Tongue Cancer: Stages, Symptoms, Causes, Pictures, Treatment

Tongue cancer, a type of head and neck cancer, develops on the surface of the tongue or within its tissue. It often starts as a tiny, painless bump or ulcer on the surface of the tongue, which can develop over time and result in a variety of symptoms. 

Tongue cancers can occur in two places in the oral cavity.

1. When the cancer develops in the mouth, at the front of the tongue, it is called oral tongue cancer. It is more likely to be seen and felt. 

2. When cancer develops in the throat, at the base of the tongue, it is called hypopharyngeal tongue cancer.

There are several types of tongue cancer based on the type of cell where the cancer develops. However, the most common tongue cancer is squamous cell carcinoma. This type of cancer starts in the thin, flat cells that line the tongue’s surface. 

Other types of tongue cancer include:

1. Adenocarcinoma: An uncommon form of tongue cancer that develops from the salivary glands in the tongue. These malignancies may need different ways of therapy than squamous cell carcinoma because they frequently arise in the ducts or secretory cells of the salivary glands.

2. Verrucous Carcinoma: A less aggressive type of tongue cancer is verrucous carcinoma. On the surface of the tongue, it typically appears as a slow-growing wart-like growth. Even while it has a tendency to grow slowly, if untreated, it can nonetheless infiltrate neighboring tissues.

3. Melanoma: Melanoma is a form of cancer that develops in the melanocytes, the cells that give skin its colour. The tongue can develop melanoma, however, it is uncommon. On the surface of the tongue, it could look like a mole or a dark-colored lesion with an uneven shape.

4. Lymphoma: A form of cancer that affects the lymphatic system, which is made up of lymph nodes and lymphatic veins, is known as lymphoma. It can develop in the tongue, despite it being relatively uncommon. A lump or swelling could be a symptom of tongue lymphoma.

Tongue Cancer Stages

The staging of tongue cancer aids in figuring out the severity of the condition, how far it has spread, and the best course of action. Tumour size, lymph node involvement, and metastasis (spread to other areas of the body) are frequently used to categorise the phases of tongue cancer. The general phases of tongue cancer are as follows:

1. Stage 0 (Carcinoma in-situ): At this stage, the cancer cells are only found in the top layers of the tongue's surface and have not invaded deeper into the tissue. It is considered a pre-cancerous stage, and the chances of successful treatment and cure are high.

2. Stage I: In the stage, I, the tumour is still small (less than 2 centimeters) and limited to the tongue. It has not spread to nearby lymph nodes or other parts of the body.

3. Stage II: At this stage, the tumour may be larger (2 to 4 centimeters) and may have spread to nearby lymph nodes. However, it has not metastasized to distant sites.

4. Stage III: In stage III, the tumour is larger than 4 centimeters and may have spread to nearby lymph nodes. It has not yet metastasized to distant areas of the body.

5. Stage IV: Stage IV is divided into two subcategories: IVA and IVB.

1. Stage IVA: The tumour can be of any size, and it may have spread to nearby structures such as the jawbone, muscles, or blood vessels. Lymph nodes may or may not be involved.

2. Stage IVB: The cancer has spread to nearby lymph nodes and may have metastasized to distant sites, such as the lungs or bones.

In early-stage tongue cancer, especially hypopharyngeal tongue cancer, people may not notice any symptoms. One of the most common early-stage tongue cancer symptoms is a sore on the tongue that bleeds easily. Other early tongue cancer symptoms may include mouth or tongue pain. 

Besides these early signs of tongue cancer, people can experience a range of other symptoms depending on the cancer stage and location. Some common tongue cancer symptoms include:

1. A persistent sore throat or hoarseness

2. Husky voice

3. Difficulty chewing, swallowing, or speaking

4. Red or white patches on the tongue in the mouth

5. A tongue ulcer that does not heal

6. Changes in the way the tongue or mouth feels, such as numbness or tingling

7. Bleeding from the tongue with no apparent cause

8. A sore or lump on the tongue that does not heal

9. Pain or discomfort in the mouth, tongue, or throat

10. A stiff tongue or jaw

11. A feeling as if something is catching in the throat

Experts do not fully understand the tongue cancer causes. Researchers believe that changes in the DNA of the tongue can lead to cancer growth. However, the cause of these DNA changes is not known. Various factors can increase the risk of developing this type of cancer, such as:

1. Tobacco Use: Smoking or using other tobacco products, such as chewing tobacco, can increase the risk of developing tongue cancer. Smoking and tongue cancer are highly related. Smokers are five times more likely to get tongue cancer than nonsmokers.  

