What Is Tongue Cancer?
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Medically reviewed by Archana Sharma, DO
Tongue cancer develops when abnormal cells grow uncontrollably on the tongue's surface. A sore or bump on the side of the tongue that doesn't go away is often the first sign of tongue cancer. As the disease progresses, additional symptoms may develop, such as a red or white patch on the tongue, difficulty moving the tongue or jaw, or tongue numbness or pain.
Tongue cancer accounts for about 1% of all cancer diagnoses each year. Lifestyle factors such as smoking, drinking excess amounts of alcohol, and having human papillomavirus (HPV) are common causes of tongue cancer. Fortunately, tongue cancer is highly curable with early detection and treatment, which may include surgery, chemotherapy, or radiation therapy.
Types of Tongue Cancer
There are two main types of tongue cancer: oral and oropharyngeal. Although both are forms of tongue cancer, they differ in location, causes, and treatment approaches.
Oral Tongue Cancer
Oral tongue cancer—medically known as squamous cell carcinoma of the tongue—develops on the front two-thirds of the tongue, which is the part of your tongue you can see and move. A pinkish-red sore or bump on the side of the tongue that does not go away is often the first symptom of oral tongue cancer. The sore may easily bleed if irritated or if you accidentally bite it.
Oropharyngeal Tongue Cancer
Oropharyngeal tongue cancer — medically known as oropharyngeal squamous cell carcinoma of the tongue — develops in the back one-third of the tongue, the part of your tongue in the back of your mouth that extends to the throat. This form of tongue cancer may initially appear as a red or white patch at the back portion of your tongue, or you may feel like something is stuck at the back of your throat.
Symptoms
In its early stages, tongue cancer may not cause any noticeable symptoms. As the disease progresses, you might experience the following symptoms:
A bump, sore, or ulcer on the tongue that does not heal or go away
Red or white patches on the tongue
Tongue that feels lumpy or thick
Bleeding from the tongue when brushing your teeth or eating certain foods
Discomfort or numbness in your mouth or on your tongue
Feeling like there's something stuck in your throat
Difficulty speaking, swallowing, or chewing
Swollen lymph nodes in your neck
Causes
Damage to the DNA in the tongue's cells causes tongue cancer. Damaged DNA (gene mutations) causes these cells to become abnormal. When the abnormal cells grow and multiply uncontrollably, they form a tumor.
While the exact trigger for these mutations is not always clear, research shows strong links between oral and oropharyngeal tongue cancer and the following:
Tobacco use: Smoking cigarettes, cigars, or vapes contain chemicals that damage the DNA in tongue cells.
Excessive alcohol consumption: When the body metabolizes alcohol, it breaks it down into a chemical called acetaldehyde. Acetaldehyde is a probable carcinogen (cancer-causing agent) found in the saliva after you consume alcohol. Heavy alcohol consumption can cause DNA damage in the tongue's cells over time and lead to cancer.
Human papillomavirus (HPV) infection: HPV is a common sexually transmitted infection (STI) that affects nearly everyone by the time they reach adulthood. There are over 100 strains of HPV, but certain strains (e.g., HPV16) can lead to the development of oropharyngeal tongue cancer.
Though more research is needed, experts suggest there are other possible causes of tongue cancer, including:
Smoking cannabis or marijuana
Chewing betel quid
Poor dental hygiene
Nutritional deficiencies
Persistent tongue irritation that may occur from poor-fitting dentures, jagged teeth, or using too much mouthwash
Risk Factors
Anyone can develop tongue cancer, but certain factors can increase your risk, such as:
Sex: People assigned male at birth are twice as likely to develop tongue cancer than people assigned female at birth
Age: The risk of tongue cancer increases with age, with the majority of cases occurring after age 55
Poor nutrition: People who eat a diet low in fruits and vegetables have an increased risk of tongue cancer and other oral and oropharyngeal cancers
Lifestyle: Those who use alcohol or tobacco excessively are 30 times more at risk of developing this cancer compared to those who don't use these substances
Diagnosis
Diagnosing tongue cancer involves a series of tests to identify abnormalities in the tongue and confirm the presence of cancer cells. Dentists are often the first to spot early signs of tongue cancer, so regular dental checkups are important, especially if you are at risk for tongue cancer.
To diagnose tongue cancer, your healthcare provider will thoroughly examine your mouth, tongue, and throat for bumps, sores, or other signs. They will also feel under your jaw and along the sides of your neck to check for swollen glands (lymph nodes) or lumps that may suggest cancer.
If your healthcare provider spots an abnormal area, they will perform a biopsy. A biopsy involves removing a small tissue sample from the suspicious area and sending it to the lab for examination under a microscope to check for cancer cells.
Additional diagnostic tests your healthcare provider may recommend include:
Imaging tests: Computed tomography (CT) scans and magnetic resonance imaging (MRI) tests provide detailed images of the affected area to assess the size of the tumor and whether it has spread to nearby tissues. A positron emission tomography (PET) scan helps identify if and where cancer has spread beyond the tongue.
Panendoscopy: During a panendoscopy, your healthcare provider will pass different types of endoscopes (long, flexible tubes), such as bronchoscopy or esophagoscopy, to examine your oral cavity, larynx (voice box), esophagus, oropharynx, and trachea (windpipe) to look for tumors or other abnormalities and determine if tongue cancer has spread.
