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{{Tongue cancer}}
{{Tongue cancer}}
{{CMG}}{{AE}}{{Simrat}}
{{CMG}}; {{AE}} {{SSW}} {{RAK}}
 
==Overview==
==Overview==
There is no classification system established for tongue cancer. Nonsquamous cell cancers comprise fewer than 3% of all lingual malignancies. More than 90% of oral cavity cancers are [[squamous cell carcinomas]]. The majority of the other lesions are of minor salivary gland origin. [[Melanomas]], [[lymphomas]], and [[sarcomas]] rarely occur in the tongue.  
There is no specific established system for the classification of tongue cancer; however, it's classified as part of the oral cancers. Oral cancer can be classified into three types based on the potential to spread to other parts of the body such as [[malignant]] [[tumors]],[[ precancerous]] conditions, and [[Benign tumor|benign tumors]]. Most common type of [[Malignant tumors|malignant tumor]] of the [[mouth]] is [[squamous cell carcinoma]]. [[Squamous cell carcinoma]] is further classified based on [[macroscopic]] and [[microscopic]] features. About 5% of oral cavity cancers are rare [[malignant tumors]] that start in different types of [[Cells (biology)|cells]] in the oral cavity. These include [[salivary gland cancer]], [[melanoma]], [[bone]] and [[soft tissue]] [[sarcomas]], [[Lymphomas]] and [[Plasmacytoma|extramedullary plasmacytomas]], [[Hodgkin lymphoma]], and [[non-Hodgkin lymphoma]] [[metastatic cancer]].
==Classification==
==Classification==
There is no classification system established for tongue cancer. Approximately any malignancy can metastasize to the tongue. Statistically, carcinomas of the [[breast]] and malignancies of the [[lung]], [[kidney]], and [[adrenal gland]] are the most common malignancies which can [[Metastasis|metastasize]] to the [[tongue]].<ref name="pmid4992864">{{cite journal| author=| title=Clinical staging system for carcinoma of the oral cavity. | journal=CA Cancer J Clin | year= 1968 | volume= 18 | issue= 3 | pages= 163-6 | pmid=4992864 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4992864  }}</ref>
There is no specific established system for the classification of tongue cancer; however, it's classified as part of oral cancer:
*[[Squamous cell carcinoma clinical features|Squamous cell carcinoma]]
 
**More than 90% of oral cavity cancers are [[squamous cell carcinomas]]. The majority of the other lesions are of [[Minor salivary gland cancer|minor salivary gland]] origin. [[Melanomas]], [[lymphomas]], and [[sarcomas]] rarely occur in the tongue.
===(i) Malignant tumors of the oral cavity===
**Oral [[Mucous membrane|mucosal melanomas]] to the tongue are rare relative to other [[oral cavity]] sites such as the alveolar gingivae, [[palate]], and lips.  
* [[Malignant tumors|Malignant tumours]] of the oral cavity are [[cancerous]] growths that have the potential to spread ([[metastasize]]) to other parts of the body.
**The two most prominent variants of oral squamous cell carcinomas that may be present are [[verrucous carcinoma]] and sarcomatoid squamous cell carcinoma.
* The [[oral cavity]] is lined with [[squamous]] [[epithelium]], which is formed by flat, scale-like [[Cells (biology)|cells]] called [[Squamous cell|squamous cells]].
*[[Verrucous carcinoma]]
* The most common oral cavity cancer starts in these cells and is called [[squamous cell carcinoma]] (SCC).
**[[Verrucous carcinoma|Verrucous]] cell carcinomas is a unique form of squamous cell carcinoma related to [[human papillomavirus]] ([[HPV]]) infection. In the early phases of its growth, the tumor may be asymptomatic and subclinical as a verruciform growth phase that lasts several years. In other patients, the lesion may appear suddenly or as a slowly growing lesion that has a rapid and sudden growth phase.
 