2. Alcohol Consumption: Heavy drinking can also increase the risk of developing tongue cancer.

3. Human Papillomavirus (HPV): Certain strains of HPV, a sexually transmitted infection, can make people more prone to thyroid cancer. 

4. Poor Oral Hygiene: Improper care of the teeth and gums increases the likelihood of tongue cancer.

5. Chronic Irritation: Repeated irritation to the tongue, such as from rough teeth, dentures, or other dental appliances, can put an individual at a greater risk of developing tongue cancer.

6. Family History: Having a family history of tongue cancer or other types of head and neck cancer can increase the risk of tongue cancer.

7. History of Cancers: A personal history of other cancers, especially squamous cell cancers, is also related to the risk of thyroid cancer.  

8. Being Males: Males are twice as likely to develop oral cancer as females. 

9. Poor Diet: A diet low in fruits and vegetables can increase the risk of oral cancers. 

Unfortunately, nothing can guarantee the prevention of tongue cancer. But some steps can be taken, and certain activities can be avoided to reduce the risk of developing this type of cancer. Here are some tips for preventing tongue cancer:

1. Avoid Tobacco Products: Smoking and using other tobacco products increase the risk of developing tongue cancer. Quitting smoking and avoiding other forms of tobacco can significantly reduce the risk.

2. Limit Alcohol Consumption: Heavy alcohol consumption increases tongue cancer risk. Limiting alcohol intake or avoiding it altogether can reduce the risk.

3. Practice Good Oral Hygiene: Maintaining good oral hygiene, including brushing the teeth twice daily, flossing regularly, and visiting a dentist for regular check-ups, can help prevent tongue cancer.

4. Eat a Healthy Diet: A diet high in vegetables, fruits, and whole grains can help reduce the risk of several types of cancer, such as tongue cancer.

5. Be Aware of any Changes in the Mouth: If a person notices any unusual changes in their mouth, such as a sore that doesn’t heal or a lump, they should see their doctor or dentist immediately

The diagnosis of tongue cancer can be complex and may involve a combination of tests and procedures depending on the individual case. It typically involves the following steps. 

1. Medical History and Physical Examination: The healthcare provider will take a detailed medical history, including symptoms the patient may be experiencing.
   They will also physically examine the patient’s mouth, throat, and neck to look for any signs of abnormalities, such as unhealed ulcers.

2. Biopsy: If the doctor finds any suspicious cell growth, they may perform a biopsy. The procedure involves removing a small tissue sample from the cell growth for examination under a microscope.
   This can help determine whether the abnormal growth is cancerous or non-cancerous. 

1. Doctors generally perform an incisional biopsy to remove a small piece of suspected cancer under local anaesthesia. 

2. Another method is a brush biopsy, in which a doctor rolls a brush over the area to collect cells for testing. 

3. Imaging Tests: If a biopsy confirms tongue cancer, the doctor may order imaging tests like a CT scan, MRI, or PET scan, to determine the extent of the cancer and whether it has spread to other body parts.

4. Staging: Once the diagnosis of tongue cancer is confirmed, the doctor will determine the stage of cancer, which is based on the tumour size and whether it has spread to lymph nodes or other body parts.

5. Referral to Specialists: Depending on the stage and severity of the cancer, the doctor may refer the patient to specialists, such as an oncologist or a surgeon, for further treatment.

How to Prepare for Doctor Consultation?

Preparing for a doctor consultation for tongue cancer can help the patient get the most out of their appointment and feel more informed and prepared about their condition. Some tips for preparing for the appointment include:

1. Make a List of the Symptoms: Patients must write down any symptoms they have been experiencing, such as pain, difficulty swallowing, or a lump in the mouth. Also, they should note when the symptoms began and how often they occur.

2. Write Down Questions to Ask: It would help to make a list of questions for the doctor, such as what tests or procedures will be needed, what treatment options are available, and what side effects to expect.

3. List of Medications: Patients must bring a list of medications, supplements, or vitamins they are taking, as well as any allergies they may have.

4. Relevant Medical Records: Patients must bring records of previous tests or procedures related to their mouth or neck to the appointment.

5. Be Prepared to Provide Medical History: The doctor may ask the patients about their medical history, including any previous surgeries, medical conditions, or family history of cancer.

6. Bring a Support Person: Patients should consider bringing a trusted friend or family member to the appointment for emotional support and to help take notes.

7. Dress Comfortably: Patients must wear comfortable clothing and avoid wearing anything that may make it difficult for the doctor to examine their mouth and neck, such as high-necked shirts or tight-fitting clothing.

What to Expect from the Doctor?

