatment and minimise the risk of recurrence. As a side effect, glossectomy can lead to changes in talking, breathing, eating and swallowing and the person may require speech therapy and talk therapy to adjust and adapt to these changes.

In early cancer, the most common treatment is to remove the affected area followed by adjuvant radiotherapy or chemoradiotherapy to prevent a recurrence. In locally advanced and advanced stages, a combination of surgery, radiotherapy, chemotherapy and immunotherapy.

The person and their family would also require counselling for dealing with the adverse effects of cancer treatments.

Survival from tongue cancer is dependent on the stage in which it is diagnosed. In the early stages of tongue cancer, the five-year relative survival rate is quite high. An early diagnosis also allows for more treatment options with limited side effects.

However, in the case where cancer has spread beyond the tongue, the relative survival rate is lower.

Tongue cancer is a rare type of cancer, found to occur mainly in men above the age of 40. The signs of oral tongue cancer can be self-identified while oropharyngeal cancer is typically diagnosed in advanced stages. An early diagnosis increases the relative survival rate. The person and their family would require counselling and speech and talk therapy to recover from the effects of the treatment.