Tongue cancer

Tongue cancer is a type of cancer that starts as a growth of cells on the tongue. The tongue begins in the throat and extends into the mouth. It’s made up of muscles and nerves that help with movement and function, such as taste. The tongue aids in speaking, eating and swallowing.

Tongue cancer that starts in the mouth is different from tongue cancer that starts in the throat.

• In the mouth, tongue cancer is called oral tongue cancer. Tongue cancer in the mouth can cause symptoms right away. A doctor, dentist or other member of your health care team might notice it first because this part of the tongue is easily seen and examined.
• In the throat, tongue cancer is called oropharyngeal tongue cancer. It may grow for a while before it causes symptoms. When symptoms happen, they tend to be symptoms that have many possible causes. If you have a sore throat or ear pain, your health care team might first check for causes other than cancer. Cancer at the back of the tongue is hard to see and examine. For these reasons, the cancer often isn’t diagnosed right away. It’s often found after the cancer cells have spread to the lymph nodes in the neck.

Several types of cancer can affect the tongue. Tongue cancer most often begins in the thin, flat cells that line the surface of the tongue, called squamous cells. Tongue cancer that starts in these cells is called squamous cell carcinoma.

Your health care team considers the type of cancer cells when making a treatment plan. The team also considers the location and size of the cancer. Tongue cancer treatment typically involves surgery and radiation therapy. Other options might be chemotherapy and targeted therapy.

Tongue cancer might not cause symptoms at first. Sometimes it’s found by a doctor or dentist who examines the mouth for signs of cancer as part of a checkup.

When tongue cancer happens in the mouth, the first sign is often a sore on the tongue that doesn’t heal. Other symptoms may include pain or bleeding in the mouth and a lump or thickening on the tongue.

When tongue cancer happens in the throat, the first sign can be swollen lymph nodes in the neck. Other symptoms may include coughing up blood, weight loss and ear pain. There also may be a lump in the back of the mouth, throat or neck.

Other tongue cancer symptoms may include:

• A red or white patch on the tongue or lining of the mouth.
• A sore throat that doesn’t go away.
• A feeling that something is caught in the throat.
• Numbness of the mouth or tongue.
• Difficulty or pain with chewing, swallowing, or moving the jaws or tongue.
• Swelling of the jaw.
• A change in voice.

When to see a doctor

Make an appointment with a doctor, dentist or other health care professional if you have any symptoms that worry you.

Tongue cancer starts when healthy cells in the tongue develop changes in their DNA. A cell’s DNA contains the instructions that tell the cell what to do. The changes tell the cells to grow out of control and to continue living when healthy cells would die as part of their natural life cycle. This makes a lot of extra cells. The cells can form a growth, called a tumor. In time, the cells can break away and spread to other areas of the body.

It’s not always clear what causes the changes that lead to tongue cancer. For some tongue cancers that happen in the throat, human papillomavirus, also called HPV, can be involved. HPV is a common virus that’s transmitted through sexual contact. Tongue cancer in the throat that’s caused by HPV tends to respond better to treatment compared with tongue cancer in the throat that’s not related to HPV.

The most common factors that can increase the risk of tongue cancer include:

• Tobacco use. Tobacco is the single largest risk factor for tongue cancer. All forms of tobacco, including cigarettes, cigars, pipes, chewing tobacco and snuff, increase the risk.
• Consuming alcohol. Frequent and heavy drinking increases the risk of tongue cancer. Using alcohol and tobacco together increases the risk even more.
• Being exposed to HPV. In recent years, tongue cancer in the throat has become more common in those exposed to specific types of HPV.

Other factors may include:

• Being male. Men are more likely to develop tongue cancer than women. This may be from higher rates of tobacco and alcohol use in men.
• Increasing age. People older than 45 have an increased risk of tongue cancer. This is typically from years of tobacco and alcohol use.
• Trouble maintaining oral hygiene. Lack of dental care can contribute to tongue cancer. The risk is even higher in those who use alcohol and tobacco.
• Having a weak immune system. This can happen if you take medicine to control the immune system, such as after an organ transplant. It also can be caused by illness, such as infection with HIV.

