Tongue Cancer – Diagnosis and Treatment

Diagnosis

Doctors, dentists, and other health professionals often spot signs of tongue cancer during a routine checkup. Early signs might include a persistent sore, lump, white patch, or area of bleeding in the mouth or on the tongue.

Swelling in the neck or changes in speech may also be noticed. Risk factors such as tobacco use and regular alcohol intake can also increase suspicion for tongue or throat cancer.

To determine if someone has tongue cancer, doctors use a series of examinations and diagnostic tests:

Physical Check and Basic Assessment

• The healthcare provider examines the mouth, throat, and neck for visible lesions or abnormal areas.
• They feel for any lumps in the tongue and check for swollen lymph nodes, especially in the neck.

Camera Inspection (Endoscopy)

• The provider gently guides an endoscope, a thin tube with a camera and light, through the nose to the throat.
• This tool helps spot hidden lesions or suspicious growths in the oral cavity, throat, or even the voice box.

Tissue Sample Analysis (Biopsy)

• If the provider finds a suspicious spot or lump, they take a sample of tissue from the tongue. This can be done in a few ways:
  • Incisional Biopsy: The provider removes a small piece from the abnormal area.
  • Excisional Biopsy: The provider removes all of the abnormal tissue.
  • Fine Needle Aspiration: The provider uses a thin needle to pull out cells from a lump.
• In a lab, specialists closely study these samples to check for cancer cells (such as squamous cell carcinoma) or other changes, including signs of HPV.

Imaging Tests

Test Type	Purpose
CT Scan	Checks cancer size and spread.
MRI Scan	Gives detailed body images.
PET Scan	Shows cancer activity and spread.
X-ray (with barium swallow)	Highlights the throat to find blockages.
Ultrasound	Looks at lymph nodes in the neck.

Imaging reveals where cancer is located and whether it has traveled to nearby areas, such as the lymph nodes or bones. These scans help with early diagnosis and planning treatment.

Doctors also look for other symptoms like numbness, a sore that will not heal, or changes in how dentures fit. Spots called leukoplakia (white patches) or unexplained bleeding can also serve as warning signs.

Treatment

Surgical Approaches for Tongue Tumors

Most people with tongue cancer need surgery as their main treatment. Glossectomy is the operation that removes part or all of the tongue.

Surgeons carefully remove not just the cancer, but also some healthy tissue nearby to lower the chances that any cancer cells remain.

The amount of tissue removed depends on how large the tumor is and where it is on the tongue. Small tumors might only need a small section removed.

Large tumors could mean losing a bigger part of the tongue, which may make talking and swallowing harder. After surgery, some patients might have trouble speaking or eating, but physical therapy can help improve these tasks.

Methods and Tools Used in Surgery

Surgeons can reach some tongue cancers using regular tools through the mouth. They often use special instruments in the mouth to remove the tumor.

When the cancer is in the back of the tongue or deep in the throat, they may use cameras and long instruments. With transoral robotic surgery, doctors control robotic arms from a special station.

The robot gives them more control and allows them to reach difficult spots, especially in the throat area. Cancers closer to the front usually do not require robotic assistance.

Lymph Node Removal

Tongue cancer can spread to lymph nodes in the neck. To check if the cancer has spread, doctors may recommend a neck dissection. This means the surgeon removes some or all lymph nodes on one or both sides of the neck.

Even if scans or exams do not show cancer, the provider may still remove some nodes to be safe. After surgery, doctors test the lymph nodes. If they find cancer cells, they may recommend more treatments such as radiation or chemotherapy.

In some situations, surgeons remove only a few lymph nodes, especially those most likely to be affected. This procedure is called a sentinel node biopsy.

If those lymph nodes do not have cancer, the chance that the cancer has spread is much lower. A sentinel node biopsy is not suitable for everyone and is used only under certain conditions.

Surgery to Rebuild the Mouth

When surgery removes a lot of tissue, surgeons may perform reconstructive surgery.

They take healthy tissue or bone from other areas of the body, such as the arm or leg, and use it to rebuild parts of the tongue, jaw, or throat. This can help restore how the mouth looks and works.

Reconstruction often happens during the same surgery as tumor removal, so the patient does not need to return for another major operation.

Medical Team Involved

Several kinds of specialists often take part in surgical care, including:

• Oral and maxillofacial surgeons (focus on mouth and jaw surgeries)
• Plastic surgeons (for reconstruction)
• Otolaryngologists (head and neck surgeons)
• Radiation oncologists
• Medical oncologists

The team collaborates to decide on the best steps before, during, and after surgery.

Table: Possible Side Effects of Tongue Surgery

Side Effect	Possible Solutions
Trouble speaking	Speech therapy, practice
Hard to swallow	Diet changes, swallowing therapy
Changes in appearance	Reconstructive surgery, counseling
Numbness or tingling	Usually improves over time
Scar tissue	Physical therapy, regular checks

Additional Treatments for Tongue Cancer

When surgery alone is not enough, or if the tumor is too hard to remove with surgery, doctors may recommend other treatments.

Radiation Therapy

Radiation therapy uses energy beams to damage and destroy cancer cells. Doctors may use it by itself when tumors are small or surgery is not an option.

