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 oral tongue, while cancer at the back of the oral 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.

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

This section includes some pictures of tongue cancer.

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.

Symptoms of tongue cancer may include:

In particular, the first signs of tongue cancer tend to include a painful lump or sore on the side of the tongue that may bleed easily and resist healing. Mouth or tongue pain is also common.

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.

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, as well as the location and size of the lymph nodes.
  • 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 indicates how the tumor cells look under a microscope. A doctor may describe them as “abnormal” or “well-differentiated.”

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 stage of the cancer.

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

Cancer may develop 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 and what causes the DNA damage.

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:

It is important to note that part of the oral tongue is in the oral cavity and part is in the oropharynx.

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 perform 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 the cancer has spread to other parts of the body.

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. However, sometimes one procedure can cover even a large tumor with extension. 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
  • swallowing
  • breathing
  • eating

Sometimes, a neck dissection may be needed. This involves examining and removing the neck lymph nodes. It can be useful in oral cavity cancer even without obvious disease in the lymph nodes.

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

Below are some commonly asked questions about symptoms of tongue cancer.

What are the first signs of cancer of the tongue?

The earliest signs of tongue cancer can include mouth pain and a lump or sore on the side of the tongue that may be painful, resist healing, and bleed easily.

Is cancer of the tongue curable?

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, which is carcinoma in situ that has not spread, 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.

Is tongue cancer usually fatal?

Cancer survival rates depend on factors such as the type of cancer, stage, and a person’s overall health. People with early stage tongue cancer typically have good outcomes, but prognosis worsens as the cancer spreads.

However, overall survival rates for tongue cancer are improving.

Does tongue cancer spread quickly?

Tongue cancer can spread rapidly. For this reason, detecting tongue cancer early is crucial because the stage at diagnosis plays a vital role in determining five-year survival.

Is cancer of the tongue curable?

For tongue cancer found in its early stages, the outlook is usually positive. Doctors can treat it with surgery, radiation, and chemotherapy.

Where does tongue cancer usually start?

Tongue cancer usually starts on the side of the tongue.

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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