Tongue Neoplasm Malignant Stage Unspecified

C02.9

Tongue cancer occurs when cells on the tongue grow and divide uncontrollably, forming a tumor that can affect your ability to speak, eat, and swallow.

Table of contents

• What is tongue cancer?
• Types and location
• Symptoms
• Causes and risk factors
• How is it diagnosed?
• Treatment options
• Outlook and survival

What is tongue cancer?

Tongue cancer is a type of cancer that starts when cells on your tongue begin to grow and divide in an uncontrolled way.^[1] Your tongue is made up of muscles and nerves that help with movement and important functions such as taste, speaking, eating, and swallowing.^[1] The tongue starts at a bone located where your chin meets your neck and ends at the floor of your mouth.^[2]

Tongue cancer is considered a type of head and neck cancer.^[2] It is one of the most common sites where head and neck cancers develop.^[3] While tongue cancer is rare overall, making up less than 1% of new cancer diagnoses in the United States, it represents one of the most frequent types of cancers affecting the mouth and throat.^[2]

• Tongue
• Mouth (oral cavity)
• Throat (oropharynx)

Types and location

The most common type of tongue cancer is squamous cell carcinoma.^[1] This cancer starts in squamous cells, which are the thin, flat cells that line the surface of the tongue.^[1] About 90% of tongue cancers are squamous cell carcinomas.^[3]

The location of the cancer on your tongue is important because it affects how the disease behaves and how it is treated. There are two main types based on location:^[1]

Oral tongue cancer affects the front two-thirds of the tongue—the part you can stick out.^[1] This type can cause symptoms right away and is easier for doctors and dentists to see and examine during checkups.^[1] Because it is visible, oral tongue cancer is often noticed and diagnosed earlier.^[1]

Base of tongue cancer (also called oropharyngeal tongue cancer) affects the back third of the tongue, the part that extends down into your throat.^[1] This type may grow for a while before causing symptoms, and when symptoms do appear, they can be vague and have many possible causes.^[1] Cancer at the back of the tongue is harder to see and examine, so it is often not diagnosed right away.^[1] It is frequently found only after the cancer cells have spread to the lymph nodes in the neck.^[1]

Symptoms

The symptoms of tongue cancer depend on where the tumor is located and how far it has grown. It is important to know that signs of tongue cancer are not always obvious, especially in the early stages.^[2]

The most common visible signs include:^[2][5]

• A red or white patch on your tongue that does not go away
• A lump on the side of your tongue that bleeds easily
• A sore spot or ulcer on your tongue that does not heal
• A lump that looks like an ulcer and is grayish-pink to red

Other symptoms may include:^[2][4]

• A sore throat that does not go away
• Pain or difficulty swallowing
• Pain or difficulty chewing
• Numbness in your tongue or other areas of your mouth
• A burning sensation on your tongue
• Thickening of the skin in your mouth
• Feeling like something is stuck in your throat
• Changes in your voice or hoarseness
• Neck pain or a lump in the neck
• Ear pain
• Jaw swelling
• Loose teeth
• Sudden changes in the way dentures fit
• Unexplained bleeding from the tongue
• Weight loss

It is important to remember that these symptoms might be caused by other, less serious conditions. However, if you notice a sore on your tongue or in your mouth that does not get better within a couple of weeks, you should see your doctor or dentist.^[2]

Causes and risk factors

Experts know that tongue cancer happens when cells on the tongue develop changes in their DNA that cause them to grow out of control.^[2] However, scientists are still learning exactly why some people develop tongue cancer and others do not.^[2]

The two most important risk factors for developing tongue cancer are heavy smoking and high alcohol use.^[3] Cigarette smoke contains harmful chemicals called carcinogens, including nitrosamines and polycyclic hydrocarbons.^[3] Alcohol breaks down in the body into a substance called acetaldehyde, which can damage DNA repair processes.^[3] Your risk increases significantly if you both smoke heavily and drink large amounts of alcohol.^[2]

Other important risk factors include:^[2][3]

• Human papillomavirus (HPV) infection—a common virus that can infect the mouth and throat. HPV is a leading cause of base of tongue cancer and can less commonly cause oral tongue cancer.^[2]
• Chewing tobacco
• Betel nut use (common in South and Southeast Asia)
• A family history of oral or throat cancers
• A personal history of cancer, especially squamous cell carcinoma
• Radiation exposure
• A weakened immune system
• Poor oral hygiene
• Jagged teeth

Tongue cancer is twice as common in men compared to women.^[2] It is also more common in people age 40 and over.^[2]

How is it diagnosed?