More often, they give it after surgery to kill any remaining cancer cells. A machine targets beams at the area where the cancer was or where it might have spread.

Some people receive both radiation and chemotherapy at the same time, especially when the cancer has spread to lymph nodes or other parts of the mouth. A radiation oncologist leads this portion of care.

Side Effects:

• Sore throat
• Mouth dryness
• Red or inflamed tissues
• Harder time swallowing
• Tiredness

Doctors monitor patients closely during radiation treatment and provide support for issues like trouble eating or pain.

Chemotherapy

Chemotherapy uses drugs to attack fast-growing cancer cells. Patients may take these drugs as a pill or through an IV. Sometimes, doctors give chemotherapy before surgery to shrink the tumor.

More often, they add it after surgery—especially if there is a higher risk the cancer will come back. In some situations, doctors combine chemotherapy with radiation therapy because the combination can be stronger than each treatment alone.

A medical oncologist manages chemotherapy. The exact medicines and schedule depend on the person’s needs and health.

Possible Side Effects:

• Nausea or vomiting
• Hair loss
• Infections
• Tiredness
• Mouth sores

Doctors help patients manage these side effects with medicine, rest, or changes in treatment if needed.

Targeted Drug Therapy

Targeted therapy uses medicines that seek out specific molecules or pathways that cancer cells need to grow. By blocking these signals, the treatment can slow or stop the cancer.

Doctors often use these therapies when the cancer has returned or spread to other parts of the body. Not all tumors have the same features, so targeted therapy is not suitable for everyone.

Immunotherapy

Immunotherapy helps the body’s immune system recognize and destroy tongue cancer cells. Some cancers can hide from the immune system, but immunotherapy makes these cells easier for the body to find.

Doctors usually give this treatment to patients whose cancer is advanced or has returned after standard care. Immunotherapy is given as a shot or through an IV, and it may have side effects like rash, tiredness, or inflammation.

Coping and support

Handling cancer can bring many emotions and challenges. Staying informed about the condition and treatment options often helps people feel more at ease with their decisions.

It is important to bring any questions to the cancer care team, who can point individuals to trustworthy resources for further information.

Seeking support from friends and family can lessen feelings of stress. Letting loved ones know specific ways they can assist, such as helping with household tasks or offering a listening ear, can be helpful.

Open communication encourages strong relationships and creates a sense of comfort during treatment. Talking with professionals such as counselors or social workers provides another layer of support.

The cancer care team can recommend mental health professionals and guide patients to local or online support groups where people can share their experiences. Groups like the American Cancer Society also offer helpful resources.

People may find value in seeking a second opinion, especially at specialized centers like MD Anderson, to feel confident about their treatment plans.

Dental care and supportive care are also crucial, as they help manage side effects and maintain overall well-being.

Key Sources of Support:

Support Type	How It Helps
Cancer care team	Answers questions and provides guidance.
Friends and family	Offers everyday support and emotional comfort.
Counselors/social workers	Helps handle stress and strong emotions.
Support groups	Connects with others facing similar challenges.
Dental and supportive care	Manages side effects and improves well-being.

Staying connected and using these support systems makes it easier to cope with the difficulties that can come with cancer treatment.

Getting Ready for Your Visit

Actions You Can Take Beforehand

Patients should do a few important things before going to their appointment. First, ask if any special instructions need to be followed, like fasting before the visit or avoiding certain medicines. This can avoid last-minute surprises.

Keeping a list can be useful. Write down:

• Symptoms: Include all current symptoms, even those that may not seem connected.
• Personal Information: Note recent changes or stresses in life that could affect health.
• Medicines and Supplements: List all prescription and non-prescription medicines, as well as any vitamins or herbal products being taken.

Bringing a relative or friend can help during the appointment. They may catch details or remember information the patient forgets.

List of questions:
Appointments can go quickly, so having questions ready is a good idea. Prioritize the most urgent topics first. Some questions might include:

Questions to Ask	Purpose
What stage is my tongue cancer?	Understanding diagnosis
Can you explain my pathology report?	Getting detailed information
Will more tests be needed?	Planning next steps
What treatment choices do I have?	Reviewing options
What are the risks and benefits of each option?	Making choices
Do you have a preferred treatment?	Expert recommendations
Should I seek a second opinion?	Gaining more confidence
Are there reliable online resources or pamphlets?	Learning more

Tip: New questions may come up during the conversation. Patients should not hesitate to ask them right away.

What the Health Care Provider Will Discuss

During the visit, the provider, such as a dentist, doctor, oral surgeon, or otolaryngologist, will likely ask some questions to better understand the issue. These might include:

• When did symptoms start?
• How often are the symptoms present?
• How strong or weak are the symptoms?
• Is there anything you have noticed that eases your discomfort?
• Are there triggers that make symptoms worse?

Doctors may ask about family history, past treatments, or other health conditions. If you are open and honest, the health care team, including otolaryngologists and other specialists, can make the best recommendations.

The provider may also explain possible next steps, such as ordering tests or referring you to other specialists like an oncologist, maxillofacial surgeon, or radiation expert.

Having information ready and knowing what to expect can help make the visit smoother.