During a consultation appointment for tongue cancer, a doctor may ask various questions to gather important information about the patient’s health and risk factors for tongue cancer and guide the diagnostic and treatment process. Some of these questions may include:

1. What symptoms are you experiencing? When did they start?

2. Have you ever had any previous medical conditions, surgeries, or treatments related to your mouth or throat?

3. Do you smoke or use tobacco products? How often and for how long?

4. Do you consume alcohol? If so, how much and how often?

5. Have you had any previous exposure to radiation therapy or chemotherapy?

6. Have you had recent injuries or trauma to your mouth or neck?

7. Have you ever been diagnosed with sexually transmitted infections, such as HPV?

8. Does any member of your family have a history of cancer?

9. Have you noticed changes in your voice or difficulty speaking?

10. Are you experiencing pain or discomfort in your mouth or throat?

11. Have you noticed any lumps or growths in your mouth or neck?

What Questions to Ask the Doctor?

By asking questions during the consultation appointment, patients can better understand their condition and treatment options, helping them make more informed decisions. Here are some questions that patients may want to consider asking their doctors:

1. What type of tongue cancer do I have?

2. What is the stage of my tongue cancer, and has it spread to other parts of my body?

3. What treatment options are available for my tongue cancer, and which do you recommend?

4. What are the potential benefits and risks of each treatment option, and what side effects can I expect?

5. How will the treatment affect my quality of life, such as my ability to eat, speak, or swallow?

6. How long will the tongue cancer treatment take, and how often will I need to come for follow-up visits?

7. What is the success rate of the recommended treatment, and what is the likelihood of recurrence?

8. Are there any experimental treatments I may be eligible for?

9. Will I need to make any lifestyle changes during or after treatment, such as quitting smoking or changing my diet?

10. What support services are available to help me cope with the physical and emotional challenges of tongue cancer treatment?

The treatment for tongue cancer will depend on the cancer stage, location, and the patient’s overall health and preferences. Treatment for tongue cancer typically involves a combination of different approaches, including surgery, radiation therapy, and chemotherapy. 

Here are some common tongue cancer treatment options:

1. Surgery: Tongue cancer surgery is often the best way to remove the cancerous tissue in the tongue. The surgeon might also remove nearby lymph nodes if the cancer has spread. In some cases, partial or complete tongue removal may be necessary with a glossectomy procedure. 

2. The patient may need reconstruction surgery if a large tongue piece is removed. 

1. During the reconstruction surgery, the doctor takes a piece of skin or tissue from another body part to rebuild the tongue. 

2. The goal of glossectomy and reconstruction surgery is to remove the tongue cancer while damaging as little of the mouth as possible.

3. However, glossectomy may cause some side effects, such as problems with speaking, eating, breathing, and swallowing.

2. Radiation Therapy: It uses high-energy beams to kill cancer cells. The treatment may be used alone or in combination with surgery or chemotherapy.

3. Chemotherapy: The treatment uses drugs to kill cancer cells. It may be used alone or with radiation therapy or tongue cancer surgery.

4. Targeted Therapy: It is a newer approach that targets specific molecules involved in cancer growth. It can be used in cases where the cancer has certain genetic mutations. Targeted therapy drugs work by interfering with the signaling pathways that promote cancer growth.

5. Immunotherapy: It uses the body's immune system to fight cancer. It works by stimulating the immune system or by using drugs that specifically target and block proteins that prevent the immune system from recognizing and attacking cancer cells. Immunotherapy may be used in advanced cases of tongue cancer or in cases where other treatments have not been effective.

Cost of Tongue Cancer Treatment

The cost of tongue cancer treatment is influenced by several factors including the stage of the cancer, the treatment method, the patient’s age, the patient’s comorbidities, location of the hospital, the type of the hospital or clinic, doctor’s expertise, and much more.

To know the cost of the treatment method, the patient must consult with his/her doctor. The below table provides an approximate cost value for various tongue cancer treatment methods.

Tongue Cancer Survival Rate

The survival rate represents the likelihood of a person with tongue cancer still being alive five years after the diagnosis compared with someone without tongue cancer. The survival rate for tongue cancer varies depending on several factors, including the cancer stage, the tumour’s location, and the patient’s overall health. However, generally, the disease has quite a high five-year survival rate, which is as follows:

Tongue cancer can cause several complications, most of which can affect a person’s quality of life. The risks and complications of tongue cancer depend on the stage and severity of the cancer. Here are the potential risks and complications:

1. Changes to the Appearance of the Mouth: Tongue cancer can cause changes, such as the development of white or red patches, ulcers, lumps, or a thickening of the tongue. In advanced cases, the cancer may cause visible swelling or deformity of the tongue or surrounding tissues.

2. Dysphagia (Swallowing difficulties): Tongue cancer can cause difficulty in swallowing due to pain, discomfort, and inflammation in the tongue and surrounding areas. As the cancer grows, it can physically obstruct the throat and make it harder to swallow.