*Sarcomatoid [[squamous cell carcinoma]]
====Squamous Cell Carcinoma====
**Sarcomatoid carcinomas are also referred to as pseudosarcomatous [[squamous cell carcinoma]], pseudosarcoma, [[Metaplasticity|metaplastic]] carcinoma, pleomorphic carcinoma, and the spindle variant of [[epidermoid carcinoma]]. The histogenesis of these [[tumors]] is not clear. 
*[[Squamous cell carcinomas]] (SCC) make up 95% of all oral cavity cancers. They are classified based on [[macroscopic]] or [[microscopic]] features.
**The tumor manifests as a polypoid, rapidly growing, polypoid, and bulky mass, often in a site exposed to before [[irradiation]]. 
**'''Macroscopic features:'''
*Nonsquamous cell carcinoma
**Can be seen without a microscope
**Nonsquamous cell cancers comprise fewer than 3% of all lingual malignancies. Malignancies of [[salivary gland]] origin may also occur, with [[mucoepidermoid]] [[carcinomas]] and [[Adenoid cystic cancer|adenoid cystic]] [[carcinomas]] predominating in histological subtypes. Relative to the [[palate]], minor [[salivary gland]] malignancies of the tongue are rare.<ref name="pmid18667978">{{cite journal| author=Soares EC, Carreiro Filho FP, Costa FW, Vieira AC, Alves AP| title=Adenoid cystic carcinoma of the tongue: case report and literature review. | journal=Med Oral Patol Oral Cir Bucal | year= 2008 | volume= 13 | issue= 8 | pages= E475-8 | pmid=18667978 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18667978  }} </ref>
**Squamous cell carcinomas are described as following based on [[macroscopic]] features:
::*Infiltrative – [[Cancer]] is growing into deep layers of the [[oral cavity]]
::*Exophytic – [[Cancer]] is growing outwards from the surface of the [[oral cavity]]
::*Verrucous– [[Cancer]] has a wart-like appearance
::*Ulcerated– [[Cancer]] appears as an open [[sore]]
::*Flat – [[Cancer]] appears as an abnormal area in the lining of the [[oral cavity]]
:*'''Microscopic features:'''
:*[[Squamous cell carcinomas]] (SCC) are further divided into the following types based on [[microscopic]] features:
::*Classical or conventional SCC: Most cancers of the [[oral cavity]] are classical or conventional [[squamous cell carcinoma]]. This type of SCC starts in the [[squamous epithelium]] that lines the [[oral cavity]] and occurs most often on the [[lower lip]], [[tongue]] and floor of the [[mouth]].
::*Variants of SCC: These [[squamous cell carcinomas]] have distinct [[microscopic]] features that make them look and behave differently from classical SCC.
:::*[[Verrucous carcinoma]]
:::*Basaloid SCC
:::*[[Papillary]] SCC
:::*Spindle cell carcinoma (SpCC)
:::*Acantholytic SCC
:::*[[Adenosquamous carcinoma]]
:::*[[Lymphoepithelioma|Lymphoepithelial carcinoma]]
 
====Rare malignant tumors====
*About 5% of oral cavity cancers are rare [[malignant tumors]] that start in different types of [[Cells (biology)|cells]] in the [[oral cavity]].
**[[Salivary gland cancer]]
**[[Melanoma]]
**[[Bone]] and [[soft tissue]] [[sarcomas]]
**[[Lymphomas]] and extramedullary [[Plasmacytoma|plasmacytomas]]
**[[Hodgkin lymphoma]]
**[[Non-Hodgkin lymphoma]]
**[[Metastatic cancer]]
===(ii) Precancerous lesions of the oral cavity===
* Several types of non-cancerous [[tumors]] and [[tumor]]-like conditions can arise in the [[oral cavity]] and [[oropharynx]].
* A premalignant (or precancerous) lesion is defined as a [[benign]], morphologically altered tissue that has a greater than normal risk of [[malignant]] transformation.
* There are several different types of premalignant lesion that occur in the [[mouth]].  
* Some oral cancers begin as white patches ([[leukoplakia]]), red patches ([[erythroplakia]]) or mixed red and white patches (erythroleukoplakia or "speckled leukoplakia").  
* The most common precancerous conditions of the [[oral cavity]] are:
** [[Leukoplakia]]
** [[Erythroplakia]]
**Erythroleukoplakia
**Proliferative verrucous [[leukoplakia]] (PVL)
**[[Oral]] [[submucous]] [[fibrosis]]
 
