Tongue Cancer Treatment in Delhi, India

Tongue cancer is a malignancy that originates in the cells of the tongue. It involves the uncontrolled growth of abnormal cells, forming a tumour within the tongue tissue. This cancer can affect either the oral tongue (the visible part of the tongue) or the base of the tongue (the part that extends down the throat). Regular screenings and prompt medical attention are, therefore, important for the early detection and management of tongue cancer.

Tongue cancer, like other forms of cancer, is a complex condition with multiple factors contributing to its development. While the exact cause of tongue cancer is often not fully understood, several risk factors have been identified:

• Tobacco use: Smoking cigarettes or cigars and using smokeless tobacco significantly increase the risk of tongue cancer. Tobacco contains carcinogenic substances that can damage the cells in the oral cavity, leading to the development of cancer.
• Alcohol consumption: Heavy and prolonged alcohol consumption is a well-established risk factor for tongue cancer. The combination of tobacco and alcohol use can further elevate the risk.
• Human papillomavirus (HPV) infection: Certain strains of HPV, especially HPV-16 and HPV-18, have been linked to an increased risk of oral cancers, including tongue cancer. HPV is a sexually transmitted infection.
• Age and gender: Tongue cancer is more common in older individuals, with the risk increasing with age. It also tends to be more prevalent in men than in women.
• Poor oral hygiene: Chronic irritation or inflammation of the tongue due to poor oral hygiene, ill-fitting dentures, or persistent trauma can contribute to the development of tongue cancer.
• Dietary factors: A diet low in fruits and vegetables, which are rich in antioxidants and other protective compounds, may increase the risk of tongue cancer.
• Genetic factors: There may be a genetic predisposition to certain types of oral cancers, including tongue cancer. Individuals with a family history of oral cancers may have a higher risk.
• Sun exposure: Prolonged exposure to sunlight, especially in regions where there is high sun intensity, has been associated with an increased risk of lip cancer, which can sometimes extend to the adjacent areas, including the tongue.
• Leukoplakia and erythroplakia: Conditions such as leukoplakia (white patches) and erythroplakia (red patches) on the tongue may be precancerous and increase the risk of developing tongue cancer.

It's important to note that the presence of one or more risk factors does not guarantee the development of tongue cancer, and some individuals diagnosed with tongue cancer may not have any apparent risk factors. Regular dental check-ups and maintaining a healthy lifestyle can contribute to early detection and prevention of tongue cancer. If there are concerns or symptoms, seeking prompt medical attention is crucial for diagnosis and treatment.

Tongue cancer can be categorised into two types based on their location:

• Oral tongue cancer: This type affects the front two-thirds of the tongue, the part you can easily see and stick out.
• Oropharyngeal tongue cancer: This type forms at the base of the tongue, in the back of the mouth near the throat.

Both types of tongue cancer most commonly start in the squamous cells, which are the flat, thin cells lining the surface of the tongue. Less common types of tongue cancer can also develop in other types of cells, such as the salivary glands or lymphoid tissue.

Some other less common types of tongue cancer.

• Verrucous carcinoma: This is a slow-growing type of cancer that rarely spreads to other parts of the body.
• Minor salivary gland carcinomas: These cancers develop in the small salivary glands located throughout the mouth and throat.
• Lymphoma: This cancer starts in the white blood cells and can affect the tongue in rare cases.
• Mucosal melanoma: This is a type of skin cancer that can also occur in the mouth, including the tongue.

The symptoms of tongue cancer can vary depending on the location and stage of the cancer. However, here are some of the most common ones to be aware of:

Early symptoms

• A sore or lump on the tongue that doesn't heal: This is the most common symptom and can appear as a red, white, or greyish-pink patch, ulcer, or lump.
• Pain or burning sensation on the tongue: This can be a dull ache or a sharp pain.
• Bleeding from the tongue: This can happen without any obvious cause, such as biting.
• Numbness in the mouth or tongue: This can make it difficult to taste or feel things in your mouth.
• Difficulty swallowing: This can be due to pain or a feeling of something being stuck in your throat.
• Changes in your voice: You may have a hoarse voice or difficulty speaking clearly.

Late symptoms

• Swollen lymph nodes in the neck: This can be a sign that the cancer has spread.
• Jaw pain or throat pain: This can be due to the cancer spreading to the surrounding tissues.
• Weight loss: This can be caused by difficulty swallowing or due to the cancer itself.
• Ear pain: This is a less common symptom, but can occur if the cancer spreads to the base of the tongue.

Note: It's important to note that these symptoms can also be caused by other conditions, such as mouth ulcers or thrush. However, if one experiences any of these symptoms for more than two weeks, it's important to see a doctor.

Diagnosing tongue cancer involves a combination of physical examination, imaging tests, and biopsy. Here's a breakdown of the typical steps:

Physical examination

• Your doctor will visually examine your mouth and throat, inspecting the tongue for any lumps, sores, discolorations, or abnormalities in texture.
• They may also palpate your neck to check for swollen lymph nodes, which could indicate the spread of the cancer.

