Cancer of the tongue is only one of the cancers that can affect the oral cavity. Cancer is an overgrowth of cells when the ability of the cell to contain growth has been over ridden. Cancer can appear in any cell of the body from the blood to bone to organs and tissues. In 2004 the American Cancer Society estimated that 1700 deaths would be attributed to tongue cancer. Their data also indicated that there would be an incidence of cancer in that time would reach over 7000 new diagnoses. The ratio of death to diagnosis reaches 23%.
The tongue is actually divided into two separate areas. The oral part is the tongue most are familiar with, which you can “stick out” at someone. The base of the tongue sits behind this area and comprises the majority of the organ. The oral tongue and the base of the tongue develop from different tissue and are very dissimilar. However, the most common cancer of the tongue originates from squamous cells located in either portion.
Squamous cell cancer of the oral tongue is usually located on the side or border. Most of the small cancers can be quickly and successfully treated through surgical removal. However, there are a variety of goals and factors that can seriously impact speech and swallowing when these tumors are removed and should be assessed with the surgeon and the patients face-to-face.
Larger cancers found on the tongue will have an effect on speech and swallowing but not treating the problem will cause a more significant issue. There are some who believe that smaller cancers can be managed through radiation therapy alone. While this may be true in some cases, especially where the patient has a serious heart or lung condition which makes anesthesia more risky, removal of the tumor completely through surgical intervention is usually the best option.
Prognosis for patients who have cancer which develops on the oral tongue and found early is very good. As with most cancers, the early the cancer is found and treated the better the prognosis for the patient.
Squamous cell cancer of the base of the tongue will occur in the posterior 1/3 of the tongue. While it is technically feasible to remove cancers surgically in this area it is the opinion of most surgeons that they should be treated with radiation therapy.
The prognosis after treatment for cancer from the base of the tongue will vary with the type of disease and the health of the patient. Although the cure rate is good, it is not nearly as good as those smaller cancers found on the oral tongue. The sad fact is that the cancers found at the base of the tongue are found later in development and are usually larger.
In research published in 2000 in the British Journal of Cancer, researchers looked at prognostic factors individuals who suffered from tongue cancer. Their research found that when cases were divided into stage one and two versus stage three and four carcinomas it appear that individuals who were over the age of 65 and had a high malignancies were associated with a poorer prognosis, even when they were in stage one or two. Individuals who suffer in stage three or four and also had a heavy use of alcohol were associated with poor disease specific survival time. This gives physicians a better idea about how aggressive treatment must be in order to improve outcomes. (1)
Complications from tongue cancer and subsequent treatments can include headaches, oral ulcerations, tongue abnormalities, dysphagia, cervical lymphadenopathy, ear pain and macroglossia. Complications don’t affect the prognosis of the disease unless they interfere with the ability of the patient to withstand the treatment protocols.
Prognosis of tongue cancer therefore is dependent upon many different factors including the age and overall health of the patient, the extent the cancer has developed and the cell type of the tumors. For these reasons patients should have a frank discussion with their doctor about the treatment modalities available for the types of tumor they have and what the expected prognosis may be based upon the factors available.
(1) British Journal of Cancer: Prognostic Factors in Tongue Cancer
Cancer REsearch UK: tongue Cancer
Cancer Treatment Centers of America: Oral Cancer Signs and Symptoms
Cleveland Clinic: Oral Cancer
NYU Langone Medical Center: Tongue Cancer