Definition

Cancer on the tongue is one type of cancer that is initiated by mutations of tongue cells, resulting in the formation of lumps or swellings on the tongue. The tongue cells contain DNA that regulates changes and chemical processes within the cells. When the DNA in cells undergoes mutations, it can cause uncontrolled cell growth and the formation of masses or lumps. Tongue cancer is known to be more commonly found in men over the age of 55 compared to women or those under 55 years old.

Tongue cancer can occur on the front part of the tongue, known as oral tongue cancer, or on the base of the tongue near the part that attaches the tongue to the base of the mouth, called oropharyngeal cancer.

There are several types of tongue cancer, with Squamous cell carcinoma being the most commonly found. Tongue cancer is classified using stages that indicate the extent of the spread of cancer. The stage is based on the TNM system (tumor, node, metastasis).

Tongue cancer is assessed based on the size of the tumor that appears on the tongue. T1 indicates a small tumor size, while T4 indicates a larger tumor size. Neck lymph nodes (Node) are evaluated to assess the spread of cancer to the lymph nodes. N0 indicates no spread to the lymph nodes, while N3 indicates extensive spread to the lymph nodes. Metastasis indicates the spread of tongue cancer to other organs in the body.

The grades in cancer indicate the level of aggressiveness of tongue cancer and the likelihood of tongue cancer spreading. Grades are divided into LMH:

• Low (cancer grows slowly and tends not to spread to other organs)
• Moderate
• High (tends to have a high likelihood of spreading and is aggressive)

Causes

The exact causes of the changes that lead to tongue cancer are not always clear. However, for some tongue cancers that occur in the throat, the human papillomavirus (HPV) can be a contributing factor. HPV is a common virus transmitted through sexual contact. Tongue cancer in the throat caused by HPV tends to respond better to treatment compared to throat tongue cancer not related to HPV.

Risk factor

Several habits and conditions can increase the risk of tongue cancer, such as:

• Male gender
• Being aged over 55 years
• Smoking or tobacco use
• Consuming alcohol in large amounts
• Chewing betel nut
• Having a family history of tongue cancer or other types of oral cancer
• History of cancer, such as other types of squamous cell cancers
• Poor diet: There is some evidence that people who consume few fruits and vegetables increase their risk of all types of oral cancer.
• Poor oral hygiene.

Symptoms

In the initial stage, tongue cancer may not show significant symptoms, making it difficult to detect. One of the primary symptoms often found in the early stages is the appearance of a sore or wound on the tongue or throat that is prone to bleeding. This wound may also fail to heal and can cause persistent pain in the mouth and tongue.

Other symptoms of tongue cancer include:

• Persistent red or white patches on the tongue
• Persistent canker sores
• Pain when swallowing
• Numbness in the mouth
• Persistent throat wounds that do not heal
• Bleeding on the tongue without any clear cause
• Persistent or enduring swelling on the tongue\

Diagnosis

To diagnose tongue cancer, doctors will conduct a medical interview and inquire about your family or personal history of cancer, whether you smoke or drink alcohol, and the extent of your smoking or drinking habits, as well as your history of HPV virus infection.

During the physical examination, doctors may find signs of cancer, such as ulcers that do not heal or swelling of the lymph nodes around the mouth or neck.

If the doctor finds signs of tongue cancer, they will conduct diagnostic tests such as a biopsy. The most commonly performed biopsy for tongue cancer is an incisional biopsy. In this type of biopsy, the doctor will administer local anesthesia and remove a small portion of tissue suspected of being cancerous.

In addition to an incisional biopsy, a brush biopsy can also be performed. In this biopsy, the doctor will roll a small brush over the area suspected of being cancerous to collect cells for further examination. This procedure may cause minor bleeding.

The tissue samples taken from both types of biopsies will be sent to the laboratory for examination. If you are diagnosed with tongue cancer, the doctor may perform imaging tests such as CT scans or MRIs to determine the extent and depth of cancer spread in your body.

Management

The treatment of tongue cancer depends on the size of the tumor and how far the cancer has spread to other body organs. In cases of early-stage oral cancer that has not metastasized, it can be treated with minor surgery to remove the affected area.

For larger tumors, removal may require a more extensive surgical procedure called partial glossectomy. The aim of this procedure is to remove the tongue cancer while minimizing damage to the mouth.

During this procedure, the part of your tongue affected by cancer will be removed. After the removal, a tongue reconstruction procedure will be performed. The doctor will take skin tissue or tissue from other parts of the body, which will then be used to reshape the tongue.

Glossectomy can cause severe side effects, including changes in breathing, swallowing, speaking, and eating. After undergoing glossectomy and surgery, it is recommended to undergo speech therapy to help you adjust to these changes.

If tongue cancer has metastasized to the lymph nodes, surgical removal will be performed. If the tumor is large or has spread to other organs, the doctor may recommend combination therapy consisting of surgical removal to remove the tumor and radiation to kill cancer cells. This procedure may cause side effects such as dry mouth and changes in taste perception.

Doctors may also recommend chemotherapy in conjunction with surgical procedures and/or radiation.

Complications

Oral or tongue cancer can spread or metastasize to other organs, including the head and neck. If tongue cancer is not treated promptly, it can cause:

• Difficulty eating and swallowing
• Difficulty speaking
• Depression
• Dehydration (fluid deficiency)
• Malnutrition
• Bleeding and pain in the tongue

Prevention

Reduce the risk of tongue cancer by taking care of your oral health and maintaining a healthy lifestyle. There are several ways to prevent tongue cancer, such as:

• Do not smoke.
• Do not chew tobacco or betel nuts.
• Limit alcohol consumption.
• Get the HPV vaccination.
• Practice safe sex.
• Consume plenty of vegetables and fruits.
• Maintain oral health by regularly brushing teeth.
• Monitor oral health every six months if possible.

When to see a doctor?

Undergo routine check-ups if you are at a risk of tongue cancer or if you experience any of the symptoms described above. Promptly seek medical attention if you notice any symptoms. Early detection and treatment of tongue cancer can improve quality of life and prevent serious complications.