Tongue Cancer: Causes, Symptoms, Treatment, and Outlook

Tongue cancer is a type of head and neck cancer that can develop in the front or back of the tongue. When tongue cancer originates in the front two-thirds of the tongue, it's thought of as oral or mouth cancer. If it originates in the back or base of your tongue, it's considered to be oropharynx or throat cancer.

Early-stage tongue cancer has symptoms that may be overlooked or confused with other conditions, like mouth ulcers.

Tongue cancer is relatively rare. According to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, tongue cancer cases accounted for 0.9% of all new cancers in 2023.

This article will discuss the causes, risk factors, symptoms, and treatments of this condition. It will also touch on prevention strategies and outlook.

what is tongue cancer — Verywell / Laura Porter

What Does Tongue Cancer Look Like?

Early-stage tongue cancer can take on the appearance of a red or white patch, grayish-pink or red mouth sore, or lump. If the lump is located on the side of your tongue, it may get large enough to touch your teeth. It may also bleed easily. Tongue cancer that starts near the base of the tongue may go unnoticed until symptoms progress.

A tongue with Cancer — Reproduced with permission from Â© DermNet dermnetnz.org 2023.

Tongue cancer is often discovered during a routine dental exam. Early detection of this condition is one reason why seeing your dentist for regular checkups is important.

Tongue Cancer Symptoms

The most common symptoms of tongue cancer are:

Patches on the tongue that are red, white, or dark in color
Ulcers or lumps that bleed easily and don't heal
Persistent sore throat pain
Pain when swallowing
Feeling of numbness in the mouth

What Are the Stages of Tongue Cancer?

The stage of your cancer is based on the tumor size and how extensively it has spread. The higher the stage's number and letter, the more severe the spread has become.

Knowing your cancer's stage is important. This information will be used to determine your treatment options and prognosis (likely course of the disease). A cancer specialist, such as an oncologist, will analyze every cancer characteristic and combination of characteristics to determine your cancer's stage.

If tongue cancer is caused by human papillomavirus (HPV), it is referred to as HPV-positive cancer. HPV-positive and HPV-negative oral cancers may be classified into stages differently.

The American Joint Committee on Cancer (AJCC) revised staging for oral cavity and oropharynx cancer in 2017. Newer staging versions are published when revised. The following is given as a general example. Discuss your staging with your oncology team.

In general, the stages of non-HPV-related tongue cancer include:

Stage 0 (carcinoma in situ): This very early stage is sometimes called precancer. In stage 0, the cancerous cells are confined to the top layer of the skin (epithelium). It has not yet spread to nearby lymph nodes or to distant sites.
Stage 1: The cancer is 2 centimeters (cm) or smaller. It isn't growing into nearby tissues. It has not yet spread to nearby lymph nodes or distant sites.
Stage 2: The cancer is larger than 2 cm (about three-fourths of an inch) but smaller than 4 cm (about 1.5 inches), It isn't growing into nearby tissues. It has not yet spread to nearby lymph nodes or distant sites.
Stage 3: The cancer is larger than 4 cm and includes cancer growing into the epiglottis (tissue beneath the tongue and at the back of the throat) that have not spread to nearby lymph nodes or distant sites. Or, the tumor is of any size, may have grown into nearby structures, and has spread to one lymph node, which is 3 cm or smaller and has not spread to distant sites.
Stage 4A: The tumor is of any size and is growing into nearby structures and possibly one or more lymph nodes. It has not spread to distant sites.

Stage 4B: The tumor is of any size and has grown into nearby soft tissues or structures and possibly one or more lymph nodes. It has not spread to distant sites.
Stage 4C: In this stage, the cancer is of any size, may have grown into nearby soft tissues or structures, and has spread to distant sites, such as the lungs.

Tongue Cancer Causes and Risk Factors

Anyone can get tongue cancer. The most common demographic group for this condition is people who were assigned male at birth and are over 40 years old.

Most instances of tongue cancer originate in squamous cells. This type of cancer is referred to as squamous cell carcinoma (SCC). Squamous cells are flat, skin-like cells located in the epithelium, as well as other structures in the body.

If you have a family history of squamous cell carcinoma of the head and neck, you may be at a higher risk for tongue cancer and other types of oral cancer.

As mentioned, tongue cancer may result from HPV infection. The strains that are responsible for causing tongue cancer are HPV 16 and HPV 18.

Smoking cigarettes and drinking alcohol to excess are significant risk factors for this condition. Smokers have a 5 times greater risk of getting tongue cancer than nonsmokers. If you've already had tongue cancer, you're at a greater risk of getting it again if you continue to smoke cigarettes or drink to excess.

Chewing smokeless tobacco or betel nut (a plant stimulant from the areca palm chewed in Southeast Asia and the Pacific) is also a potential cause of this condition.