Imaging tests

• X-rays: X-rays provide basic images of the mouth and jaw, and can detect bone involvement from the cancer.
• CT scan: These detailed cross-sectional images offer a clearer picture of the tumour's size, location, and extent within the mouth and throat.
• MRI scan: MRI scans capture detailed images of soft tissues, which can be helpful in determining the stage of the cancer and whether it has spread to lymph nodes.
• PET scan: PET scans use radioactive tracers to highlight areas of active metabolism, which can help identify the presence and extent of cancer cells.

Biopsy

• This is the definitive way to diagnose tongue cancer. During a biopsy, a small sample of tissue is taken from the suspicious area and examined under a microscope by a pathologist to determine if it's cancerous and, if so, the specific type of cancer.
• Different biopsy techniques might be used, depending on the location and accessibility of the lesion. These include fine-needle aspiration, incisional biopsy, and excisional biopsy.

Additional tests

• Endoscopy: In some cases, a thin, flexible tube with a camera (endoscope) may be inserted through the nose or mouth to get a closer look at the back of the throat and base of the tongue.
• HPV testing: This test may be conducted on the biopsy sample to determine if the cancer is HPV-related, which can influence oral cancer treatment options.

Once the diagnosis is confirmed, further tests may be required to determine the stage of the cancer, which helps guide treatment decisions. This might involve additional imaging tests, blood tests, and possibly another biopsy of lymph nodes.

Tongue cancer stages are determined using the TNM system, an acronym representing Tumour, Node, and Metastasis, which evaluates factors such as tumour size, location, lymph node involvement, and the presence of distant metastasis.

The stages of tongue cancer are as follows:

• Stage 0: Also known as carcinoma in situ, this stage involves the presence of abnormal cells without deeper tissue invasion. It represents the earliest stage and boasts a high curability rate.
• Stage I: The tumour is less than 2cm in size and has not spread to nearby lymph nodes.
• Stage II: The tumour is larger than 2cm but less than 4 cm and may involve nearby lymph nodes on the same side of the neck.
• Stage III: The tumour can be of any size and might entail more extensive lymph node involvement, including nodes on both sides of the neck or deeper nodes.
• Stage IV: This is the most advanced stage, characterised by cancer spread to distant organs like the lungs, liver, or bone.

Within each stage, additional details are indicated by numbers ranging from 0 to 3, providing information on factors such as tumour size, depth of invasion, and the number of affected lymph nodes.

The treatment of tongue cancer depends on various factors, including the stage of the cancer, its location, and the overall health of the patient. Common treatment modalities for tongue cancer include:

Surgery

• Tumour removal (resection): It is one of the most common surgeries that are performed to remove the cancerous tumour from the tongue. The extent of surgery depends on the size and location of the tumour. In some cases, a partial glossectomy (removal of part of the tongue) or a total glossectomy (removal of the entire tongue) may be necessary.
• Neck dissection: If the cancer has spread to nearby lymph nodes, a neck dissection may be performed to remove affected lymph nodes.
• Reconstructive surgery: After extensive surgery, reconstructive surgery may be performed to restore the appearance and function of the tongue and surrounding structures. This may involve the use of tissue flaps or other reconstructive techniques.

Radiation therapy

During radiation therapy, high-energy rays are used to target and kill cancer cells. It may be employed as the primary treatment or in combination with surgery. Also, radiation therapy is often used when surgery alone may not be sufficient to remove the entire tumour, or to target any remaining cancer cells after surgery.

Chemotherapy

Anti-cancer drugs are used to kill or slow the growth of cancer cells. Chemotherapy may be given before surgery to shrink tumours, after surgery to kill remaining cancer cells, or in combination with radiation therapy.

Targeted therapy

Targeted therapy are designed to specifically target cancer cells while minimising damage to normal cells. These drugs may be used in conjunction with other treatments and are often considered in cases where specific molecular targets are identified.

Immunotherapy

Immunotherapy drugs stimulate the body's immune system to recognize and attack cancer cells. This treatment option is being explored in clinical trials for tongue cancer.

Speech and swallowing therapy

If there has been significant removal of the tongue during surgery then speech and swallowing therapy may be recommended to help patients regain or improve these functions.

Palliative care

Palliative care focuses on relieving symptoms and improving the quality of life for individuals with advanced cancer. It may be integrated into the overall treatment plan to manage pain, discomfort, and other symptoms.

The specific treatment plan for the individual will be tailored by their doctor based on their individual case. It is important for the individual to discuss the potential benefits and risks of each treatment option with their tongue cancer doctor to make an informed decision.