Stages of Tongue Cancer
Once healthcare providers diagnose tongue cancer, they need to determine the type and stage of the disease. This information helps them develop the most effective treatment plan for you. Tongue cancer staging uses the TNM staging system:
T: Tumor size
N: Lymph node involvement
M: Distant metastases (cancer spread to other parts of your body)
The stages of tongue cancer are as follows:
Stage 0: Cancer is limited to the top layer of cells lining the tongue
Stage I: Cancer is small (two centimeters or smaller) and has not grown into nearby tissues or spread to the lymph nodes
Stage II: Cancer is 2 to 4 centimeters wide and has not grown into nearby tissues or spread to the lymph nodes
Stage III: Cancer is larger than 4 centimeters and may have spread to nearby tissues or lymph nodes but has not metastasized (spread) to distant body areas
Stage IVA: Cancer is any size and has grown into nearby structures or lymph nodes but not distant body sites
Stage IVB: Cancer is any size and has grown into nearby structures and lymph nodes but not to distant body areas
Stage IVC: Cancer is any size and has grown into nearby tissues, may or may not have spread to nearby lymph nodes, and has spread to distant areas, such as the lungs
Treatment
Treatment for tongue cancer focuses on removing the tumor(s), eliminating cancer cells, and preventing the disease from returning. Your exact treatment plan will depend on the stage and location of the cancer.
Surgery
Surgery is the first line of treatment for tongue cancer. A glossectomy (tongue resection) involves removing the portion of the tongue where the tumor is. Depending on the tumor size, this may involve removing only a small part of the tongue, a larger portion, or the entire tongue.
Radiation Therapy
Radiation therapy uses high-energy beams to destroy or slow the growth of cancer cells. Not everyone with tongue cancer requires radiation therapy. Healthcare providers usually recommend this therapy to people with tongue cancer when:
The cancer is aggressive and fast-growing
Cancer has spread to the lymph nodes or other nearby tissues
The tumor is large, and radiation may help shrink it to reduce the amount of tissue removal during surgery
Healthcare providers want to ensure no cancer cells remain after surgery
Chemotherapy
Chemotherapy uses anti-cancer drugs to kill cancer cells throughout the body. It is not a standard treatment for tongue cancer but is sometimes combined with radiation therapy if tongue cancer has spread to other body tissues or organs.
How to Prevent Tongue Cancer
Not all cases of tongue cancer are preventable, but there are steps you can take to lower your risk of tongue cancer. These include:
Avoid tobacco products: Tobacco use, including smoking and chewing tobacco, is the leading risk factor for tongue cancer. Quitting tobacco is the best way to reduce your risk of developing the disease.
Limit alcohol intake: Excessive alcohol consumption is a significant risk factor for tongue cancer. Drinking less alcohol or abstaining from alcohol altogether can lower your risk of tongue cancer.
Protect yourself from HPV: Getting the HPV vaccine can protect you from several strains of HPV, including those associated with tongue cancer.
Get regular dental checkups: Regular visits with your dentist (once every six months) allow your dentist to detect any early signs of tongue cancer or oral health problems.
Eat a nutritious diet: Eating a healthy diet with plenty of fruits, vegetables, and whole grains may lower your risk of tongue cancer. It can also help to reduce your intake of processed and sugary foods.
Complications
Tongue cancer and its treatments can sometimes lead to more serious complications, such as:
Difficulty swallowing and speaking: Tongue cancer or surgery to remove the tumor can interfere with the tongue's movements or shape, causing difficulty swallowing, chewing, and speaking. Some people with tongue cancer may develop speech impairments, such as trouble forming clear sounds or pronouncing certain words.
Oral health problems: Treatments for tongue cancer can sometimes lead to dry mouth, loss of or changes in taste, and tooth loss.
Cancer recurrence: After treatment, cancer can sometimes come back. People with a history of tongue cancer have a higher risk of other head and neck cancers. Regular checkups with healthcare providers are essential for detecting cancer recurrences early.
Psychological distress: A diagnosis of tongue cancer can take a toll on your psychological and emotional well-being.
A Quick Review
Tongue cancer develops in the cells that line your tongue. Oral tongue cancer forms in the front two-thirds of the tongue, while oropharyngeal tongue cancer forms in the back of the tongue towards your throat. Tobacco use, heavy alcohol consumption, and human papillomavirus (HPV) infections are the most common causes of tongue cancer.
If you develop tongue cancer, you might experience symptoms like sores or bumps on the tongue that don't heal, tongue numbness, white or red patches on the tongue, a tongue that bleeds easily, and throat discomfort. Treatments to reduce symptoms include surgery, radiation therapy, and chemotherapy. You can lower your risk of tongue cancer by avoiding tobacco products, limiting your alcohol intake, eating a healthy diet, and getting regular dental checkups.
Frequently Asked Questions
Is tongue cancer curable?
Tongue cancer is curable when detected and treated early. The five-year survival rate for localized tongue cancer is 84%, meaning 84% of people with tongue cancer that has not spread are still alive five years after diagnosis. The five-year survival rate for regional tongue cancer that has spread to nearby tissues is 70%, and the five-year survival rate for distant tongue cancer that has spread to distant body areas is 41%.
Does tongue cancer spread fast?
Most tongue cancer cases are squamous cell carcinoma—a type of cancer that spreads quickly. Tongue cancer may initially spread to the lymph nodes or other tissues near the tongue. As the disease progresses it can spread to distant body areas, such as the lungs.
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