Tongue Cancer: What It Is, Symptoms, Types

Tongue cancer is one of the types of oral cancer that develops from the cells found in all areas of the tongue. This condition can lead to the formation of tumors, growths, and lesions in the mouth. Tongue cancer is divided into different subtypes depending on which part of the tongue it develops in. These subtypes have their own specific symptoms. The most common symptom of tongue cancer is the presence of non-healing sores on the tongue. While tongue cancer is more commonly seen in older individuals, there has been a recent increase in cases among younger and middle-aged individuals. With early diagnosis and treatment, tongue cancer can be managed and treated effectively.

What is Tongue Cancer?

Tongue cancer is one of the most common types of oral cancer in our country, which can occur in different cells of the tongue and lead to masses or lesions on the tongue. Since cancerous cells tend to grow and multiply abnormally, they can cause more serious problems if left untreated. Other types of cancer that develop in the mouth can also affect the tongue. However, tongue cancer is uncontrolled growth that occurs directly in the cells of the tongue. In the early stages, tongue cancer may present different and varied symptoms. Typically, the symptoms seen in the early stages include red or white lesions in the mouth, non-healing and bleeding sores. Identifying the type of cells in which the cancer develops on the tongue can help choose the most appropriate treatment method. Additionally, the location of the tongue cancer plays an important role in determining the treatment approach.

Types of Tongue Cancer

Tongue cancer is a general term used to describe cancers that develop in different areas of the tongue. Tongue cancer is divided into two types based on the area of the tongue where it develops. These are as follows:

• Oral Tongue Cancer: The most common type of tongue cancer, oral tongue cancer is easier to detect by individuals. This type of cancer starts on the tongue and may affect the floor of the mouth, the inside of the lips and cheeks, the jawbone, and the gums. Over time, the tumor can metastasize to the lymph nodes in the neck, creating a mass in the neck. It develops in the front two-thirds of the tongue.
• Oropharyngeal Tongue Cancer: This cancer develops in the root of the tongue, where the tongue is adjacent to the throat. In advanced stages, the cancer can spread to the front of the tongue, the tonsils, pharynx, and larynx. The tumor may metastasize to the lymph nodes in the neck, appearing as a mass in the neck. It develops in the back third of the tongue.

Tongue cancer is also classified according to the type of cell from which it originates, such as squamous cell carcinoma, various salivary gland tumors, soft tissue tumors, or lymphoma in the root of the tongue.

What Are the Symptoms of Tongue Cancer?

Tongue cancer typically presents as non-healing sores, bleeding, and white and red plaques on the surface of the tongue in the early stages. In the case of oropharyngeal tongue cancer, which develops at the base of the tongue, symptoms often become apparent in the later stages. In such cases, symptoms may include difficulty speaking and swallowing, pain, and impairment of tongue movement. The symptoms of tongue cancer are generally similar to those of other types of oral cancer. In addition to these, pain around the tongue and mouth may also occur. The general symptoms of tongue cancer can be listed as follows:

• Non-healing white or red lesions on the tongue
• Non-healing ulcers on the tongue
• Pain or discomfort while swallowing
• Persistent numbness in the mouth
• Ongoing sore throat
• Bleeding in the tongue without any known cause
• Persistent lumps on the tongue
• Pain or discomfort while speaking
• Lumps felt in the neck

If these symptoms persist for a period, it is important to visit a healthcare facility and consult an ENT (Ear, Nose, and Throat) specialist for early diagnosis and treatment.

What Are the Risk Factors for Tongue Cancer?

Although there is no definitive cause for tongue cancer, various behaviors and factors can increase the risk of developing it. These include:

• Heavy smoking
• Chewing tobacco
• Having a sexually transmitted human papillomavirus (HPV) infection (for base of tongue cancer)
• Family history of tongue or oral cancer
• History of cancer in other squamous cells in the body
• A diet low in fruits and vegetables
• Poor oral hygiene
• Having rough teeth

Oral and tongue cancers are more commonly found in individuals over 55 years of age. The risk is particularly higher in older men compared to women and younger individuals.

Treatment of Tongue Cancer

To determine the most suitable treatment for tongue cancer, it is important to identify the cells and areas where the cancer is developing. The doctor first performs a detailed examination of the patient's mouth and tongue structure and learns about their medical history. They will ask if there is any family history of cancer. The doctor performs a physical exam and may also check for swelling in the lymph nodes in the neck. If any signs of tongue cancer are present, the doctor will perform tests to gather more information. Based on the findings, the most appropriate diagnosis will be made. Methods used for confirming a diagnosis of tongue cancer include:

• Incisional Biopsy: In this diagnostic method, the doctor takes a biopsy sample from the suspicious area on the patient's tongue to assess the presence of cancerous cells. This type of biopsy is usually done under local anesthesia.
• Brush Biopsy: The brush biopsy method involves brushing a suspicious area on the tongue. During the procedure, the area may bleed, allowing the doctor to collect cells for examination.

Once tongue cancer is diagnosed, the doctor plans treatment options based on the patient's condition. Treatment for tongue cancer can vary depending on the size of the tumor and how far it has spread. Surgery is considered the ideal treatment for cancers of the front portion of the tongue. Post-surgery, radiation therapy and/or chemotherapy may be added based on the pathology results. For base of tongue tumors, radiation therapy can be successfully applied, especially if they are related to the HPV virus. Surgical options include:

• Partial Glossectomy: If the cancer is in an early stage and hasn't spread, the cancerous area can be surgically removed.
• Hemiglossectomy: If the cancerous cells have spread to a larger area, particularly near the middle of the tongue, a hemiglossectomy may be performed, where a larger portion of the tongue is removed.
• Total Glossectomy: This method involves removing most of the tongue in cases of very large tumors.
• Reconstruction Surgery: If the cancer has spread extensively throughout the tongue, reconstruction surgery may be performed using tissue transplanted from another part of the body to maintain the integrity of the tongue.
• Neck Dissection: Almost all patients with tongue cancer will undergo neck dissection alongside surgery to remove any lymph nodes that may have been affected or are at risk.

After surgery, the patient may experience issues with eating, speaking, swallowing, and breathing. A speech therapist can help manage these issues post-procedure. If the cancer has spread to surrounding tissues or if there is a large tumor, radiation therapy is applied after surgery. Additionally, chemotherapy may be added to the treatment plan.

Stages of Tongue Cancer

Tongue cancer can be classified through staging and grading. Staging determines how far the cancer has spread. The stages are as follows:

• T indicates the size of the tumor. T1 refers to a smaller tumor, while T4 indicates a larger tumor.
• N indicates whether cancer cells have spread to the lymph nodes. N0 means there is no spread, while N3 indicates that cancer has spread to multiple lymph nodes.
• M indicates whether cancer cells have metastasized (spread) to other parts of the body.

The grade of tongue cancer is determined by how aggressive the cancer is and the likelihood of its spread. The cancer grades are:

• Low-grade (slow-growing and low risk of spread)
• Moderate-grade (neither very slow nor very fast-growing)
• High-grade (rapidly growing with a high risk of spread)

To prevent the development of tongue cancer, it is important to avoid actions that can increase the risk. Measures to reduce risk include:

• Not smoking
• Getting the HPV vaccine
• Eating a diet rich in fruits and vegetables
• Maintaining good oral hygiene
• Visiting the dentist for check-ups every six months

If you believe you have symptoms of tongue cancer, do not hesitate to seek early diagnosis and treatment by visiting your doctor or a health facility.