What are the early signs of tongue cancer?
Tongue cancer is a type of mouth cancer, or oral cancer, that usually develops in the squamous cells on the surface of the tongue. It can cause tumors or lesions. The most noticeable signs of tongue cancer are a sore on the tongue that does not heal and a painful tongue.
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.
Symptoms of oral cancer can include:
- red or red and white patches (oral leukoplakia) that appear on the lining of the mouth or the tongue
- sores and mouth ulcers that will not heal
- a sore throat or pain when swallowing
- a feeling that there is something lodged in the throat
- a painful tongue
- a hoarse voice
- difficulty moving the jaw or tongue
- neck or ear pain
- loose teeth
- swelling in the area that remains for more than three 3 weeks
- a lump in the mouth
- thickening of the lining of the mouth
- dentures that no longer fit correctly
Many of the early signs of mouth cancers can be hard to spot, so people may not notice any signs or symptoms when the cancer develops initially.
People who are more at risk of mouth cancer, such as those who smoke or drink excessively, should stay vigilant to any early signs. They should also schedule regular appointments with a doctor or dentist who can examine their mouth and identify any issues.
Tongue cancer symptoms
The most common type of tongue cancer is called squamous cell carcinoma. Squamous cells are thin, flat cells that are present on the surface of the skin and the tongue, in the lining of the digestive and respiratory tracts, and in the lining of the mouth, throat, thyroid, and larynx.
The primary symptoms of tongue cancer are a painful tongue and the development of a sore on the tongue. Additional symptoms may include:
- pain in the jaw or throat
- 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.
It is also possible for people to have some of these symptoms without having tongue cancer or another type of oral cancer.
Image credit: DermNet New Zealand
Squamous cell carinoma of the tongue
Image credit: Pastore, L., Fiorella, M. L., Fiorella, R., & Muzio, L. L., PLOS, 2008
What are the stages?
Doctors classify most cancer types into stages according to how much cancer is present and whether or not it has spread, or metastasized, to other parts of the body.
The classification system uses letters and numbers. The letter T indicates a tumor, and the letter N refers to neck lymph nodes. These letters each have a grading from 1–4 or 0–3 respectively.
People with a T1 tumor have the smallest grade of tumor, while people with a T4 tumor have the largest grade.
An N0 classification signifies that the tongue cancer has not spread to any neck lymph nodes. Tongue cancer that has spread to a significant number of lymph nodes has an N3 classification.
It is also possible to grade tongue cancer in the following ways:
- low grade
- high grade
This grading denotes how aggressively the cancer is growing and how likely it is to spread to other parts of the body.
Experts do not fully understand why some people get tongue cancer. However, specific risk factors can increase a person's likelihood of developing this disease.
Known risk factors include:
- smoking or chewing tobacco
- consuming alcohol in excess
- 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
Older men are the group most at risk of tongue cancer. Oral cancers are most common in those aged 50 or above.
Smokers who also drink heavily are 15 times more likely to develop oral cancers than other people.
Additional risk factors include:
- gastroesophageal reflux disease (GERD)
- betel chewing, a common habit in Southeast Asia
- exposure to particular chemicals, including asbestos, sulfuric acid, and formaldehyde
- poor oral hygiene or other factors affecting the mouth, such as jagged teeth that cause irritation or dentures that do not fit properly
How is it diagnosed?
A doctor may perform a biopsy if tongue cancer is suspected.
Anyone who is concerned that they might have tongue cancer should make an appointment with a doctor as soon as possible.
At the appointment, the doctor is likely to spend time:
- asking about any relevant medical history, including family medical history
- examining the tongue and mouth
- examining the lymph nodes to see if there is any enlargement
If a doctor suspects that tongue cancer is present, they will perform a biopsy. This will involve them removing some tissue and sending it off for testing.
Can it be cured?
It is possible to cure tongue cancer, and the outlook is better for people who get an early diagnosis. People who have cancer that has not spread have a higher rate of survival.
It is not possible to prevent tongue cancer from developing. However, if people notice any of the signs or symptoms of tongue cancer they should make an appointment with their doctor as soon as possible. The earlier a doctor can diagnose the disease, the sooner treatment can begin and the more favorable the outlook.
There are also lifestyle factors that people can control to minimize their risk of developing tongue cancer. These include:
Quitting smoking can reduce the risk of developing tongue cancer.
- quitting smoking
- avoiding chewing tobacco products or betel
- limiting alcohol intake or avoiding it completely
- eating a varied, healthful diet that includes lots of fruit and vegetables
- practicing good dental hygiene by brushing and flossing regularly and attending regular dental appointments
- receiving a full course of the HPV vaccine
- practicing safe sex and using a dental dam for oral sex
How is tongue cancer treated?
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 if 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:
In addition to surgery, some people may have radiation or chemotherapy treatment to kill any cancerous cells that remain.
The outlook for a person with tongue cancer depends on its stage at diagnosis, and the success of the treatment.