===(iii) Benign tumors and conditions of the oral cavity===
*'''Benign tumors:''' There are many different types of benign oral cavity tumors.
**[[Hyperplasia]]
**[[Papillomas]]
**[[Pleomorphic adenoma]]
**[[Soft tissue]] tumors
***[[Lymphangioma]]
***[[Hemangioma]]
***[[Neurofibroma]]
***[[Lipoma]]
*[[Benign]] odontogenic [[tumors]] and cysts
**[[Osteoma]]
**Ossifying [[fibroma]]
*[[Benign]] conditions
**[[Candidiasis]] ([[Oral candidiasis|thrush]])
**[[Aphthous ulcers]] ([[canker sores]])
**Recurrent [[herpes labialis]] ([[cold sores]])
**[[Erythema migrans]] ([[geographic tongue]])
**Hairy tongue
**[[Lichen planus]]
**Frictional [[hyperkeratosis]]
**[[Mucocele]]
 
== TNM Classification of oral cavity carcinoma ==
The TNM classification of oral cavity carcinoma is as follows:<ref>{{cite book | last = Sobin | first = L. H. | title = TNM classification of malignant tumours | publisher = Wiley-Blackwell | location = Chichester, West Sussex, UK Hoboken, NJ | year = 2009 | isbn = 9781444332414 }}</ref>
{| class="wikitable"
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |TNM Staging for Oral Cavity Cancers
|-
| colspan="2" |'''Tumor'''
|-
|TX
|[[Primary tumor]] cannot be assessed.
|-
|T0
|[[Primary tumor]] cannot be assessed.
|-
|Tis
|[[Carcinoma in situ]]
|-
|T1
|[[Tumor]] <2 cm or less in greatest dimension
|-
|T2
|[[Tumor]] more than 2 cm but not more than 4 cm in greatest dimension
|-
|T3
|[[Tumor]] more than 4 cm in greatest dimension
|-
|T4 (lip)
|[[Tumor]] invades through cortical bone, [[inferior alveolar nerve]], floor of the mouth, or [[skin]] of the face (e.g., chin or nose).
|-
|T4a (oral cavity)
|[[Tumor]] invades adjacent structures (e.g., through cortical bone into deep [extrinsic] [[muscle]] of the [[tongue]] [[[genioglossus]], [[hyoglossus]], [[palatoglossus]], and [[styloglossus]]], [[maxillary sinus]], or [[skin]] of the [[face]]).
|-
|T4b
|[[Tumor]] invades masticator space, [[pterygoid]] plates, or skull base and/or encases [[internal carotid]] canal.
|-
| colspan="2" |'''Regional Lymph Nodes (N)'''
|-
|NX
|Regional [[lymph nodes]] cannot be assessed
|-
|N0
|No regional [[lymph node]] [[metastasis]]
|-
|N1
|[[Metastasis]] in a single [[ipsilateral]] [[lymph node]], 3 cm or less in greatest dimension
|-
|N2a
|[[Metastasis]] in a single [[ipsilateral]] [[lymph node]], more than 3 cm but not more than 6 cm in greatest dimension
|-
|N2b
|[[Metastasis]] in multiple [[ipsilateral]] [[lymph nodes]], none more than 6 cm in greatest dimension
|-
|N2c
|[[Metastasis]] in bilateral or [[contralateral]] [[lymph nodes]], none more than 6 cm in greatest dimension
|-
|N3
|[[Metastasis]] in a [[lymph node]] more than 6 cm in greatest dimension
|-
| colspan="2" |'''Distant Metastasis (M)'''
|-
|MX
|Distant [[metastasis]] cannot be assessed
|-
|M0
|No distant [[metastasis]]
|-
|M1
|Distant [[metastasis]]
|-
| colspan="2" |M = Distant [[metastasis]]; N = regional [[Lymph node|lymph nodes]]; T= [[primary tumor]]; Tis = [[carcinoma in situ]].
<nowiki>#</nowiki> = Staging system of the American Joint Committee on Cancer.
|}
{| class="wikitable"
! colspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Staging of Oral Squamous Cell Carcinoma
|-
|'''Stage'''
|'''Description'''
|-
|0
|Tis, N0, M0
|-
|I
|T1, N0, M0
|-
|II
|T2, N0, M0
|-
|III
|T3, N0, M0
T1, N1, M0
 