3. Speech Difficulties: People require the interaction between muscles, bones, and tissues of their tongue, lips, teeth, and soft palate to speak. Tongue cancer treatment can affect this process, making it difficult to pronounce several sounds. 

4. Psychological and Emotional Effects: Tongue cancer and its treatment can cause psychological and emotional effects like depression and stress. 

Risks if not Treated in Time

Delaying treatment for tongue cancer can increase the risk of cancer spreading and becoming more difficult to treat. Here are some risks associated with delaying treatment:

1. Spread of Cancer: If tongue cancer is left untreated, it can spread to other body parts, including the lymph nodes, lungs, and bones. Once cancer has spread, it is much more difficult to treat and may require more aggressive treatment.

2. Increased Risk of Complications: Tongue cancer can cause difficulty speaking, swallowing, and breathing. Delaying treatment can increase the risk of these complications becoming more severe or permanent.

3. Reduced Treatment Options: Delaying treatment can limit the treatment options available, as some treatments may be less effective or no longer an option if the cancer has advanced.

4. Decreased Survival Rate: The earlier tongue cancer is detected and treated, the better the survival chances. Delaying treatment can decrease the likelihood of successful treatment and long-term survival.

When to Consult a Doctor?

Early detection and treatment of tongue cancer can significantly increase the possibility of successful treatment and long-term survival. Patients should seek prompt medical attention if they suspect they have tongue cancer or have any symptoms related to tongue cancer. The following are some symptoms to watch out for:

1. A sore or lump in the mouth that does not heal

2. Pain in the tongue or mouth that does not go away

3. Difficulty or pain when swallowing or chewing

4. Numbness or tingling in the tongue or mouth

5. A feeling that something is caught in the throat

6. Difficulty speaking or moving the tongue

A healthy and balanced diet is vital for individuals with tongue cancer to maintain their overall health and aid in the recovery process. While specific dietary recommendations may vary depending on individual needs and treatment plans, here are some general guidelines for a healthy diet for tongue cancer:

1. Focus on Nutrient-Dense Foods: Select foods high in vitamins, minerals, and other necessary nutrients. Variety is key when it comes to fruits, vegetables, whole grains, lean meats, and healthy fats.
   These foods offer the nutrients required to strengthen the immune system and encourage recovery.

2. Adequate Protein Intake: Protein is essential for tissue regeneration and repair. Incorporate lean protein sources into your diet, such as fish, chicken, beans, lentils, tofu, and Greek yoghurt.
   If swallowing becomes challenging, you might need to change the protein sources' consistency or texture to make them more palatable.

3. Stay Hydrated: In order to assist in healing and maintain general health, proper hydration is crucial. Make an effort to get enough water throughout the day.
   If swallowing is difficult, drink water frequently throughout the day and include hydrating meals like smoothies, soups, and broths.

4. Soft and Easy-to-Swallow Foods: Foods may need to be altered in texture to facilitate swallowing, depending on the treatment and individual circumstances.
   During the healing stage, soft and pureed foods such as mashed potatoes, cooked vegetables, soups, and smoothies can be helpful.

5. Avoid Irritating or Spicy Foods: The mouth and throat might become irritated by spicy or acidic foods. Such meals should be avoided, especially if they make you feel sick or hurt.
   Choose bland flavours and stay away from anything that could make your symptoms worse.

If the patient has a dry mouth due to radiotherapy, the following tips can help:

1. Sucking on ice pops and ice cubes

2. Moistening their food with sauces, creams, gravy, custard, and ice cream

3. Chewing sugarless gum to make the salivary glands produce more saliva

4. Take small sips of water throughout the day

Tongue cancer stages and treatment play a crucial role in determining patients' prognosis and survival rate. With early detection and treatment, the chances of successful outcomes increase significantly. Tongue cancer treatment varies depending on the stage and location of the cancer, and a multidisciplinary approach is often necessary to ensure the best possible care.
Therefore, it is important to seek prompt medical attention if you experience tongue cancer symptoms and work with your healthcare team to develop a personalised treatment plan.

HexaHealth is a healthcare technology platform that can help patients with tongue cancer by providing access to various services, including online consultations with medical professionals, appointment scheduling, and support resources. The platform can also help patients manage their treatment plans and connect them with specialists who provide individualised care and support.
With HexaHealth, patients with cancer under the tongue can access the care they require, no matter where they are, and receive support and guidance throughout their cancer journey. So without any delay, get in touch with a HexaHealth expert TODAY! 

Suggested Reads

1. Oral Cancer

2. Cancer Screening Tests for Males

3. Cancer Insurance Plan