Overview

Tongue cancer is a type of cancer that starts in the cells of the tongue, and can cause lesions or tumors on your tongue. It’s a type of head and neck cancer.

Tongue cancer can occur on the front of the tongue, which is called “oral tongue cancer.” Or it may occur at the base of the tongue, near where it attaches to the bottom of your mouth. This is called “oropharyngeal cancer.”

Squamous cell carcinoma is the most common type of tongue cancer. This type of cancer occurs:

  • on the surface of the skin
  • in the lining of the mouth, nose, larynx, thyroid, and throat
  • in the lining of the respiratory and digestive tracts

All of these parts of the body are covered in squamous cells.

Stages and grades

Tongue cancer is classified using stages and grades. The stage indicates how far the cancer has spread. Each stage has three potential classifications:

  • T refers to the size of the tumor. A small tumor is T1 and a large tumor is T4.
  • N refers to whether or not the cancer has spread to neck lymph nodes. N0 means the cancer has not spread, while N3 means that it has spread to many lymph nodes.
  • M refers to whether or not there are metastases (additional growths) in other body parts.

The grade of the cancer refers to how aggressive it is and how likely it is to spread. Tongue cancer can be:

  • low (slow-growing and unlikely to spread)
  • moderate
  • high (very aggressive and likely to spread)

Pictures of tongue cancer

What are the symptoms?

In the early stages of tongue cancer, especially with cancer at the base of the tongue, you might not notice any symptoms. The most common early symptom of tongue cancer is a sore on your tongue that doesn’t heal and that bleeds easily. You might also notice mouth or tongue pain.

Other symptoms of tongue cancer include:

  • a red or white patch on your tongue that persists
  • a tongue ulcer that persists
  • pain when swallowing
  • mouth numbness
  • a sore throat that persists
  • bleeding from your tongue with no apparent cause
  • a lump on your tongue that persists

What causes it and who’s at risk?

The cause of tongue cancer is unknown. However, certain behaviors and conditions can increase your risk, including:

  • smoking or chewing tobacco
  • heavy drinking
  • being infected with human papillomavirus (HPV), a sexually transmitted disease
  • chewing betel, which is particularly common in south and southeast Asia
  • a family history of tongue or other mouth cancers
  • a personal history of certain cancers, such as other squamous cell cancers
  • a poor diet (there is some evidence that a diet low in fruits and vegetables increases the risk of all oral cancers)
  • poor oral hygiene (constant irritation from jagged teeth or ill-fitting dentures can increase your risk of tongue cancer)

Tongue cancer is also more common in older men than in women or younger people. Oral cancers are most common in people over 55 years old.

How is it diagnosed?

To diagnose tongue cancer, your doctor will first take a medical history. They’ll ask you about any family or personal history of cancer, whether you smoke or drink and how much, and if you’ve ever tested positive for the HPV virus. Then they’ll do a physical examination of your mouth to look for signs of cancer, such as unhealed ulcers. They’ll also examine nearby lymph nodes, to check for swelling.

If your doctor sees any signs of tongue cancer, they’ll do a biopsy of the area of suspected cancer. An incisional biopsy is the most frequently used type of biopsy. In this type of biopsy, your doctor will remove a small piece of the suspected cancer. This is usually done under local anesthesia in your doctor’s office.

Instead of an incision biopsy, your doctor might do a newer type of biopsy called a brush biopsy. In this biopsy, they’ll roll a small brush over the area of suspected cancer. This causes minor bleeding and allows your doctor to collect cells for testing.

Cells from either type of biopsy will be sent to a lab for analysis. If you have tongue cancer, your doctor might do a CT scan or MRI to see how deep it goes and how far it’s spread.

How is it treated?

Treatment for tongue cancer depends on how big the tumor is and how far the cancer has spread. You might only need one treatment or you might need a combination of treatments.

Early mouth cancer that hasn’t spread can usually be treated with a small operation to remove the affected area. Larger tumors usually need to be removed with a surgery called a partial glossectomy, in which part of the tongue is removed.

If doctors remove a large piece of your tongue, you might undergo reconstruction surgery. In this surgery, your doctor will take a piece of skin or tissue from another part of your body and use it to rebuild your tongue. The goal of both the glossectomy and reconstruction surgery is to remove the cancer while damaging as little of your mouth as possible.

Glossectomy can lead to severe side effects, including changes in how you eat, breathe, talk, and swallow. Speech therapy can help you learn to adjust to these changes. In addition, talk therapy can help you cope.

If the cancer has spread to your lymph nodes, those will likely be removed with surgery.

If you have a large tumor in your tongue or the cancer has spread, you’ll probably need to have a combination of surgery to remove the tumor and radiation to ensure that all tumor cells are removed or killed. This can lead to side effects such as a dry mouth and taste changes.

Doctors may also recommend chemotherapy to treat your cancer, in combination with surgery and/or radiation.

Can it be prevented?

You can reduce your risk of tongue cancer by avoiding activities that can lead to tongue cancer, and by taking care of your mouth. To reduce your risk:

  • don’t smoke or chew tobacco
  • don’t drink, or drink only occasionally
  • don’t chew betel
  • get a full course of the HPV vaccine
  • practice safe sex, especially oral sex
  • include lots of fruits and vegetables in your diet
  • make sure that you brush your teeth daily and floss regularly
  • see a dentist once every six months, if possible

What’s the outlook?

The five-year relative survival rate for tongue cancer (which compares the survival of people with cancer with the expected survival rate for people without cancer) depends on the stage of the cancer. If the cancer has spread far, the five-year relative survival rate is 36 percent. If the cancer has only spread locally (for example, to lymph nodes in the neck), the relative survival rate is 63 percent. If the cancer has not spread beyond the tongue, the five-year relative survival rate is 78 percent.

As these survival rates show, earlier diagnosis leads to better outcomes. With early diagnosis, you can be treated before the cancer spreads. If you have a lump, ulcer, or sore on your tongue that doesn’t go away after a long period of time, you should see your doctor. Early diagnosis of tongue cancer allows for more treatment options, with fewer side effects, and a good five-year survival rate.