Our tongue plays a vital role in our everyday life, from savouring our favourite foods to expressing our thoughts, but what happens when it's affected by cancer?
Tongue cancer is a type of oral (mouth) cancer, that has the potential to spread to other parts of the body. Read on to understand this rare type of cancer, its signs and symptoms, how it is treated, and how to prevent it.
The tongue can be divided into two parts: the oral tongue (front two-thirds of tongue), which is the visible part that sticks out, and the base of the tongue (back third of tongue), which is located at the back end near the throat. Cancer that develops in the front is classified as mouth/oral cancer and cancer that occurs at the back is classified as oropharyngeal cancer.1,2
With almost one-third of all cases being tongue cancer, it is the most prevalent form of oral cancer. It happens when tongue cells develop into tumours due to uncontrollable cell growth. Squamous cell carcinoma (SCC) is a type of tongue cancer that frequently occurs, as the mouth and throat are covered by this type of cell (squamous).2
Tongue cancer makes up around 1-2% of all new cases of cancer each year in the UK, making it very rare. It can occur in all age groups, but it is mostly observed in individuals above the age of 40. However, the incidence of tongue cancer has been steadily increasing in recent years, particularly among younger adults, due to various factors. Early detection and treatment prove to be effective in eradicating cancer cells and have shown recovery.1,2
Stages of tongue cancer
Tongue cancer is staged based on how much the tumour has grown and whether it has spread to nearby tissues, glands (thyroid) or lymph nodes.
The stages of tongue cancer progression are:1,3
- Stage 0: The top layer of the tongue, e.g.the surface cells are affected
- Stage I: The cells start abnormally dividing and have not spread to lymph nodes or nearby tissues
- Stage II: Cancer has grown in size (tumour) and could have spread to nearby tissues, but it hasn't yet reached the lymph nodes
- Stage III: Cancer might have spread to neighbouring tissues and has invaded surrounding lymph nodes
- Stage IV: Cancer has spread to distant organs or areas of the body
Overall, the staging of tongue cancer helps doctors in understanding the extent of the cancer and selecting the best course of treatment.
Causes of tongue cancer
The exact cause of tongue cancer is not known, but studies have shown several factors can increase the risk of developing it.
Some well-known causes of tongue cancer are:1,2,4
- Tobacco use: One of the biggest risk factors for tongue cancer is smoking or using tobacco products like chewing tobacco or snuff. The risk of cancer is increased by the toxic compounds in tobacco smoke, which can affect the cells of the tongue and other oral tissues
- Alcohol consumption: Drinking excessive amounts of alcohol might also raise your chances of acquiring tongue cancer. Alcohol can irritate the mouth and throat's lining, making it simpler for substances that cause cancer to enter the body
- Human papillomavirus (HPV): HPV infections have recently been linked to a higher risk of tongue cancer. A sexually transmitted virus called HPV may infect the mouth and throat and modify the cells genetically making them cancerous
- Weak immune system: Immune system weakness raises the possibility of tongue cancer. Infections and other health issues that might result in cancer are more likely to affect people with specific medical conditions, such as HIV or autoimmune diseases
- Poor Diet: A diet heavy in processed foods and red meat and poor in fruits and vegetables may raise the chance of acquiring tongue cancer.
- It's crucial to understand that not every person who gets tongue cancer has a certain risk factor. Some people may be prone to it for unknown reasons, while others may be more susceptible to it due to a combination of risk factors
Signs and symptoms of tongue cancer
A tongue ulcer, sore, or lump that doesn't go away or bleed is a common symptom of tongue cancer. It is often observed to be accompanied by tingling or burning of the tongue.
Some signs and symptoms of tongue cancer to look out for:1,2,4,6
- A sore throat that doesn't go away
- A lump or thickening in the tongue
- Pain when swallowing or talking
- Difficulty moving the tongue or jaw
- Numbness, burning or tingling in the tongue
- White or red patches on the tongue
- Bleeding from a sore
- Fatigue and unexplained weight loss
It can be challenging to recognise some of the early symptoms of mouth cancer from those of other diseases, such as mouth or tongue ulcers. Hence it is important to visit your GP if you have an unhealed mouth ulcer or other mentioned symptoms.
Diagnosis of tongue cancer
Tongue cancer tumours are often diagnosed by dentists during routine check-ups. Those who have oral tongue tumours may start treatment earlier than those who have base tongue tumours. Diagnosis of tongue cancer typically involves several steps, including a physical exam, imaging tests, and a biopsy to confirm the presence of cancerous cells.
The steps of diagnosis are:1,2,6
- Checking for lumps, sores, and discolouration during a physical exam
- Determine the size and location of tumours using imaging tests (X-rays, CT scans, and MRI scans)Biopsy to look for cancerous cells in the tissue under a microscope
- Staging analysis to determine the extent of the disease
- Referral to an oncologist for treatment planning
Management and treatment for tongue cancer
The progression of the tumour and the patient's overall health determines the course of treatment for tongue cancer. Chemotherapy, radiation therapy, surgery, or a combination of these therapies may all be used to treat tongue cancer.