You can reduce your risk of tongue cancer by:

• Don’t use tobacco. If you don’t use tobacco, don’t start. If you currently use tobacco of any kind, talk with your health care team about strategies to help you quit.
• Limit alcohol intake. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
• Consider the HPV vaccine. Receiving a vaccination to prevent HPV infection may reduce your risk of HPV-related cancers, such as tongue cancer. Ask your health care team whether an HPV vaccine is appropriate for you.
• Have regular health and dental exams. During your appointments, your dentist, doctor or other member of your health care team can check your mouth for signs of cancer and precancerous changes.

Tongue cancer is usually found first by a doctor, dentist or other member of your health care team during a routine checkup. A number of tests and procedures are used to help diagnose tongue cancer. Which ones are best for you depends on your medical history and symptoms.

Testing for tongue cancer may include:

• Examining the mouth and throat. In a physical exam, a member of your health care team looks at your mouth, throat and neck. That person checks for any lumps on the tongue and for swollen lymph nodes in the neck.
• Using a tiny camera to look at the mouth and throat. Called an endoscopy, this test uses a thin tube with a light and camera. The tube is inserted into the nose and passed down to the throat. It looks for signs of tongue cancer in the mouth and throat. It also may be used to see if the cancer has spread by looking at other parts of the throat, such as the voice box.
• Removing a tissue sample for testing. Called a biopsy, this test involves taking a sample of cells from the tongue. There are different types of biopsy procedures. A sample may be collected by cutting out a piece of the suspicious tissue or the entire area. Another type of biopsy uses a thin needle that’s inserted directly into the suspicious area to collect a sample of cells. The samples are sent to a lab for testing. In the lab, tests can show whether the cells are cancerous. Other tests give more information about the cancer cells, such as if they show signs of HPV.

• Imaging tests. Imaging tests capture pictures of the body. The pictures can show the size and location of the cancer. Imaging tests used for tongue cancer may include X-rays and CT, MRI and positron emission tomography, also called PET, scans.

  Sometimes an X-ray involves a barium swallow. In this type of X-ray, a liquid called barium helps to check for signs of cancer in the throat. Barium coats the throat and makes it easier to see on X-rays. An ultrasound may be used to look for cancer in the lymph nodes. Ultrasound creates pictures using sound waves. It might show whether the cancer has spread to lymph nodes in the neck.

Treatment for tongue cancer usually includes surgery followed by radiation, chemotherapy or both. Your health care team considers many factors when creating a treatment plan. These might include the cancer’s location and how fast it’s growing. The team also may look at whether the cancer has spread to other parts of your body and the results of tests on the cancer cells. Your care team also considers your age and your overall health.

Tongue cancer surgery

Surgery is the most common treatment for tongue cancer. Operations used to treat tongue cancer include:

• Surgery to remove some or all of the tongue. This surgery is called a glossectomy. The surgeon removes the cancer and some of the healthy cells around it, called a margin. Removing the margin helps ensure that all the cancer cells are removed. How much of the tongue the surgeon removes depends on the size of the cancer. The surgery might remove some of the tongue or all of the tongue. Sometimes surgery causes trouble with speaking and swallowing. This depends on how much of the tongue is removed. Physical therapy and rehab can help improve these issues.

  Surgeons use cutting tools to remove the cancer cells. The tools are put into the mouth to access the cancer. If the tongue cancer is in the throat, surgeons might put tiny cameras and special tools through the mouth and into the throat to get to the cancer. This is called transoral surgery. At some medical centers the tools are placed at the ends of robotic arms the surgeon controls from a computer. This is called transoral robotic surgery. Robotic surgery helps the surgeon operate in hard-to-reach areas of the mouth and throat, especially the back parts of the tongue. Many cancers at the front part of the tongue can be removed without robotic aid.

• Surgery to remove lymph nodes in the neck. When tongue cancer spreads, it often goes to the lymph nodes in the neck first. If there are signs that the cancer has spread to the lymph nodes, you might need surgery to remove some lymph nodes, called a neck dissection. Even if there are no signs of cancer in the lymph nodes, you may have some of them removed as a precaution. Removing the lymph nodes removes the cancer and helps your health care team decide if you need other treatments.

  To get to the lymph nodes, the surgeon makes a cut in the neck and removes the lymph nodes through the opening. The lymph nodes are tested for cancer. If cancer is found in the lymph nodes, other treatment might be needed to kill any cancer cells that are left. Options might include radiation or radiation combined with chemotherapy.

  Sometimes it’s possible to remove only a few lymph nodes for testing. This is called a sentinel node biopsy. It involves removing the lymph nodes to which cancer is most likely to spread. The lymph nodes are tested for cancer. If there’s no cancer detected, it’s likely that the cancer hasn’t spread. Sentinel node biopsy isn’t an option for everyone with tongue cancer. It’s only used in certain situations.