How Is Tongue Cancer Diagnosed?

If a physical exam uncovers symptoms of tongue cancer, testing will be done to confirm the diagnosis or to uncover a different cause.

A specialist, such as an otolaryngologist (an ear, nose, and throat doctor, or ENT), will examine your entire head and neck region. They'll look for swollen lymph nodes and other symptoms, like tumors or lumps on the tongue.

They may use small mirrors or tools like an endoscope to get a full view of the back of your tongue. An endoscope is a flexible tube with a camera on the end that can be inserted into the mouth or other orifice.

If you smoke and drink heavily, your healthcare provider may also check for lung and esophageal cancer (cancer of the esophagus, the food tube) since these cancers sometimes accompany tongue cancer. This is done with an endoscope during a surgical procedure called a panendoscopy.

As a next step, you'll undergo a biopsy. The location of the suspicious area will determine whether the biopsy is done in a doctor's office or as a surgical procedure.

During the biopsy, a tiny piece of tissue will be extracted from the suspicious area. A pathologist (specialist in anatomic and laboratory medicine) will view the tissue under a microscope to look for cancer cells. They will also test for evidence of an HPV infection.

If cancerous cells are found, imaging tests may be done to determine whether the cancer has spread nearby or into distant areas of the body. Several tests may be done, including:

How Is Tongue Cancer Treated?

If testing uncovers tongue cancer, a treatment plan will be put in place for you. Factors that may determine your treatment include:

Location of the tumor or tumors
Cancer stage (how much it has spread)
Type of cancer
Cancer grade (how abnormal the cells appear microscopically)
Your overall health and age
How treatment side effects may affect you

In many instances where the cancer has not spread to distant sites, surgical removal of the cancer will be used as a first-line treatment. In some instances, a portion of the tongue may be removed. When this level of surgery is needed, the removed area may also be reconstructed.

Additional treatments may be recommended, either alone or with other therapies. They include:

Chemotherapy: Medications that kill actively growing cells are given. Chemo may be done before surgery to shrink the tumor. It may also be used instead of surgery or afterward to combat the spread of cancer.
Radiation: Radiation treatment (high energy particles delivered to the area of the tumor) may be done alone or along with chemo (chemoradiotherapy).
Targeted therapy: This treatment uses drugs that precisely target proteins that control cancer cells.
Immunotherapy: This treatment uses drugs that work with your immune system to fight and control cancer.

Can Tongue Cancer Be Prevented?

If you smoke, use tobacco products, or drink alcohol to excess, you're putting yourself at increased risk for tongue and other types of cancer. It can be hard to give up unhealthy habits, but doing so is a powerful way to reduce your risk for this disease.

When you're ready, talk to your healthcare provider about smoking cessation aids, like nicotine patches, that can help.

If you suspect that you may have alcohol use disorder, or if you drink heavily and wish to stop or cut down, treatments can help. They include medications, behavioral therapy, and 12-step programs like Alcoholics Anonymous.

Getting vaccinated against HPV is another powerful preventative. HPV vaccines are available for people ages 9 through 45.

Other preventive measures include:

Reduce sun exposure.
Don't use tanning beds or other forms of ultraviolet (UV) light.
Eat a healthy diet high in fruits and vegetables.
See your dentist regularly to check for cancer and precancerous growths.
Replace ill-fitting dentures that cause irritation.

What’s the Outlook for Someone With Tongue Cancer?

When caught early, tongue cancer can be cured. There is always a chance for recurrence, especially if you continue to smoke or drink alcohol.

The stage and type of cancer you have will both affect your post-treatment outlook. So will your body's response to treatment. Tongue cancer can be fast-growing, so early detection and treatment are pivotal to outlook and prognosis.

Tongue cancer caused by HPV tends to produce a better prognosis than tongue cancer caused by other factors.

Data from the SEER database gives these five-year relative survival rates for tongue cancer:

Localized cancer: 84%
Regional spread: 70%
Distant spread: 41%

Keep in mind that these are based on averages for all people with tongue cancer. Your individual prognosis will be based on factors specific to your case. These percentages are also based on the experiences of people who were diagnosed with tongue cancer at least five years ago. The statistics do not reflect improvements in treatments.

Summary

Tongue cancer is a type of head and neck cancer. It can affect either the front or base of the tongue.

Often, tongue cancer is discovered during regular dental checkups. If you or your healthcare provider suspects tongue cancer, testing will be done to confirm or eliminate the diagnosis.

The stage and type of cancer you have will play a role in your prognosis. Cure or remission is possible, especially when the cancer is caught at an early stage.

Cigarette smoking and drinking alcohol to excess are strong risk factors for this disease. HPV infection can also be a cause.

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