The management and treatment strategies for tongue cancer are:1,2,4,5,6
- Surgery: For tongue cancer, surgery is frequently the initial course of treatment. The malignant tumour and any surrounding healthy tissue might be removed by the surgeon. Surgery occasionally includes the removal of surrounding lymph nodes or a portion of the tongue. To regain function and attractiveness following surgery, the patient may require speech therapy or reconstructive surgery
- Radiation therapy: High-energy X-rays or other forms of radiation are used in radiation treatment to destroy cancer cells. Radiation therapy may be used either on its own or in combination with chemotherapy or surgery
- Chemotherapy: Chemotherapy uses medications to destroy cancer cells. Chemotherapy can be administered on its own or in combination with other therapies like radiation or surgery
- Palliative care: Palliative care is a form of medical treatment that aims to relieve symptoms and enhance the quality of life for patients with advanced or terminal cancer. Pain treatment, symptom reduction, and emotional support are provided in palliative care
It's important to note that the treatment for tongue cancer can have side effects, such as difficulty swallowing or speaking, changes in taste, and fatigue. Healthcare professionals will work with the patient to manage these side effects and improve their quality of life during treatment. Regular follow-up appointments will be necessary to monitor for any signs of recurrence or complications.
Risk factors of tongue cancer
Some known risk factors are:2,5,6
- Tobacco use: Smoking cigarettes, cigars, or pipes, as well as using chewing tobacco or snuff, greatly increases the risk of tongue cancer
- Heavy alcohol consumption: Consuming large amounts of alcohol regularly also increases the risk of tongue cancer
- Human papillomavirus (HPV) infection: Some variants of HPV can increase the risk of developing tongue cancer
- Gender: Studies showed people assigned male at birth are at a higher risk of developing tongue cancer than people assigned female at birth
- Age: Tongue cancer is more commonly seen in the older population (>40 years of age)
- Poor oral hygiene: Neglecting oral hygiene, such as not brushing or flossing regularly, can increase the risk of developing tongue cancer due to bacterial overload
- Hereditary: Having a family history of tongue cancer or other head and neck cancers can increase the risk of developing tongue cancer
- Radiation exposure: Previous exposure to radiation therapy to the head and neck area can increase the risk of developing tongue cancer
The presence of one or more risk factors should not be mistaken for a confirmation that a person will get tongue cancer, but it is still important to be aware of them and take precautions to reduce the risk.
How common is tongue cancer?
Tongue cancer is relatively uncommon, accounting for around 1-2% of all cancers in the UK.2
How can I prevent tongue cancer?
By abstaining from cigarette use, consuming alcohol in moderation, eating a nutritious diet high in fruits and vegetables, and engaging in safe sex to lower your chance of HPV infection, you can lower your risk of acquiring tongue cancer.4,6
When should I see a doctor?
If you experience any recurring signs of tongue cancer or any other oral cancer, such as a persistent sore throat, a lump or thickening in the tongue, swallowing pain, trouble moving the tongue or jaw, numbness or tingling in the tongue, white or red patches on the tongue, or unexplained weight loss, you should consult a doctor.2,4
Tongue cancer, also known as oropharyngeal cancer, is a type of oral cancer that can occur in either the oral tongue or the base of the tongue near the throat. It can cause symptoms such as ulcers, sores, or bumps on the tongue that do not heal or fade away, and may be painful or feel like a burning sensation. Tongue cancer is diagnosed through a physical exam, imaging tests, biopsy, staging evaluation, and referral to a specialist. Treatment may include surgery, radiation therapy, chemotherapy, or a combination of these approaches. Risk factors for tongue cancer include smoking, alcohol consumption, and human papillomavirus (HPV) infection. Early detection and treatment can improve outcomes, making it important to see a doctor if you experience any symptoms or risk factors.
- Gonzalez M, Riera March A. Tongue cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: http://www.ncbi.nlm.nih.gov/books/NBK562324/
- Tongue cancer [Internet]. Available from: https://www.cancerresearchuk.org/about-cancer/mouth-cancer/stages-types-grades/tongue-cancer
- Almangush A, Bello IO, Coletta RD, Mäkitie AA, Mäkinen LK, Kauppila JH, Pukkila M, Hagström J, Laranne J, Soini Y, Kosma VM. For early-stage oral tongue cancer, depth of invasion and worst pattern of invasion are the strongest pathological predictors for locoregional recurrence and mortality. Virchows Archiv. 2015 Jul;467:39-46.
- Tongue cancer: symptoms, causes, treatment & survival rate [Internet]. Cancer Treatment Centers of America. 2022. Available from: https://www.cancercenter.com/cancer-types/oral-cancer/types/tongue-cancer
- Sessions DG, Spector GJ, Lenox J, Haughey B, Chao C, Marks J. Analysis of treatment results for oral tongue cancer. The Laryngoscope. 2002 Apr;112(4):616-25.
- Tongue cancer | memorial sloan kettering cancer center [Internet]. Available from: https://www.mskcc.org/cancer-care/types/mouth/types-mouth/tongue