• Reconstructive surgery. Reconstructive surgery may be needed when parts of the face, jaw or neck are removed during surgery. Healthy bone or tissue may be taken from other parts of the body and used to fill gaps left by the cancer. This tissue can replace part of the lip, tongue, palate or jaw, face, throat, or skin. If reconstruction is used to replace parts of the tongue, it is usually done at the same time as surgery to remove the cancer.

Other tongue cancer treatments

Other treatments for tongue cancer include:

• Radiation therapy. Radiation therapy uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources. During radiation therapy, a machine directs beams of energy to specific points on the body to kill the cancer cells there.

  Radiation therapy is sometimes the main treatment for tongue cancer. It also can be used after surgery to kill any remaining cancer cells. Sometimes radiation therapy and chemotherapy are used at the same time to treat other parts, such as the lymph nodes, if the cancer has spread.

  Radiation for tongue cancer can make it hard to swallow. Eating can become painful or difficult. Your health care team will work to keep you comfortable and help you get nutrition during treatment.

• Chemotherapy. Chemotherapy uses strong medicines to kill cancer cells. Chemotherapy may be used before surgery to control the growth of the cells. It also may be used after surgery to kill any remaining cells. Sometimes chemotherapy is done at the same time as radiation therapy because it makes the radiation work better.
• Targeted therapy. Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy is used to treat tongue cancer that comes back or spreads.
• Immunotherapy. Immunotherapy is a treatment with medicine that helps your body’s immune system kill cancer cells. Your immune system fights off diseases by attacking germs and other cells that shouldn’t be in your body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. Immunotherapy might be used when the cancer is advanced and other treatments haven’t helped.
• Clinical trials. Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask a member of your health care team if you might be able to be in a clinical trial.

Treatment for advanced tongue cancer can impact your ability to speak and eat. Working with a skilled rehabilitation team can help you cope with changes that result from tongue cancer treatment.

Facing a serious illness might make you feel worried. With time, you’ll find ways to cope with your feelings, but you may find comfort in these strategies:

• Ask questions about tongue cancer. Write down questions you have about your cancer. Ask these questions at your next appointment. Also ask your health care team for reliable sources where you can get more information.

  Knowing more about your cancer and your treatment options can help you more comfortable about making decisions about your care.

• Stay connected to friends and family. Your cancer diagnosis can be stressful for friends and family too. Try to keep them involved in your life.

  Your friends and family will likely ask if there’s anything they can do to help you. Think of tasks you might like help with, such as caring for your home if you have to stay in the hospital or just listening when you want to talk.

  You may find comfort in the support of a caring group of your friends and family.

• Find someone to talk with. Find someone you can talk to who has experience helping people facing a life-threatening illness. Ask your health care team to suggest a counselor or medical social worker you can talk with. For support groups, contact the American Cancer Society or ask your health care team about local or online groups.

Start by making an appointment with your usual doctor, dentist or other health care professional if you have symptoms that worry you.

If your health care team is concerned that you may have tongue cancer, you may be referred to:

• A doctor who treats problems of the face, jaw and mouth, called an oral and maxillofacial surgeon.
• A doctor who treats problems in the ears, nose and throat, called an ENT specialist.
• A doctor who uses medicines to treat cancer, called a medical oncologist.
• A doctor who uses radiation to treat cancer, called a radiation oncologist.

Because appointments can be short, and because there’s a lot of information to discuss, it’s a good idea to be prepared. Here’s some information to help you get ready.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you’re experiencing, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, as well as any vitamins or supplements, that you’re taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information you get during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask.

Your appointment time may be limited, so prepare a list of questions to help you stay focused. List your questions from most important to least important in case time runs out. For tongue cancer, some basic questions include:

• What is my stage of tongue cancer?
• Can you explain the pathology report to me? Can I have a copy of my pathology report?
• Will I need more tests?
• What are the treatment options for my tongue cancer?
• What are the benefits and risks of each option?
• Is there one treatment option you recommend over the others?
• What would you recommend to a loved one in my same situation?
• Should I get a second opinion from a specialist? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you’ve prepared, don’t hesitate to ask other questions during your appointment.

What to expect from your doctor

Be ready to answer some basic questions about your symptoms and your health, such as:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?