Tongue cancer, like any serious illness, can present potential complications both during and after treatment. It's important to be aware of these possibilities and discuss them with a doctor to manage them effectively and prioritise one’s well-being. Here are some of the potential complications associated with tongue cancer:

• Speech and swallowing difficulties: Surgery, radiation therapy, and chemotherapy can affect the muscles and tissues involved in speech and swallowing, making it difficult to talk and eat normally. Speech therapy and swallowing therapy can be helpful in managing these issues.
• Dry mouth: Radiation therapy can damage the salivary glands, leading to dry mouth, which can cause discomfort and increase the risk of cavities. Using artificial saliva, staying hydrated, and sucking on sugar-free candy can help alleviate dry mouth.
• Pain and fatigue: Both surgery and cancer treatment can cause pain and fatigue. The doctor can prescribe pain medication and recommend strategies to manage fatigue, such as resting and exercising regularly.
• Nutritional deficiencies: Difficulty swallowing or changes in taste due to treatment can make it challenging to maintain adequate nutrition. Working with a nutritionist can help ensure that the patient gets the required nutrients for quick recovery.
• Infection: Surgery and radiation therapy can weaken one’s immune system, increasing their risk of infection. Maintaining good hygiene and promptly reporting any signs of infection to a doctor are, therefore, crucial.

• Recurrence: There is a risk that the cancer could return after treatment. Regular follow-up appointments with the doctor are essential for monitoring for any signs of recurrence.
• Lymphedema: This condition involves swelling of the lymph nodes, which can occur after surgery or radiation therapy that removes or damages lymph nodes in the neck. Wearing compression garments and practising lymphatic drainage exercises can help manage lymphedema.
• Trismus: This is difficulty opening the mouth due to scarring or muscle tightening after treatment. Jaw stretching exercises and physical therapy can help improve jaw mobility.
• Dental problems: Radiation therapy can damage teeth and increase the risk of cavities. It's important to maintain good oral hygiene and schedule regular dental checkups.
• Mental health challenges: Living with and receiving treatment for cancer can be emotionally challenging. Anxiety, depression, and post-traumatic stress disorder (PTSD) are possible experiences. Seeking support from a therapist or counsellor can be helpful in managing these emotions.

Remember, these complications are not guaranteed to occur in everyone with tongue cancer. Many people successfully manage them with supportive care and rehabilitation. Open communication with one’s healthcare team is crucial throughout the treatment journey. They can provide guidance and support to address any challenges that patients may face and help them adjust to life after treatment.

Here are some tips to reduce the risk of tongue cancer:

• Quit tobacco: Avoid smoking and using smokeless tobacco products.
• Moderate alcohol: Limit alcohol consumption to decrease the risk.
• Have a healthy diet: Consume a balanced diet with plenty of fruits and vegetables.
• Ensure HPV protection: Practise safe sex and consider HPV vaccination.
• Avoid direct exposure to sun: Use lip balm with sunblock for lip cancers.
• Maintain oral hygiene: Maintain good oral hygiene with regular dental check-ups.
• Pay attention to symptoms: Be aware of symptoms and seek prompt medical attention.
• Consider regular screening: High-risk individuals should consider regular screenings.
• Maintain a healthy lifestyle: One must adopt a healthy lifestyle with regular exercise and weight management.

While these measures can lower the risk, regular check-ups and screenings are crucial for early detection. Also, it is advisable to consult a tongue cancer doctor for personalised advice.

What can I expect in terms of recovery after completing tongue cancer treatment?

Post-treatment recovery may involve follow-up appointments, rehabilitation, and ongoing monitoring for any potential side effects or recurrence.

Are there specific dietary recommendations for individuals with tongue cancer during and after treatment?

Depending on treatment effects, a healthcare provider or nutritionist may recommend modifications such as soft or pureed foods to ease swallowing.

How can one cope with speech and swallowing challenges after tongue cancer surgery?

Speech therapy and exercises may be recommended to improve communication, and swallowing therapy can help overcome difficulties in eating.

What support services are available for individuals diagnosed with tongue cancer?

Support groups, counselling, and rehabilitation services are often provided to help individuals cope emotionally and physically with the challenges of tongue cancer.

How often should one undergo follow-up care after tongue cancer treatment, and what does it involve?

Follow-up schedules vary, but regular check-ups may include physical examinations, imaging tests, and discussions about ongoing health and potential concerns.

How might tongue cancer and its treatment impact daily life beyond physical health?

Coping with changes in appearance, speech, and eating habits may require emotional support, and individuals may find assistance through counselling or support groups.

How can individuals effectively communicate with their healthcare providers regarding concerns or side effects?

Open and honest communication, keeping a symptom diary, and asking questions during appointments can help ensure comprehensive care.

Can individuals with tongue cancer continue working and maintain an active social life during and after treatment?

Depending on individual circumstances, many individuals can continue working and engaging in social activities, although some adjustments may be necessary.

Is it advisable to seek a second opinion after receiving a tongue cancer diagnosis?

Seeking a second opinion is a common and encouraged practice, providing individuals with additional insights and confidence in their chosen treatment plan.

How often does tongue cancer recur, and what signs should one watch for?

Recurrence rates vary, and regular follow-up appointments are crucial for monitoring any signs or symptoms that may indicate a recurrence.

Reviewed by Dr. Akshat Malik, Senior Consultant - Cancer Care / Oncology, Surgical Oncology, Head & Neck Oncology, Robotic Surgery on 30-Jan-2024.