Tongue cancer usually develops in the squamous cells on the surface of the tongue, leading to tumors or lesions. The most noticeable symptoms are red or white patches on the tongue, pain, and a sore that does not heal.

Tongue cancer is a type of mouth or oral cancer. Cancer can develop in two different areas of the tongue. Tongue cancer develops at the front of the tongue, while cancer at the back of the tongue is known as oropharyngeal cancer.

Many of the early signs of mouth cancers may be difficult to distinguish from those of other disorders, such as mouth ulcers or tongue ulcers. Some people may not notice any symptoms when the cancer first develops.

Certain factors can increase the risk of developing tongue cancer, such as drinking alcohol in excess or smoking.

This article looks at tongue cancer in more detail, including the symptoms, stages, causes, and more.

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The most common type of tongue cancer is squamous cell carcinoma. Squamous cells are thin, flat cells that are present on the surface of the skin and the tongue. They are also in the lining of the digestive and respiratory tracts and the lining of the mouth, throat, thyroid, and larynx.

Symptoms of tongue cancer may include:

  • jaw pain
  • throat pain
  • pain when swallowing
  • feeling as though something is catching in the throat
  • a stiff tongue or jaw
  • problems swallowing or chewing food
  • a red or white patch forming on the lining of the mouth or tongue
  • a tongue ulcer that will not heal
  • numbness in the mouth
  • bleeding from the tongue without reason
  • a lump on the tongue that does not go away

The symptoms of tongue cancer are similar to those of other oral cancers, and they may also not be evident in the early stages of the disease.

Having these symptoms does not necessarily mean that a person has tongue cancer. Other conditions that affect the mouth or throat can produce similar symptoms.

This section includes some pictures of tongue cancer.

Doctors classify most cancer types into stages according to the size of the tumor and whether it has metastasized, or spread, to the lymph nodes or other parts of the body.

The classification system, known as the TNM staging system, uses the letters T, N, and M, as well as the numbers 0–4. It is the system that hospitals most commonly use.

The letters represent the following:

  • T: This letter represents the size and local spread of the tumor.
  • N: N refers to the number of nearby lymph nodes to which the cancer has spread.
  • M. This letter indicates whether the cancer has metastasized to other parts of the body.

The numbers show the extent of each of these. For example, people with a T1 tumor have the smallest size of tumor, while people with a T4 tumor have the largest size.

An N0 classification signifies that the tongue cancer has not spread to any neck lymph nodes. In contrast, tongue cancer that has spread to a significant number of lymph nodes will likely have an N3 classification.

It is also possible to grade tongue cancer in the following ways:

  • low grade
  • moderate
  • high grade

This grading denotes how aggressively the cancer is growing and how likely it is to spread to other parts of the body.

There is a separate staging system for oral cancers that are positive for human papillomavirus (HPV). If necessary, a doctor will explain any staging system to a person to make sure that they understand the state of the cancer.

Experts do not fully understand why some people get tongue cancer.

They theorize that the underlying cause may be due to changes in the DNA of the tongue, which can lead to cancer growth. However, a lot of research is still necessary to confirm what specifically can cause this disease.

Heavy smoking and a high intake of alcohol are the two most significant modifiable risk factors for developing tongue cancer. Many cases occur in older males with a history of one or both of these behaviors.

Evidence suggests that smokers who also drink heavily are 15 times more likely to develop oral cancers than other people.

However, in recent years, a higher number of younger people and females have started to develop tongue cancer. Experts believe that this may, at least in part, correspond to a rise in HPV-associated oropharyngeal squamous cell carcinoma cases. They continue to look at other potential risk factors that may explain the shifting demographic.

Other known risk factors include:

  • chewing tobacco
  • eating a diet low in fruit and vegetables and high in red meat or processed foods
  • having a human papillomavirus (HPV) infection
  • having a family history of tongue or mouth cancers
  • having had previous cancers, particularly other squamous cell cancers
  • being males, as oral cancer is twice as common in males than females

Doctors and dentists can perform some tests to detect tongue cancer early.

These include:

  • A toluidine blue dye test: The doctor or dentist coats the inside of the mouth in dye. The dye turns a darker blue if it spreads over an abnormal area.
  • A fluorescent light test: The dentist or doctor shines a special light into the mouth. The light will reflect differently off any abnormal areas.

If a healthcare professional finds any abnormal areas, they will examine them closely to see whether cancer cells are present.

Often, a dentist is the first to identify potential oral cancer. If they find any abnormal areas where cancer cells could be present, they may refer a person to a specialist to receive a diagnosis.

At the appointment, the doctor will usually:

  • ask about any relevant medical history, including family medical history
  • examine the tongue and mouth
  • examine the lymph nodes to see whether there is any enlargement

If a doctor suspects that a person might have tongue cancer, they will likely order a biopsy. A tongue biopsy involves the removal of a small sample of tissue, which the doctor or facility will send to a lab for testing. There, pathologists will determine whether the cells are cancerous.

If the biopsy results confirm cancer, a doctor may recommend a CT scan, MRI scan, or PET scan, which will show whether cancer has spread to other parts of the body.

The success of tongue cancer treatment depends on many factors, including the stage of the cancer. According to the American Cancer Society, nearly all people with stage 0 tongue cancer who receive treatment survive and do not require further treatment.

However, the later the stage of tongue cancer, the more difficult it is to treat.

Therefore, an early diagnosis helps improve the treatment outlook. However, even when treatment “cures” cancer, it can come back within a few weeks or several years.

Even those who take steps to reduce their risk may still develop tongue cancer. Due to this, it is important to go for regular dental checkups to detect any abnormal areas as early as possible.

Steps that a person can take to help reduce their risk include:

  • drinking alcohol in moderation or not at all
  • avoiding tobacco products
  • getting vaccinated for HPV
  • eating a nutritious, well-balanced diet

People with tongue cancer will usually require surgery to remove the cancerous tissue. Surgeons can generally remove smaller tumors in a single operation.

Multiple and more complicated operations may be necessary if larger tumors are present or the cancer has spread. The surgeon may also need to remove part of the tongue. If this is the case, they will attempt to rebuild the tongue using skin or tissue from other parts of the body.

Surgery that involves the removal of part or all of the tongue is called a glossectomy. Although doctors will attempt to minimize the damage to the mouth during the procedure, some side effects are inevitable.

Glossectomy can affect:

  • speaking
  • eating
  • breathing
  • swallowing

In addition to surgery, some people may have radiation therapy or chemotherapy treatment to kill any cancerous cells that remain.

The outlook for people with tongue cancer is generally positive, with this disease having quite a high 5-year relative survival rate.

This statistic represents the likelihood of a person with the condition still being alive 5 years after their diagnosis compared with someone without the condition.

Many factors affect a person’s survival, including their age and overall health, the size of the tumor, and whether it has spread.

The 5-year relative survival rate for tongue cancer is:

  • 83% before cancer spreads
  • 69% if it has spread to any lymph nodes
  • 41% if it has spread to other areas of the body

Tongue cancer is a form of oral cancer that has a generally favorable outcome when doctors detect and treat it early.

To confirm the diagnosis, a doctor will likely order a biopsy of the tongue. Once they have diagnosed tongue cancer, the doctor will likely recommend surgery to remove the cancer.

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