Tongue cancer is often first detected by a dentist during routine dental exams or oral cancer screenings, or by a doctor during a checkup for another condition.^[2][1]

To diagnose tongue cancer, your healthcare team will use several tests and procedures:^[1]

Physical examination: Your doctor will examine your mouth, throat, and neck, checking for any lumps on the tongue and for swollen lymph nodes in the neck.^[1] They may use a small, long-handled mirror to look down your throat.^[4]

Endoscopy: This test uses a thin tube with a light and camera that is inserted into the nose and passed down to the throat. It allows the doctor to look for signs of tongue cancer and see if the cancer has spread to other parts of the throat, such as the voice box.^[1]

Biopsy: This is the only way to confirm a diagnosis of cancer. A biopsy involves taking a sample of tissue from the suspicious area on your tongue.^[1] There are different ways to obtain this sample:^[4]

• Fine needle aspiration biopsy—a thin needle is inserted into the tumor and a sample is drawn out
• Incisional biopsy—a sample is removed with a surgical knife
• Punch biopsy—a small circular blade removes a round piece of tissue

The tissue sample is sent to a laboratory, where a specialist examines it under a microscope to see if the cells are cancerous. Other tests can provide more information about the cancer cells, such as whether they show signs of HPV infection.^[1]

Imaging tests: These tests create pictures of your body to show the size and location of the cancer.^[1] Imaging tests used for tongue cancer include:^[1][4]

• X-rays
• CT (computed tomography) scans—X-rays that show images in thin sections
• MRI (magnetic resonance imaging) scans
• PET (positron emission tomography) scans—which use radioactive materials to identify areas where the tumor may be growing

Treatment options

Treatment for tongue cancer depends on several factors, including the type of cancer cells, the location and size of the tumor, whether the cancer has spread, and your overall health.^[1]

The main treatments for tongue cancer include:^[1]

Surgery is usually the main treatment for tongue cancer.^[3] The surgeon removes the cancer and an area of normal tissue around it to make sure all the cancer cells are removed.^[10] The type of operation depends on where the cancer is located and how large it is. For very small cancers, a simple operation may be all that is needed. For larger cancers, the surgeon may need to remove part of the tongue (partial glossectomy) or the entire tongue (total glossectomy).^[10] You may also need surgery to remove lymph nodes in your neck if the cancer has spread there.^[10]

In some cases, you may need reconstructive surgery to rebuild your tongue using tissue from another part of your body.^[10] You might require a temporary feeding tube and breathing tube to help you during recovery.^[12]

Radiation therapy uses high-energy beams to kill cancer cells.^[1] It may be used after surgery to prevent the cancer from coming back, or it may be the main treatment if surgery is not possible.^[10] Radiation therapy typically involves treatments over a period of six weeks.^[12]

Chemotherapy uses drugs to kill cancer cells.^[1] It is often given together with radiation therapy for advanced cancers.^[12] The most common chemotherapy drugs used for tongue cancer are platinum-based agents.^[12]

Targeted therapy uses drugs that target specific features of cancer cells. One targeted drug called cetuximab may be used along with chemotherapy or radiation for certain types of tongue cancer.^[10]

Immunotherapy helps your immune system fight cancer. Drugs such as pembrolizumab or nivolumab may be used for advanced squamous cell tongue cancer.^[10]

The goal of treatment is to cure the cancer completely while preserving or restoring your ability to speak, eat, and swallow.^[3] After treatment, you may work with a speech and language therapist to help you adapt to changes in your speech and improve your tongue’s strength and movement.^[19]

Outlook and survival

The outlook for people with tongue cancer depends on several factors, including the stage of the cancer when it is diagnosed and the location of the tumor.^[3]

Early cancers that are smaller and have not spread are highly curable with surgery or radiation therapy.^[14] However, despite advances in diagnosis and treatment, the long-term outlook for patients with advanced-stage tongue cancer is generally less favorable, with five-year survival rates around 50%.^[3]

Early detection is very important for improving outcomes.^[2] Regular dental checkups and oral cancer screenings can help find tongue cancer at an earlier, more treatable stage.^[2] Long-term follow-up after treatment is essential, as the cancer can sometimes come back.^[3]