Tongue cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs is a rare type of oral or mouth cancer that develops on the tongue, a muscular structure in the mouth that aids in speech, digestion and taste. Most tongue cancers develop as squamous cell carcinomas (cancers arising from the squamous cells in the tissues that line the tongue), however in rare cases they can develop as other types.
The tongue has two main sections: the oral tongue and the base of the tongue. The oral tongue is classified as the front two-thirds of the tongue, and is where most tongue cancers develop. Cancers of the oral tongue are generally classified as oral or mouth cancers. The base of the tongue, which is classified as the back third of the tongue, are less common and may be classified as a type of oropharyngeal cancer.
Tongue cancers are more common in males, and tend to be diagnosed over the age of 60. However, anyone can develop this disease.
Treatment
If tongue cancer is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cellsthe basic structural and functional unit of all living things look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Oral tongue cancers are staged as oral/mouth cancers, while base of tongue cancers are staged as oropharyngeal cancers. However, both are staged using the TNM stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localisedaffecting only one area of body cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for tongue cancer may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
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- Tumour excisionto surgically remove/cut out.
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- Glossectomycomplete or partial removal of the tongue.
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- Lymphadenectomysurgical removal of lymph node(s).
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- Reconstructive surgerysurgery to restore appearance and/or function to an area of the body of the tongue.
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells.
- Chemotherapya cancer treatment that uses drugs to kill or slow the growth of cancer cells, while minimising damage to healthy cells.
- Targeted therapymedication that targets specific molecular features of cancer cells.
- Immunotherapya treatment that uses a person's immune system to fight cancer.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
While the cause of tongue cancer remains unknown, some of the following factors may increase the likelihood of disease:
- Excessive alcohol consumption.
- Smoking, vaping and/or tobacco usage.
- Poor oral hygiene.
- Being infected with the Human Papillomavirus (HPV).
- Having a family history of mouth cancer.
Not everyone with these riskthe possibility that something bad will happen factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
Symptoms of oral tongue cancer may include:
- A sore on the tongue that doesn’t heal.
- A pink, red or white patch on the tongue that doesn’t go away.
- A painful lump on the tongue.
- A sore on the tongue that bleeds easily when touched or bitten.
Cancers on the base of the tongue may be asymptomatic during the early stages of disease. As the tumour progresses, some of the following symptoms may appear:
- Pain or difficulty with chewing, swallowing or tongue movement.
- Ear pain.
- Changes and/or difficulties with speech.
- Persistent sore throat.
- Lymphadenopathyswollen lymph nodes/glands, also known as adenopathy.
Not everyone with the symptoms above will have cancer, but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have tongue cancer, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
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- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
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- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
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- PET (positron emission tomography) scana type of medical imaging that uses radioactive tracers to create detailed images of the body.
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- X-raya type of medical imaging that uses x-ray beams to create detailed images of the body .
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- Ultrasounda type of medical imaging that uses soundwaves to create detailed images of the body .
- Endoscopya procedure that involves inserting a long, flexible tube with a light and small camera (endoscope) into the body to view internal organs.
- Biopsyremoval of a section of tissue to analyse for cancer cells