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Tongue Cancer
By peace | July 12, 2006
Tongue cancer is a common type of cancer found in people who are addicted to smoking and consumption of tobacco and related products. Tongue cancer cases are also common in people who drink excess alcohol and those who don’t follow good oral hygiene regularly. Cancer of the tongue is characterized with the growth of a malignant tumor at the base of the tongue or on the tongue itself. The cancer in its advanced stages can also spread to other parts of the tongue and also up to the throat. Tongue cancer is one of the types of mouth cancer. The people who are regular consumers of tobacco and other tobacco related products like snuff are more prone to be affected by tongue cancer.
Symptoms of tongue cancer include a lump or sore at the base of the tongue or on the tongue itself. The cancer begins as a small whiter patch or lump which may gradually grow into an ulcer. If the tumor lies undetected for a long time then it can spread to the gums and the floor of the mouth. The common symptoms that may follow afterwards are bad breath, difficulty in swallowing, difficulty in speech and pain. Hence if any of these symptoms persist for a long time then it is prudent to visit a doctor or a specialist immediately.
The doctor will examine the tongue and check it for any growth or irregularities. A tongue biopsy will also be conducted where a tissue sample of the tongue is taken out and studied under a microscope. If the cancer is detected treatment is started immediately. Treatment includes surgery to remove the malignant tumor or radiation or chemotherapy. Treatment also depends on the stage at which the cancer has reached and the age of the person. A combination of the above treatments can also be used depending on the particular stage. Speech therapy can also be used if it necessary to remove any portion of the tongue or other affected part. Chemotherapy comes with its own side effects as powerful drugs are used to reduce the chances of getting cancer in the future. After the treatment one should refrain as much as possible from bad habits like smoking and tobacco. Consumption of these products and related products should actually be minimized. Prevention is better than cure and hence one must follow good oral hygiene methods and also eating well balanced foods and exercising regularly.
The most common type of cancer of the tongue is called Squamous Cell
Carcinoma. There are other types of cancers of the tongue but they are statistically uncommon.
The tongue is actually divided into 2 separate anatomical areas, the oral tongue is the part you can “stick out” at somebody and extends backward to a V-shaped group of lumps on the back of the tongue which are actually specialized taste buds. The base of tongue is behind these. The oral tongue and the base of the tongue comprise the whole tongue but it is important to know that they develop from different embryonic tissue and really are somewhat dissimilar. Most importantly, this explains why the treatment for squamous cell carcinoma for the oral tongue is usually quite different from the treatment for squamous cell carcinoma of the base of tongue.
Squamous cell Cancer of The oral tongue
This tumor is usually located on the side, or what we call the lateral border, of the oral tongue. It is usually somewhat ulcerated and is grayish-pink to red in color. It will often bleed easily if bitten or touched. Smoking and drinking are known to contribute to the formation of the cancers, although some folks have developed squamous cancer of the tongue with no known extra risk factors.
Most very small cancers of the oral tongue can be quickly and successfully treated by surgical removal leaving behind little cosmetic or functional change. THIS IS NOT ALWAYS TRUE, HOWEVER, AS THERE CAN BE MANY VARIABLES AND FACTORS THAT CAN SERIOUSLY IMPACT SPEECH AND SWALLOWING. This can only be assessed by a face to face Surgeon/Patient meeting and examination.
Larger cancers may indeed have some effect on speech and on swallowing, but one must remember that not treating this problem would cause far more significant problems, up to, and including death. If one thinks about that for a moment; a few changes in speech or swallowing seem like a pretty good swap.
There is a school of thought that small oral tongue cancers can be better managed by radiation therapy alone, and this is indeed true in some cases, especially where the patient has serious heart and/or lung disease that might make anesthesia risky. Fortunately, this is a rare occurrence.
The main reason for treating small sqamous cancer of the oral tongue with surgery is that it is at least as curative as radiation, possibly better, it is over with quickly, oftentimes done as an out patient procedure instead of 5 – 6 weeks of daily therapy, it may be significantly less expensive, and finally, and most importantly, it means that if a patient were to later present with a 2nd or 3rd Squamous Cell Cancer of the mouth/throat/or voice box area, you would still have radiation therapy as a treatment option, perhaps then being able to avoid a significant and disfiguring operation. There is a limit as to how much radiation normal tissue can take before it dies.
Some cases of Oral Tongue Cancer can be treated with just removal of the primary tumor in the tongue. But as the size of the primary tumor increases the statistical possibility of some cancer cells spreading through lymphatic vessels to the lymph nodes of the neck increases. The site and pattern of the involved lymph nodes is pretty much constant — that is to say we know where in the neck to look for enlarged lymph nodes that might contain metastatic cancer cells from the oral tongue cancer. Exceptions to these rules are sometimes seen, but they are uncommon. When the presence of enlarged lymph nodes in the neck is detected or when the index of suspicion is high that there may be cancer cells present in lymph nodes, then an operation called a neck dissection is performed to remove these “secondary” deposits of cancer. Remember, the oral tongue cancer is the “primary” tumor from where the spreading cells originate.
Squamous Cell Cancer of the base of tongue Like the oral tongue, the base of tongue (or posterior 1/3) can also grow several types of cancers, but again, squamous cell carcinoma is the most common and we will direct our comments with that in mind.
Unlike oral tongue cancers, base of tongue squamous cell cancer is usually larger when diagnosed because in the early stages it can not be seen and it creates few, if any, symptoms. Later however, base of tongue cancer may create pain, a sense of fullness, changes in what the voice sounds like, and perhaps even some difficulty in swallowing. Also, because the diagnosis often comes a bit later, a greater number of patients with this disease will already have neck metastasis, that is, cancer cells in the lymph nodes of the neck, by the time they are seen by the Head and Neck Surgeon.
While it may technically feasible to surgically remove some base of tongue cancers, it is our opinion that most can and should be treated by radiotherapy. These tumors are arguably more sensitive to radiation treatment than some other cancers. Certainly, there are exceptions to this. Radiation therapy can also be used to control the cancer in the neck nodes as long as it is not too advanced. Interestingly, in those cases, we will sometimes remove massive neck node disease before starting radiation therapy when we know that x-ray therapy alone would not be successful in controlling the neck disease.
The prognosis after treatment of base of tongue cancer will vary from patient to patient as with any type of malignant disease. It has been our experience that the cure rate is good, but not quite as good as for early detected oral tongue cancer. The fact that base of tongue cancers are usually larger at the time of diagnosis probably is a significant contributing factor to this disparity. Very large base of tongue cancer may require a combination of surgery and radiation.
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