Understanding Tongue Cancer

Tongue cancer is a type of oral cancer that forms in the front two-thirds of the tongue. Cancer that forms in the back third of the tongue is considered head and neck cancer.

Tongue cancer usually develops in the squamous, or the thin, flat cells that cover the surface of the tongue. Cells in the tongue sometimes change and cease to grow or behave normally. Tongue cancer develops when the cells acquire a genetic mutation, which causes them to rapidly divide and multiply out of control.

Prevalence/Incidence

Because the tongue is so sensitive and the front 2/3 of it are visible to the eye, tongue cancer is almost always caught early, when a cure is most likely.

The five-year relative survival rate for tongue cancer is a 84%. It’s estimated that 2,900 men and 1,400 women will be diagnosed with oral cancer each year in Canada..

Causes and Risk Factors

Tongue cancer is more common after the age of 40, although it may be found in people under 40. It is twice as common in men.

Tongue cancer is also one of the 15 cancers caused by smoking. A person who smokes is five times more likely to develop the disease than non-smokers.

Excessive alcohol consumption also increases a person’s lifetime risk of developing tongue cancer.

The Human papillomavirus (HPV) HPV 16 and HPV 18 increase a person’s risk of tongue cancer. Also, African-American men are at greater risk than Caucasians.

Screening

There is no standard screening for tongue cancer. Patients should discuss any lesions, persistent sore throat, visible sores, difficulty swallowing or pain in the jaw or tongue with their physician. Finding and reporting tongue cancer soon increases the chance of a good outcome or cure.

General Symptoms

Tongue cancer can often be mistaken for a cold or a sore in the mouth that won’t go away. Other symptoms include a persistent tongue and/or jaw pain, a lump or thickening on the inside of the mouth, a white or red patch on the gums, tongue, tonsil, or lining of the mouth, a persistent sore throat or feeling that something is caught in the throat, difficulty swallowing or chewing, and difficulty moving the jaw or tongue.

Squamous cell carcinoma is the most common type of tongue cancer. Squamous cells are thin, flat cells that line the mouth and other organs. There are two types of tongue cancer: oral tongue cancer, which is cancer that occurs in the front 2/3 of the tongue, and cancer of the base of the tongue, which is considered a type of head and throat cancer. Several types of cancer grow in the tongue but squamous cell carcinoma is the most common.

Diagnosis and Medical Work-up

To make a diagnosis, the doctor will take a medical history and ask about symptoms. A patient’s tongue and neck will be examined and a long-handed mirror will be used to look down the throat.

Other tests that may be performed include X-rays of the mouth and throat, including CAT scans, and PET scans. A biopsy is the best way to confirm or rule out a diagnosis of tongue cancer. In a biopsy for tongue cancer, a small sample of tissue will be removed from the tumor and sent for analysis. There are three different methods types of biopsy for tongue cancer including fine needle aspiration (FNA), incisional biopsy and punch biopsy.

Treatment

Tongue cancer is treated with surgery, radiation, chemotherapy or targeted therapies, depending on the type and stage of the disease.

Tumor resection is a type of surgery in which the entire tumor is removed from the tongue. Minimally invasive surgical techniques are preferred whenever possible.

High doses of radiation can be administered for tongue cancer with pinpoint accuracy, sparing healthy tissue and shortening procedure and recovery times.

Chemotherapy is often combined with radiation. It can be given if the tongue cancer has spread to nearby lymph nodes. Different chemotherapy drugs can be used at different stages to decrease the chance of drug resistance or to work around drug resistance once it has occurred.

Targeted drug therapy interferes with the cell growth of malignant tongue cancer cells on a molecular level. It is often combined with chemotherapy and/or radiation therapy.

Sources:

Canadian Cancer Society – Signs and Symptoms 
Canadian Cancer Society – Oral Cavity Cancer Statistics
Global News Article – New made-in-Canada screening test could detect oral cancer earlier
Canadian Dental Association
Cancer Treatment Centers of America
American Cancer Society
Cedars-Sinai

Originally published October 12, 2017 by CAREpath, a division of Bayshore HealthCare.