Tongue cancer

NANDISH VASTRAD

NANDISH VASTRAD

Consultant Pathologist/Nephropathologist & Assistant Professor

MBBS, MD, CNC, (PGDHE),

Peer Reviewed By

Dr.Sajjan Madappady


Article Views: 1730

Published On: Friday December 15, 2017



Tounge cancer

Brief description:

Tongue cancer is a form of cancer that is caused due to uncontrolled and abnormal proliferation of cells of the tongue. Many types of cancer can affect the tongue, but most common tongue cancer begins in the squamous cells that line the surface of the tongue.

Tongue cancer can occur in:

Mouth (oral tongue cancer): In this it can be seen and felt. Since it is seen easily this will usually be diagnosed early i.e., when the cancer is small and therefore it can be more easily removed through surgery.

Throat (base of the tongue): This type of cancer may usually develop with few signs and symptoms (hypopharyngeal tongue cancer). Since it cannot be visualised in the initial stages it is usually diagnosed at an advanced stage. If the tumor is larger and the cancer has spread into the lymph nodes in the neck radical surgical procedures is required.

Symptoms: 

Oral Tongue Cancer

  • Lump on the side of the tongue touching the teeth
  • Lump with an ulcer (grayish-pink to red in color)
  • Lump that bleeds easily if bitten or touched

Base of Tongue Cancer

  • The tumor is often difficult to see in the early stages so it is usually diagnosed when it is larger
  • There are few symptoms in the early stages
  • In later stages, the cancer may cause pain, a sense of fullness in the throat, difficulty swallowing, the feeling of a lump in the neck or throat, voice changes or ear pain

Causes and Risk Factors:

  • Some people develop cancer with no risk factors.
  • More common in older age groups, although it may be found in younger age.
  • It is more common in men.
  • Smoking, five times more likely to develop tongue cancer than nonsmokers
  • Alcohol consumption.
  • Human papillomavirus (HPV), a sexually transmitted disease. HPV 16 and HPV 18

Indications:

Whenever the lesion is identified. Earlier the treatment, better is the treatment and prognosis.

Treatment modalities:

Surgery, chemotherapy and radiation therapy are used to treat tongue cancer.

Surgery

Oral Tongue Cancer:

Small tumors: Surgical removal of the primary tumor might be the only treatment needed.

Large tumors: Surgical removal of the primary tumor along with removal of the affected lymph nodes in the neck (called a neck dissection).

Larger tumors can spread and cause swallowing difficulties. Surgery for large tumors also affects speech and swallowing. With the latest reconstuctive techniques doctors are able to restore most speech and swallowing problems.

Tounge cancer

Base of Tongue Cancer:

Tumors on the base of the tongue are usually larger when diagnosed because in the early stages the tumor is difficult to see. The only early symptom is ear pain. Voice changes and difficult swallowing occur later. This may require resection of the primary tumor along with removal of the affected lymph nodes in the neck (called a neck dissection).

Radiation Therapy

This includes intensity modulated radiation therapy which helps to stop cancer cells from dividing and slows the growth of the tumor. Radiotherapy also destroys cancer cells and can shrink or eliminate tumors. Intensity modulated radiation therapy allows the use of more effective radiation doses with fewer side effects than conventional radiotherapy techniques.

Radiation therapy involves 5-6 weeks of daily treatments.

Chemotherapy:

Chemotherapy is prescribed for different reasons:

  • Together with radiotherapy as an alternative to surgery (called chemoradiation)
  • After surgery to decrease the risk of the cancer returning
  • To slow the growth of a tumor and control symptoms when the cancer cannot be cured (palliative treatment)

Pre- Procedure:

Doctors recommend you to:

  • Consume a prescription solution to clean your intestines for few days before the

          procedure.

  • Stay nil per oral for both solid and liquid foods for atleast 6 hours prior to the

          surgery.

  • Stop intake of certain medications that may increase the risk of bleeding.

During Procedure:

Almost all tongue lesions will be accessed via the combined oral and neck approaches.

glossectomy and associated tongue reconstructions can be classified into the following categories:

  • Partial Glossectomy (less than one third of tongue)
  • Hemiglossectomy (one third to half of tongue)
  • Near-total glossectomy (half to three quarters of tongue)
  • Total glossectomy (greater than three quarters of tongue)

Surgery of the Tongue:

  • Tumor resection should include at least 2 cm margin from the macroscopic border.
  • Almost all tongue tumors can be approached via the combined oral and neck.
  • If a mandibulectomy is required for adequate surgical margins, a lip-splitting procedure need not be performed in combination, as this may increase postoperative morbidity.
  • If the lip split with median or paramedian mandible osteotomy is performed, then complications from this procedure may be decreased by combining the paramedian approach (including stair step) with rigid fixation of the osteotomy with titanium plates/screws.
  • Lingual artery ligation is often required for large tongue resections.
  • Careful attention to the location of the hypoglossal nerve is critical to preserve the function of the remainder of the tongue in order to optimize speech and swallowing outcomes.

Reconstruction:

The goals of reconstruction are restoration of chewing, swallowing and speech, as well as cosmetically acceptable. In order to achieve these goals, multi-specialty reconstructive and rehabilitative efforts are very important. Different types of reconstruction techniques used are:

  • Pedicled flaps
  • Pectoralis flap
  • Radial forearm flap
  • Anterolateral thigh free flap
  • Rectus Abdominis free flap

Surgical management of the neck

Surgical management of the neck in tongue cancer consists of the modified radical neck dissection including levels I, II, III, and IV with preservation of the spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle.

Additional adjunctive radiotherapy may be required for increased regional control of disease in the presence of neck metastasis.

Post Procedure:

  • Advised regular dressing until surgical wound heals
  • Avoid contamination to prevent infection

Risk and Complications:

  • Intraoperative bleeding.
  • Recurrence
  • Post-operative infections
  • Chemotherapy and radiotherapy related side effects

Average duration of Hospital Stay:

Pre –Procedure

(Hospital)

Post –Procedure

(Hospital)

Recovery

(Local Hotel)

Follow-Up

(From Home)

Contraindications:

  • Inoperable cases
  • Uncooperative patients
  • Associated co-morbid conditions

More Info:

For more details Call us on 8100-999-111 for  FREE Medical Assistance or visit our website www.DynamicMedicare.com for all information on Doctors, Hospitals, Treatments and Healthcare.

Reference:

  • Tongue cancer – Symptoms and causes – Mayo Clinic.
  • Tongue Cancer Signs & Symptoms from Cedars-Sinai Cancer Institute.
  • medscape.com
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