What Is Tongue Cancer?

Tongue cancer occurs when cells on the surface of the tongue begin to mutate and multiply uncontrollably, leading to tumor formation. It typically begins as a sore, ulcer, or lump that doesn’t heal. Over time, the lesion may grow larger or become painful, making it difficult to eat, speak, or swallow.

This type of cancer accounts for about 1% of all new cancer cases annually. While it may sound rare, early detection is critical, as prompt treatment significantly improves the likelihood of a full recovery. Most cases are linked to lifestyle factors such as tobacco use, excessive alcohol consumption, and certain strains of human papillomavirus (HPV).

Types

There are two primary categories of tongue cancer, each affecting a different region of the tongue and requiring different diagnostic and treatment strategies.

Oral Tongue Cancer

This form of cancer affects the front two-thirds of the tongue—the visible and movable portion inside the mouth. It usually appears as a red or pink sore on the side of the tongue that does not heal or may bleed easily when touched or irritated.

Oropharyngeal Tongue Cancer

This type develops at the base or back third of the tongue, extending toward the throat. It may not be easily visible and is more likely to be discovered due to symptoms such as a persistent throat discomfort, a sensation of a foreign object in the throat, or unexplained difficulty swallowing.

Symptoms

In early stages, tongue cancer can be asymptomatic. As it progresses, individuals may notice symptoms such as:

  • Persistent sores or lumps on the tongue
  • Red or white patches on the surface of the tongue
  • Bleeding from the tongue without apparent injury
  • Numbness or tingling in the tongue or mouth
  • Difficulty swallowing, chewing, or moving the tongue
  • Speech difficulties
  • A constant sore throat
  • Enlarged lymph nodes in the neck
  • Bad breath
  • A sensation of something stuck in the throat

Symptoms may vary based on the tumor’s size and location, and some symptoms may be mistakenly attributed to less serious oral issues.

Causes

Tongue cancer typically results from mutations in the DNA of tongue cells, causing them to grow uncontrollably. These mutations may be triggered or accelerated by various factors:

  • Tobacco Use: Whether smoked or chewed, tobacco is the leading risk factor for tongue cancer. It contains carcinogens that directly damage cell DNA.
  • Heavy Alcohol Consumption: Alcohol breaks down into acetaldehyde, a known carcinogen, especially when consumed excessively over time.
  • HPV Infection: High-risk strains of the human papillomavirus, particularly HPV16, have been strongly associated with oropharyngeal cancers, including those at the base of the tongue.
  • Other Possible Contributors:
    • Marijuana smoking
    • Chewing betel nuts
    • Chronic tongue irritation from dental appliances
    • Poor oral hygiene
    • Nutritional deficiencies, particularly in vitamins and antioxidants

Risk Factors

Though anyone can develop tongue cancer, several risk factors significantly increase the chances:

  • Sex: Males are at a higher risk than females
  • Age: Risk increases significantly after age 55
  • Diet: Low consumption of fruits and vegetables
  • Lifestyle Habits: Heavy use of tobacco or alcohol increases risk by up to 30 times
  • HPV Exposure: Increases risk, particularly for oropharyngeal tongue cancers
  • Genetics and Family History: While less common, some genetic predispositions may contribute

Diagnosis

Early detection plays a critical role in successful treatment. Diagnosis typically begins with a physical exam:

  • Oral Exam: A healthcare provider or dentist examines the tongue, mouth, and throat for visible lesions, lumps, or discoloration.
  • Palpation: Feeling for lumps or swollen lymph nodes under the jaw and along the neck.
  • Biopsy: The most definitive diagnostic tool, in which a small tissue sample is taken from the suspicious area and analyzed for cancerous cells.
  • Imaging Tests:
    • CT and MRI scans to visualize the tumor and surrounding tissues
    • PET scan to detect cancer spread (metastasis)
  • Panendoscopy: This involves using scopes to examine the entire upper digestive and respiratory tract to check for spread beyond the tongue.

Staging

Tongue cancer is staged using the TNM system, which evaluates:

  • T (Tumor): Size and extent of the tumor
  • N (Nodes): Whether lymph nodes are affected
  • M (Metastasis): Whether cancer has spread to distant organs

Staging Breakdown:

  • Stage 0: Cancer confined to the top layer of tongue tissue
  • Stage 1: Tumor ≤2 cm, no spread
  • Stage 2: Tumor 2–4 cm, no spread
  • Stage 3: Tumor >4 cm or has spread to one nearby lymph node
  • Stage 4A: Cancer has invaded nearby tissues or more lymph nodes
  • Stage 4B: More extensive local spread, possibly affecting critical areas
  • Stage 4C: Distant metastasis, commonly to the lungs or liver

Treatment

Treatment plans are tailored based on cancer type, location, stage, and overall health. The main goal is to eliminate the cancer and prevent recurrence.

Surgery

Most early-stage cases are treated with surgical excision. A glossectomy involves removing the affected part of the tongue. The extent of removal may vary:

  • Partial Glossectomy: Small tumor excised, preserving much of tongue function
  • Total Glossectomy: In advanced cases, full removal of the tongue may be necessary, which can require reconstructive surgery and speech therapy

Radiation Therapy

This treatment uses targeted high-energy rays to destroy cancer cells and is often used:

  • After surgery to kill remaining cells
  • To shrink large tumors before surgery
  • When surgery is not an option
  • In combination with chemotherapy in advanced cases

Chemotherapy

This involves anti-cancer drugs, usually administered intravenously. While not always a first-line treatment, chemotherapy may be used when:

  • Cancer has spread beyond the tongue
  • Combined treatment is required for aggressive tumors
  • The patient is not a candidate for surgery

Prevention

While not all cases can be prevented, certain lifestyle choices can significantly reduce risk:

  • Avoid Tobacco: Quit smoking or chewing tobacco completely
  • Limit Alcohol: Moderate or avoid alcohol consumption
  • HPV Vaccination: Recommended for prevention of virus strains linked to cancer
  • Maintain Good Oral Hygiene: Brush, floss, and visit your dentist twice yearly
  • Eat a Healthy Diet: Emphasize fruits, vegetables, and whole foods

Complications

Tongue cancer and its treatment can lead to several physical and emotional complications:

  • Speech and Swallowing Issues: Tumors or surgery can affect the tongue’s mobility and coordination
  • Dry Mouth and Taste Loss: Especially following radiation
  • Recurrent Infections: Poor oral health post-treatment can lead to complications
  • Cancer Recurrence: Ongoing monitoring is crucial to catch relapses early
  • Emotional Impact: Anxiety, depression, and self-esteem issues may follow treatment, particularly after extensive surgery or speech impairments

Outlook and Recovery

With early diagnosis and prompt treatment, tongue cancer has a relatively high survival rate. The five-year survival rate varies depending on the stage:

  • Early stage (1–2): Over 80% survival
  • Moderate stage (3): Around 60–70%
  • Advanced stage (4): Drops to 40% or lower depending on spread

Rehabilitation, including speech therapy and dietary modifications, is often necessary post-treatment. Ongoing follow-ups are vital to monitor healing and detect any signs of recurrence.