Tongue cancer is the malignant transformation of the cells that make up the tongue. The tongue is the organ that allows us to speak, to chew, to taste and swallow. These are essential functions in everyday life. This organ is divided into two parts: one is the mobile tongue and the other, called the base of the tongue, is in the back of the throat. Thus there are two types of tongue cancer: those that are on the mobile part, highly visible and easy to detect, and those that are at the base of the tongue. The former accounts for 85% of the cases (the vast majority being men). As for cancers of the base of the tongue, they are diagnosed in most cases at an advanced stage.
What are the risk factors
Tongue cancer rather affects:
– over 40 years (with a peak between 55 and 66 years)
– heavy smokers (tobacco multiplies by 6 to 25 the risk of tongue cancer),
– and heavy drinkers (alcohol has an influence, it is mainly the tobacco/alcohol combination that multiplies the risks).
80% to 90% of cancers of the tongue are estimated linked to smoking and alcoholism.
– Poor oral hygiene and teeth and gums in bad condition also are risk factors for its development.
– Oral leukoplakia: a mucous condition characterized by the appearance of white patches or plaques that do not disappear when scratched. It is a precancerous lesion that can degenerate into cancer in the presence of risk factors such as tobacco and alcohol.
– Oral erythroplakia: a premalignant condition that causes superficial red plaques on the mucous membrane of the mouth that can turn into cancer if not treated.
Can tongue cancer be prevented?
The prevention is directly towards the risk factors. It is therefore recommended to ensure good oral hygiene (prevention of gum infections), to stop smoking and to limit the consumption of alcohol.
Finally, any lesion of the tongue which lasts longer than 3 weeks, and especially in presence of ganglions in the neck, must lead to consultation without delay.
Overview of the symptoms of tongue cancer
– The occurrence of ulcers or sores that do not heal after a while. These injuries are often painful, so it is important to pay attention to them.
– The appearance of a small or medium red or white stain on any area of the tongue. In those places where it is not possible to see the spot, it is possible that it can be felt by touching the tongue with other parts of the mouth such as the palate or cheeks.
– Discomfort during tongue movements or when coughing.
– Difficulty to swallow.
– Tingling or pain when eating acidic, alcoholic or spicy foods.
– Change in speech (due to difficulty moving the tongue).
Other symptoms such as ear pain, jaw pain and lump in the neck. The appearance of these symptoms is usually related to large lesions and, therefore, to a worse prognosis.
To confirm or exclude the diagnosis of tongue cancer, the doctor performs thoroughly a test in the area of the mouth and pharynx. The anterior two-thirds of the tongue can be assessed with the naked eye. Finally, with the help of a mirror the base of the tongue can be seen. When tongue cancer is suspected, the doctor takes a tissue sample (biopsy) of the affected areas of the tongue, thus ensuring the diagnosis.
To determine how far the cancer of the tongue has spread from its original location, the doctor uses imaging scanning procedures such as computed tomography (CT) or magnetic resonance tomography (MRT). In this way, it can be determined if branched tumors (metastases) are found in the lymph nodes of the throat. However, sometimes it is enough to make an ultrasound of the lymph nodes.
The staging of carcinoma of the tongue is classified according to the TNM system, acronyms in English representing the extent of the primary tumor (T), the presence of regional lymph nodes (N) and the presence of distant metastases (M). This classification is very important for the doctor, since through this information, the adequate treatment can be established as well as the evaluation of the prognosis of the disease.
Overview of the treatment of tongue cancer
The choice of treatment depends on:
– The size and location of the tumor.
– The degree of invasion of cancerous cells.
– The personal characteristics of the patient (age, family history).
– The general state of health and life choices of the patient.
The different treatments
Like most cancers, the treatment combines surgery, chemotherapy, and radiotherapy. The combination of these treatments is defined on a case-by-case basis.
The main treatment remains the surgery with resection (that is to say the removal) of part or all of the tongue. Depending on the situation, size and location of the tumor, the surgeon can perform the reconstruction of a new tongue with fragments taken usually in the neck. This heavy operation, with disabling consequences for the patient, requires a long rehabilitation. Tongue cancer surgery is usually combined with other forms of treatment (radiation or chemotherapy) to ensure that all cancer cells have been eliminated.
Note that tongue cancer tends to spread in the upper aerodigestive tract. It can also metastasize, especially to the lungs, the liver, the bones.
Surveillance is necessary for about ten years (recurrence, other localization, complications …).
Who to consult?
– An oncologist: for all matters relating to the general treatment of cancer. Make sure of his specialty is “tongue cancer”.
– An otolaryngologist (ENT physician): for all matters relating to the removal of the tumor. Make sure of he is specialized in tongue cancer.
What are the latest advances in tongue cancer?
Currently, the research attempts to unravel the genetic mechanism that causes tongue cancer. It is known that alteration of the suppressor oncogene encoding the p53 protein is closely related to the onset of many squamous cell carcinomas of the head and neck. In addition, other genes such as ErbB1 and c-myc are involved.
There is increasing evidence that viral infections may play a role in the origin of tongue cancer. The virus most frequently found in these tumors is human papilloma virus (HPV-16).
Future research will reveal the cause and mechanism of origin of tongue cancer and this will allow doctors to apply more effective and less aggressive treatments.
Where to find more information?
Do not hesitate to ask your doctor or any other member of your healthcare team. It is important that you learn as much as possible about your illness or treatment so that you know what to expect and especially how to stay as healthy as possible despite your illness. Your doctor knows all the details of your case, he/she is the best person to whom you can address your questions.