Tongue cancer overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Classification
Pathophysiology
Genes involved in the pathogenesis of tongue cancer include TP53, c-myc, and erb-b1. On gross pathology, exophytic, ulcerative, and infiltarative growth patterns are characteristic findings of tongue cancer.
Causes
Tongue cancermay be caused by either tobacco, alcohol, or human papillomavirus. Tongue cancer is caused by a point mutation in the tumor suppressor gene (TP53). The other oncogenes associated with oral squamous cell cancers of tongue include c-myc and erb -b1. Other causes of tongue cancer include areca nuts, the betel nuts or quid, use of slaked lime, and Plummer-Vinson syndrome.
Differential Diagnosis
Tongue cancer must be differentiated from other diseases that cause malignant lesions of the oral cavity and from few non-neoplastic lesions of the oral cavity, such as lymphoma, adenoid cystic carcinoma, adenocarcinoma, mucoepidermoid carcinoma, rhabdomyosarcoma, liposarcoma, infections at the floor of mouth and mandible, and normal adenoid tissue for lesions at base of tongue.[1]
Epidemiology and Demographics
In 2009, the incidence of tongue cancer was estimated to be 10,530 cases per 100,000 individuals in the United States. Males are more commonly affected with tongue cancer than females. The male to female ratio is approximately 2 to 1. The incidence of tongue cancer increases with age; the median age at diagnosis is 61 years. Approximately one-third of all diagnoses occurred in patients under the age of 55. There is no racial predilection to the tongue cancer.[2]
Risk Factors
The most potent risk factor in the development of oral cancer is alcohol intake, tobacco use and human papillomavirus transmitted through sexual contact. The other risk factors include history of betel quid intake, male gender, age over 55 year, ultraviolet light, Fanconi anemia, dyskeratosis congenita, lichen planus, graft-versus-host disease (GVHD), immune system suppression, mouthwash and irritation from dentures.[1]
Screening
According to the United States Preventive Services Task Force, screening for salivary gland tumors is not recommended.[3]
Natural History, Complications and Prognosis
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.[1]
Staging
According to the TNM staging system by the American Joint Committee on Cancer, there are four stages of oral cancer based on the tumor size, lymph nodes involved, and metastasis.[1][4]
History and Symptoms
Symptoms of tongue cancer include a red or white patch on the tongue, sore throat, an ulcer or lump on the tongue, pain on swallowing, speaking, or moving the tongue, numbness in the mouth, bleeding from the tongue, pain in the ear, and pain in the mouth or tongue.
Physical Examination
Common physical examination findings of tongue cancer include otalgia, submandibular gland asymmetry, and cervical lymphadenopathy.
Laboratory Findings
Laboratory findings consistent with the diagnosis of tongue cancer include reduced CBC levels, abnormal prothrombin time (PT), abnormal activated partial thromboplastin time (aPTT), and abnormal international normalized ratio (INR).
Chest X Ray
Chest and dental x-rays may be performed to detect metastases of tongue cancer to the lungs and mandible.
CT
Head and neck CT scan may be helpful in the diagnosis of tongue cancer. Findings on CT scan suggestive of tongue cancer include soft tissue attenuation of lesions, bony erosions, and increased attenuation of involved nodes.[1]
MRI
Head and neck MRI scan is diagnostic of tongue cancer. On head and neck MRI, tongue cancer is characterized by isointense to hypointense mass on T1-weighted MRI and isotense to hyperintense mass on T2-weighted MRI.[1]
Ultrasound
Ultrasound may be performed to detect metastases of tongue cancer to cervical lymph nodes and to aid in FNAC of suspicious nodes.[1]
Other Imaging Studies
Other diagnostic studies for tongue cancer include bone scan and positron emission tomography.
Other Diagnostic Studies
Other diagnostic studies for tongue cancer include tumor biopsy and panendoscopy.
Medical Therapy
The predominant therapy for tongue cancer is surgical resection. Adjunctive chemotherapy, radiation, chemoradiation, or brachytherapy may be required.
Surgery
Surgery is the mainstay of treatment for tongue cancer.
Primary Prevention
Effective measures for the primary prevention of tongue cancer include avoiding the use of tobacco and excessive use of alcohol.
Secondary Prevention
Secondary prevention strategies following tongue cancer include monthly follow-ups for the first 12-18 months following therapy.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Squamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 16, 2015
- ↑ Cancer of the oral cavity and pharynx. SEER(2015) http://seer.cancer.gov/csr/1975_2012/results_merged/sect_20_oral_cavity_pharynx.pdf#search=tongue+cancer Accessed on November 28, 2015
- ↑ http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=tongue+cancer Accessed on November 28, 2015.
- ↑ Staging of Sqamous cell carcinoma of the oral cavity. Radiopedia(2015) http://radiopaedia.org/articles/staging-of-squamous-cell-carcinoma-of-the-oral-cavity Accessed on November 17, 2015