Tongue cancer natural history, complications and prognosis

Tongue cancer Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Tongue cancer from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging
History and Symptoms
Physical Examination
Laboratory Findings
Chest X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Tongue cancer natural history, complications and prognosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Tongue cancer natural history, complications and prognosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Tongue cancer natural history, complications and prognosis
CDC on Tongue cancer natural history, complications and prognosis
Tongue cancer natural history, complications and prognosis in the news
Blogs on Tongue cancer natural history, complications and prognosis
Directions to Hospitals Treating Tongue cancer
Risk calculators and risk factors for Tongue cancer natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

If left untreated, patients with tongue cancer may progress to develop metastasis. Common complications of treatment of tongue cancer include neurotoxicity, bleeding, radiation caries, trismus, osteonecrosis, oral mucositis, chronic dysphagia, anemia, pharyngocutaneous fistula, aspiration, infections, xerostomia, taste alterations, nutritional compromise, and abnormal tooth development. Prognosis is generally good, and the five-year mortality rate of patients with stage I and II tongue cancer is approximately 89 and 95 respectively. The five- year disease specific survival rate of patients with stage III and IV cancers is 39 and 27 percent respectively.

Natural History

Carcinomas of the tongue base are clinically silent until they deeply infiltrate the tongue musculature. They are usually less differentiated. Because of the difficulties with direct visualization, they may extend into the oral tongue or have clinical lymph metastases before the diagnosis is established. As the tumors enlarge, they may cause a mass effect which can lead to respiratory compromise when the patient presents late in their illness. Malignancies of the tongue may grow to significant size before they cause symptoms. Approximately three fourths of the cancer occurs in the mobile tongue and is most often well differentiated. Because of the relative laxity of the tissue planes separating the intrinsic tongue musculature, cancer cells may spread easily and become symptomatic only when tumor size interferes with tongue mobility. Squamous cell carcinoma of the tongue may arise in apparently normal epithelium, in areas of leukoplakia, or in an area of chronic glossitis. These lesions are usually larger than 2 cm at presentation, with the lateral border being the most common subsite of origin. At this point, the patient may develop speech and swallowing dysfunction. Pain occurs when the tumor involves the lingual nerve, and this pain may also be referred to the ear.

Complications

• Complications of chemotherapy includes the following:
  • Neurotoxicity- This complication is a side effect of certain classes of drugs, such as the vinca alkaloids.
  • Bleeding
• Complications of radiation therapy includes the following:
  • Radiation caries
  • Trismus
  • Osteonecrosis
  • Osteoradionecrosis
• Complications common to both chemotherapy and radiation include the following:
  • Oral mucositis
  • Chronic dysphagia
  • Anemia
  • Pharyngocutaneous fistula
  • Aspiration
  • Infections such as viral, bacterial, and fungal that results from myelosuppression, xerostomia, and damage to the mucosa from radiotherapy or chemotherapy
  • Xerostomia
  • Functional disabilities such as impaired ability to swallow, eat, taste and speak because of trismus, dry mouth, mucositis, and infection
  • Taste alterations such as changes in taste perception of food.
  • Nutritional compromise such as poor nutrition from eating difficulties caused by dry mouth, mucositis, dysphagia, and loss of taste.
  • Abnormal dental development
    • Altered tooth development, craniofacial growth, or skeletal development in children secondary to high doses of chemotherapy and/or radiotherapy before age 9.

Prognosis

Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good. The five- year mortality rate of patients with stage I and II cancers is 89 and 95 percent. The five-year survival rate calculated from a population-based database is reported as, 67 and 51 percent, respectively The five- year disease specific survival rate of patients with stage III and IV cancers is 39 and 27 percent respectively. Cancer of the tongue has been associated with a worse prognosis compared with other oral cavity subsites in some series. In younger patients (ie, less than 40 years) the tongue cancer is found to have a more aggressive course.