Understanding Tongue Cancer
Tongue cancer is a type of oral cancer that develops in the cells of the tongue. It can occur in two distinct regions:
- Oral tongue cancer: Affects the front two-thirds of the tongue (the mobile portion)
- Base of tongue cancer: Affects the back third of the tongue, considered part of the oropharynx
Risk factors for tongue cancer include:
- Tobacco use (smoking, chewing tobacco)
- Heavy alcohol consumption
- Human papillomavirus (HPV) infection (particularly for base of tongue cancer)
- Poor oral hygiene
- Chronic irritation from jagged teeth or ill-fitting dentures
- Previous history of oral cancer
Early symptoms may include:
- A persistent sore or lump on the tongue that doesn’t heal
- A red or white patch on the tongue
- Pain or difficulty swallowing
- Persistent sore throat
- Numbness in the mouth
- Unexplained bleeding from the tongue
- Ear pain (particularly with base of tongue cancer)
Early detection is crucial for successful treatment. At Premier Head and Neck Surgery, we emphasize the importance of regular oral examinations and prompt evaluation of any persistent oral symptoms.
Diagnostic Approach
Accurate diagnosis and staging are essential for developing an effective treatment plan. Our comprehensive diagnostic approach includes:
- Thorough physical examination of the mouth, tongue, and neck
- Endoscopic evaluation of the oral cavity, pharynx, and larynx
- Biopsy of suspicious lesions for definitive diagnosis
- Imaging studies to assess the extent of the tumor and potential spread:
- CT scan
- MRI
- PET/CT scan for advanced cases
- Evaluation of lymph nodes in the neck for potential metastasis
- HPV testing for base of tongue tumors
This multifaceted approach allows us to determine the precise nature and extent of the cancer, guiding our treatment recommendations.
Surgical Approaches for Tongue Cancer
Surgery is often the primary treatment for tongue cancer. At Premier Head and Neck Surgery, we offer a range of surgical approaches tailored to the specific characteristics of each tumor:
Partial Glossectomy
- Removal of part of the tongue
- Appropriate for smaller tumors confined to one area
- Preserves maximum tongue function while ensuring complete tumor removal
- May be performed through the mouth (transoral approach)
Hemiglossectomy
- Removal of half of the tongue
- Used for larger tumors confined to one side
- May require reconstruction to optimize function
Subtotal or Total Glossectomy
- Removal of most or all of the tongue
- Reserved for extensive tumors
- Requires complex reconstruction to restore function
- May be combined with laryngectomy in advanced cases
Neck Dissection
- Removal of lymph nodes in the neck
- Often performed in conjunction with tongue surgery
- May be:
-
- Selective: Removing specific groups of lymph nodes
- Modified radical: Preserving important structures while removing most lymph nodes
- Radical: Comprehensive removal of all lymph node groups (rarely necessary)
Reconstruction After Tongue Surgery
Reconstruction is a critical component of tongue cancer surgery, particularly for larger resections. The goal is to restore both appearance and function, particularly speech and swallowing. Our reconstructive options include:
Primary Closure
- Direct closure of the surgical defect
- Suitable for small resections where minimal tongue tissue is removed
- Preserves most natural function
Local and Regional Flaps
- Using nearby tissue to reconstruct the tongue
- Options include facial artery musculomucosal (FAMM) flap or buccal mucosa flap
- Appropriate for moderate-sized defects
Free Tissue Transfer
- Using tissue from elsewhere in the body with its blood supply
- Common options include:
- Radial forearm free flap: Thin, pliable tissue ideal for tongue reconstruction
- Anterolateral thigh flap: Provides more bulk for larger defects
- Rectus abdominis flap: Used for extensive reconstructions
- Allows for reconstruction of even total glossectomy defects
- Optimizes potential for speech and swallowing rehabilitation
Multidisciplinary Treatment Approach
Radiation therapy
Often recommended after surgery to eliminate any remaining cancer cells
Chemotherapy
May be combined with radiation for advanced cases
Targeted therapy
For specific types of cancer with certain genetic markers
Immunotherapy
Emerging treatment that helps the immune system fight cancer
Our team works closely with medical oncologists, radiation oncologists, speech pathologists, and other specialists to develop comprehensive treatment plans tailored to each patient’s specific needs.