Tongue cancer

Definition: What is tongue cancer?

Tongue cancer, medically referred to as tongue carcinoma, is a malignant transformation of mucosal cells in the tongue. These cells start proliferating uncontrollably while damaging other healthy tissue. In advanced stages, the cancerous cells can enter blood and lymphatic vessels and form deposits in distant organs, known as metastases. 

Tongue cancer can develop in the front visible part of the tongue or at the base of the tongue, which can only be visualized with the help of a mirror. It most commonly occurs at the lateral border of the tongue.

Overall, tongue cancer is relatively rare. An estimated 10,000 people are diagnosed with tongue cancer each year in Germany. In comparison, around 70,000 women develop breast cancer annually. Nevertheless, tongue cancer is a serious disease, and accounts for the majority of oral cancers. Particularly older individuals with risk factors are affected. Statistically, man are affected more often than women.

Causes and risk factors: How does tongue cancer develop?

In many cases, no single cause for tongue cancer can be identified. Usually, multiple risk factors coincide in the development of cancer. These risk factors increase the likelihood of the disease occurring.

Among the risk factors for the development of tongue cancer are tobacco smoke and excessive consumption of alcohol, particularly high proof alcohol. Insufficient oral hygiene in this context may also contribute to the development of oral cancer.

Further contributing factors include chronic inflammation in the oral cavity and the presence of high-risk HPV infections. The same human papillomaviruses are also responsible for causing cervical cancer.

However, none of these risk factors directly cause cancer but merely increase the risk of cancer development. A genetic predisposition can also be considered.

Symptoms: How does one notice tongue cancer?

Tongue cancer may remain asymptomatic or unnoticed for a long period of time. In its early stages, leucoplakia can occur, as a nonspecific mucosal lesion. It can have many different causes, but it may also be an early sign of tongue cancer. 

Leucoplakia usually presents as a white or grey, slightly raised patch. It can often be found at the lateral border of the tongue or on the underside. As the lesion itself does not cause any pain, it often goes unnoticed.

Possible abnormalities include persistent pain in the tongue and throat region, foreign body sensation, difficulty swallowing, newly developed bad breath, or persistent red or white coatings on the tongue that have a tendency to bleed. Moreover, increased salivation or numbness in the oral cavity may also be signs of tongue cancer.

In late stages, systemic symptoms such as fatigue, night sweats, or unintentional weight loss may appear. Cervical swelling may indicate the involvement of regional lymph nodes. In some cases, tongue cancer can be detected during a dental visit as the dentist closely examines the oral cavity.

Diagnosis: How is tongue cancer diagnosed?

If oral cancer is suspected, a thorough diagnostic evaluation should be performed by an ENT specialist. First, a medical history is taken with particular focus on present risk factors. Afterwards, the oral cavity is thoroughly inspected.

The diagnosis can be made by taking a small sample from the suspicious lesion, while visualising the overall cavity with a mirror or endoscope. This procedure is performed under local anaesthetic. The sample is then examined under a microscope.

Once the lesion has been confirmed as cancerous, imaging techniques are performed to assess the extent of the cancer. This may involve various imaging modalities such as ultrasound, CT scans or MRI scans. This allows for a precise diagnosis to initiate an appropriate treatment plan.

Treatment: What treatment options are available?

Cancer treatment is based on three pillars: surgery, radiotherapy, and chemotherapy. 

The primary treatment involves the surgical excision of the cancerous lesion. The goal is to completely remove the cancer while preserving as much healthy tissue as possible. 

In order to preserve the swallowing function after surgery, it is important to preserve as much tongue tissue as possible, and to spare surrounding nerves.

In advanced stages, additional excision of lymph nodes as well as radiation and/or chemotherapy may become necessary.

For very advanced tumours involving surrounding organs, surgery is generally no longer possible. In such cases the aim of treatment is palliative, which no longer aims at curing the disease but at relieving symptoms and therefore maintaining quality of life. Depending on the extent of the cancer and the general health status of the patient, radiotherapy or chemotherapy may be used.

In any case, harmful substances such as tobacco and alcohol should be avoided.

Chances of recovery and prognosis

Similar to all other cancers, the prognosis depends on the extent of the cancer. In the presence of affected cervical lymph nodes or metastases in distant organs the prognosis is significantly worse. The five-year survival rate for tongue cancer ranges between 15% and 50%. Generally speaking, cancer at the base of the tongue has a somewhat poor prognosis compared to cancer at the lateral tongue border.

A complete surgical removal of the tumour can mean a cure for patients. Reconstruction of the tongue through plastic surgery, possibly requiring a transplant, may be necessary.

In such cases, rehabilitation is often needed following surgery to practise speaking and swallowing. 

Which physician is a specialist for tongue cancer?

Generally, an ENT specialist is the primary contact for diseases of the tongue and the initiation of treatment for tongue cancer. If necessary, the specialist may consult with oncologists or radiation oncologists. 

We help you find an expert for your condition. All listed physicians and clinics have been carefully reviewed by us for their outstanding specialization in the field of tongue cancer and are available to receive your inquiry or treatment request.