Tongue cancer 

Diagnosis

Tongue cancer is typically initially detected by a healthcare professional, such as a doctor, dentist, or another member of your medical team, during a routine checkup. Various tests and procedures are employed to aid in the diagnosis of tongue cancer. The specific tests recommended for you will depend on your medical history and presenting symptoms.

The diagnostic process for tongue cancer may involve:

• Physical examination: During a physical examination, a healthcare provider examines your mouth, throat, and neck. They will assess the tongue for any lumps or abnormalities and check for swollen lymph nodes in the neck.
• Endoscopy: An endoscopy is performed using a slender tube equipped with a light and camera. This tube is inserted through the nose and into the throat to examine the mouth and throat for signs of tongue cancer. It can also be used to assess whether the cancer has spread to other parts of the throat, such as the voice box.
• Biopsy: A tissue sample is taken for testing in a procedure known as a biopsy. There are various biopsy methods, including excision of a portion of suspicious tissue or the entire affected area. Another approach involves inserting a thin needle directly into the suspicious area to collect cell samples. These samples are sent to a laboratory for analysis, where they can determine whether the cells are cancerous. Additional tests may reveal specific characteristics of the cancer cells, such as the presence of HPV.
• Imaging tests: Imaging tests are used to capture images of the body, providing information about the size and location of the cancer. Common imaging tests for tongue cancer include X-rays, as well as more advanced techniques like computed tomography (CT), magnetic resonance imaging (MRI) , and positron emission tomography (PET) scans.
• Barium swallow (X-ray): In some cases, a barium swallow X-ray may be conducted. This procedure involves swallowing a liquid called barium, which coats the throat and makes it more visible on X-rays. It helps detect signs of cancer in the throat.
• Ultrasound: Ultrasound, which utilizes sound waves to generate images, may be employed to check for cancer in the lymph nodes. It can provide insights into whether the cancer has spread to lymph nodes in the neck.

Treatment

Treatment for tongue cancer typically involves a multi-faceted approach, tailored to individual factors such as the cancer’s location, growth rate, potential spread, and the patient’s overall health and age. The primary treatments for tongue cancer include surgery, radiation therapy, chemotherapy, and sometimes a combination of these approaches.

• Surgery: Surgery is the most common treatment for tongue cancer and may involve different procedures:
  • Glossectomy: This surgery removes the cancerous tissue along with some surrounding healthy cells, ensuring complete removal. The extent of tongue removal varies based on the tumor’s size, potentially affecting speech and swallowing. Physical therapy and rehabilitation can address any post-surgery difficulties.
  • Transoral surgery: In cases where the tumor is located in the throat, surgeons can access it through the mouth using cutting tools or, in some cases, tiny cameras and specialized tools. Robotic-assisted surgery is also an option for hard-to-reach areas, particularly the back of the tongue.
  • Neck dissection: If there’s a suspicion of cancer spreading to the lymph nodes in the neck, surgeons may perform a neck dissection to remove affected nodes. Even without clear signs of cancer in the lymph nodes, some nodes may be removed as a precaution. Testing the lymph nodes helps determine if additional treatments like radiation or chemotherapy are necessary.
  • Sentinel node biopsy: This procedure involves testing the lymph nodes most likely to be affected by cancer. If no cancer is found, it suggests that the cancer hasn’t spread. Sentinel node biopsy is used selectively.
  • Reconstructive surgery: In cases where portions of the face, jaw, or neck are removed during surgery, reconstructive surgery may be required. Healthy tissue or bone from other body parts can fill the gaps left by cancer removal, often done simultaneously with cancer surgery.
• Radiation therapy: Radiation therapy employs energy beams, like X-rays or protons, to target and destroy cancer cells. It can be the primary treatment for tongue cancer or used after surgery to eliminate any remaining cancer cells. Sometimes, radiation therapy and chemotherapy are administered together, especially when treating affected lymph nodes.
• Chemotherapy: Chemotherapy utilizes potent medications to kill cancer cells. It may be employed before surgery to control tumor growth or after surgery to eliminate residual cells. In some cases, chemotherapy is combined with radiation therapy to enhance its effectiveness.
• Targeted therapy: Targeted therapy employs medications that specifically target certain chemicals within cancer cells. By blocking these chemicals, targeted treatments induce cancer cell death. This approach is used for recurrent or metastatic tongue cancer.
• Immunotherapy: Immunotherapy harnesses the body’s immune system to identify and destroy cancer cells. It is an option for advanced cases where other treatments have been ineffective.
• Clinical trials: Clinical trials offer access to experimental treatments and the opportunity to explore the latest advancements in cancer care. However, the risks and side effects of these treatments may not be fully understood.

Treatment for advanced tongue cancer can affect speech and eating abilities. Collaboration with a skilled rehabilitation team is crucial to manage these changes resulting from treatment.