T2, N1, M0
 
T3, N1, M0
|-
|IVA
|T4a, N0, M0
T4a, N1, M0
 
T1, N2, M0
 
T2, N2, M0


T3, N2, M0
T4a, N2, M0
|-
|IVB
|Any T, N3, M0
T4b, any N, M0
|-
|IVC
|Any T, any N, M1
|-
| colspan="2" |M = Distant [[metastasis]]; N = regional [[lymph nodes]]; T = [[primary tumor]]; Tis = [[carcinoma in situ]].
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}
 
{{WH}}
[[Category:Types of cancer]]
{{WS}}
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[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Otolaryngology]]

Latest revision as of 21:08, 5 December 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sargun Singh Walia M.B.B.S.[2] Roukoz A. Karam, M.D.[3]

Overview

There is no specific established system for the classification of tongue cancer; however, it's classified as part of the oral cancers. Oral cancer can be classified into three types based on the potential to spread to other parts of the body such as malignant tumors,precancerous conditions, and benign tumors. Most common type of malignant tumor of the mouth is squamous cell carcinoma. Squamous cell carcinoma is further classified based on macroscopic and microscopic features. About 5% of oral cavity cancers are rare malignant tumors that start in different types of cells in the oral cavity. These include salivary gland cancer, melanoma, bone and soft tissue sarcomas, Lymphomas and extramedullary plasmacytomas, Hodgkin lymphoma, and non-Hodgkin lymphoma metastatic cancer.

Classification

There is no specific established system for the classification of tongue cancer; however, it's classified as part of oral cancer:

(i) Malignant tumors of the oral cavity

Squamous Cell Carcinoma

Rare malignant tumors

(ii) Precancerous lesions of the oral cavity

(iii) Benign tumors and conditions of the oral cavity

TNM Classification of oral cavity carcinoma

The TNM classification of oral cavity carcinoma is as follows:[1]

TNM Staging for Oral Cavity Cancers
Tumor
TX Primary tumor cannot be assessed.
T0 Primary tumor cannot be assessed.
Tis Carcinoma in situ
T1 Tumor <2 cm or less in greatest dimension
T2 Tumor more than 2 cm but not more than 4 cm in greatest dimension
T3 Tumor more than 4 cm in greatest dimension
T4 (lip) Tumor invades through cortical bone, inferior alveolar nerve, floor of the mouth, or skin of the face (e.g., chin or nose).
T4a (oral cavity) Tumor invades adjacent structures (e.g., through cortical bone into deep [extrinsic] muscle of the tongue [[[genioglossus]], hyoglossus, palatoglossus, and styloglossus], maxillary sinus, or skin of the face).
T4b Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid canal.
Regional Lymph Nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
N2a Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension
N2b Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
N2c Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
N3 Metastasis in a lymph node more than 6 cm in greatest dimension
Distant Metastasis (M)
MX Distant metastasis cannot be assessed
M0 No distant metastasis
M1 Distant metastasis
M = Distant metastasis; N = regional lymph nodes; T= primary tumor; Tis = carcinoma in situ.

# = Staging system of the American Joint Committee on Cancer.

Staging of Oral Squamous Cell Carcinoma
Stage Description
0 Tis, N0, M0
I T1, N0, M0
II T2, N0, M0
III T3, N0, M0

T1, N1, M0

T2, N1, M0

T3, N1, M0

IVA T4a, N0, M0

T4a, N1, M0

T1, N2, M0

T2, N2, M0

T3, N2, M0

T4a, N2, M0

IVB Any T, N3, M0

T4b, any N, M0

IVC Any T, any N, M1
M = Distant metastasis; N = regional lymph nodes; T = primary tumor; Tis = carcinoma in situ.

References

  1. ↑ Sobin, L. H. (2009). TNM classification of malignant tumours. Chichester, West Sussex, UK Hoboken, NJ: Wiley-Blackwell. ISBN 9781444332414.

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