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Carcinoma of Tongue

TONGUE CARCINOMA

The tongue is the most common intraoral site of cancer in most countries.
The disease affects males more frequently than females, with a male-to-female ratio of 2:1.

Etiology:

Tobacco,
Alcohol,
Other factors: Areca catechu tree,the betel nuts or quid as well as the use of slaked lime
Detection of mutations in tumor suppressor genes TP53.

Pathophysiology

More than 90% of oral cavity cancers are squamous cell carcinomas.
Most of the other lesions are of minor salivary gland origin.
Lymphomas, melanomas, and sarcomas rarely occur in the tongue.
Squamous cell carcinoma is by far the most common malignancy of the tongue, typically having 3 gross morphologic growth patterns: exophytic, ulcerative, and infiltrative. The infiltrative and ulcerative types are observed most commonly on the tongue.
Lateral border being the most common subsite of origin.

Premalignant lesions

Leukoplakia and erythroplakia

Clinical Presentation

Weight loss, dysphagia and odynophagia, referred otalgia, hemoptysis, neck mass, hoarseness, and articulation difficulties
Most common site of carcinoma tongue is middle of lateral border or the ventral aspect of the tongue followed by tip and dorsum.
In carcinoma base of tongue pain is referred to the ipsilateral ear because of the common nerve supply of the base of tongue and ear i.e. Glossopharyngeal nerve.
Incidence of cervical lymphnode metastasis Posterior tongue —> 70%

Classification of stage of tumor of oral cavity based on size of lymph node

N0: There is no evidence of regional metastasis
N1: Metastasis occur to a single ipsilateral lymph node, 3 cm or less in greatest dimension
N2a: Metastasis in single ipsilateral lymph node, >3 cm and
N2b: Metastasis occur in multiple ipsilateral lymph nodes, all nodes
N2c: Metastasis occur in bilateral or contralateral lymph nodes, all nodes

Treatment

Treatment of oral tongue cancer is primarily surgical, with wide local excision and negative margin control.
Small tumors (T1- T2)- may be removed by wide local excision and primary closure or closure by secondary intention.
Excision of larger tumors – requires partial glossectomy or hemiglossectomy.
Schwartz writes- “The CO2 laser may be used for excision of early tongue cancers or for ablation of premalignant lesions.”
If regional lymphnodes are involved- Modified radical neck dissection or selective neck dissection is done.
Indications for postoperative radiation therapy include evidence of perineural or angiolymphatic spread or positive nodal disease.
T1 stage (< 2cm in size): Insterstitial irradiation or excision (partial glossectomy).
T2 stage (> 2 cm) in size: External beam radiotherapy or hemiglossectomy
Management plan for locally advanced tongue carcinomas includes subtotal glossectomy + selective neck dissection + mandibulectomy.

Exam Important

A patient has carcinoma of right tongue on its lateral border of anterior 2/3rd, with lymph node of size 4 cm in level 3 on left side of the neck, stage of disease is N2.
In carcinoma base of tongue pain is refered to the ear through Glossopharyngeal nerve.
A patient with carcinoma of tongue is found to have lymph nodes in the lower neck. The treatment of choice for the lymph nodes is Radical neck dissection.
Radiotherapy is used for which stage-I cancer -Anterior 2/3rd of Tongue.
A patient presented with a 1 x 1.5 cms growth on the lateral border of the tongue.
The treatment indicated would be Laser ablation.
Carcinomatous ulcers are painless but may become painful in advanced stages, with extension into surrounding tissues.
Commonest site of carcinoma tongue is Anterior 2/3 of Lateral borders
Carcinoma tongue less than 2 cm is treated by Excision
Tobacco chewing is a risk factor for Tongue Carcinoma.
Lymph node invovlement occurs in case of Tongue Carcinoma.
60 year old man presents with an ulcer on lateral margin of tongue also complains of ear pain, most probable diagnosis is Carcinomatous Ulcer.
Tongue carcinoma is usually Radio-sensitive.
Posterior tongue most commonly metastasizes to cervical lymph nodes.
Referred pain in the ear is commonly from Carcinoma of Tongue.
Most common histological type of carcinoma of tongue is Squamous cell carcinoma.

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Carcinoma of Tongue