Tongue tumor

Generality

Tongue cancer is the result of a generally malignant neoplastic process, which begins, following a slow accumulation of DNA mutations, in one of the cells forming the tissues of the tongue.

Currently, it is not clear if there is a precise cause of tongue cancer; however, doctors and scientists believe that, in the appearance of malignant neoplasms of the tongue, factors such as: tobacco consumption, excessive alcohol consumption, poor oral hygiene and continuous exposure to fumes, dust, and so on play a decisive role. toxic substances.

The most common symptoms of tongue cancer are: persistent sore throat, pain during chewing and swallowing, tongue bleeding, numbness in the tongue and hoarseness.

With an early diagnosis of tongue cancer, the chances of success of the therapy are greater and the prognosis tends to be, therefore, better.

Possible treatments for tongue cancer include: surgery, radiotherapy and chemotherapy.

Brief review of the concepts of tumor and malignant tumor

In medicine, the term tumor and its synonym neoplasia identify an abnormal mass of very active cells, able to divide and grow uncontrollably.

Doctors talk about a malignant tumor, when the mass of abnormal cells that make up a tumor has a very high capacity for growth and division and has a tendency to spread both in the surrounding tissues and in the distant ones.

The terms "malignant tumor", "cancer" and "malignant neoplasia" all have the same meaning.

What is Language Cancer?

Tongue cancer is the result of a neoplastic process of almost always malignant nature, which originates from one of the cells that make up the tissues of the tongue.

Throat cancer site and classification

The language of the human being can be divided into two parts, called oral language and basic language .

The oral language constitutes 2/3 of the language and is the middle-anterior part of the latter, which an individual exhibits during a medical examination by the otolaryngologist or when he makes the so-called tongue. The base of the tongue, on the other hand, represents the remaining third of the tongue and the back of the latter, located in the immediate vicinity of the pharynx (or throat ).

Tongue cancer can be located both on the oral tongue and on the basis of the tongue. In the first case (oral language), tongue cancer is an example of a tumor in the mouth (or oral tumor ), while, in the second case (base of the tongue), it is an example of an oropharyngeal throat tumor .

Other tumors of the mouth

• Gum cancer
• Lip cancer
• Palate tumor
• Oral floor tumor
• Salivary gland tumor
• Tumor of the inner wall of the cheeks

What kind of malignant tumor is it?

Tongue cancer can originate from many different types of cells that make up the tongue; however, in most cases it is derived from squamous type cells, which make up the surface of the tongue.

Malignant tumors that derive from squamous type cells, such as the most common tongue tumors, are better known by the terms squamous carcinoma or spinocellular carcinoma .

Curiosity

After tumors of the tongue that originate from squamous cells, the most widespread tongue tumors are those that derive from endothelial cells, which gives them the same characteristics as Kaposi's sarcoma .

Epidemiology

According to statistics, oral cancer is the most common type of mouth cancer, a disease with a significant mortality rate but fortunately not particularly widespread.

According to some studies, in Europe (to be precise in France), tongue cancer affects 8 male people per 100, 000 per year.

Tongue cancer is a malignant neoplasm common in many countries of the world.

Some statistical data on cancer of the mouth

• In 2013, in the world, deaths due to cancer of the mouth - therefore in the total count also include deaths from oral cancer - were 135, 000; twenty years earlier, in 1990, it was 82, 000.
• The mortality rate of mouth cancer is higher than that of more known tumors, such as Hodgkin's lymphoma, malignant melanoma or testicular cancer.

Causes

Similarly to other malignant neoplasms, also tongue cancer is the consequence of a slow accumulation of genetic mutations by the DNA of one of the cells that make up the organ in question (in this case the tongue).

These mutations are responsible for that uncontrolled process of division and growth which was mentioned initially and which is typical of neoplasms.

Despite numerous research on this, doctors have not yet identified the precise causes of the genetic mutations in question; however, they are fairly confident that factors such as:

• Tobacco consumption in all its forms. Therefore, cigarettes, cigars, pipes, chewing tobacco, etc;
• Alcohol abuse ;
• Infections with human papilloma virus (or HPV, from the English Human Papilloma Virus );
• A diet low in vegetables and fruit ;
• Poor oral hygiene ;
• Advanced age . According to some statistical studies, tongue cancer is much more common among individuals over the age of 60;
• The exposure continues to dusts, fumes and toxic substances, and their subsequent and inevitable inhalation . It is a risk run by people working in factories or industrial plants.

Symptoms and Complications

The typical symptoms and signs of a tongue tumor are:

• Persistent sore throat;
• Jaw pain;
• Pain during chewing, which makes this action difficult;
• Pain during swallowing, which complicates this action;
• Inexplicable bleeding from the tongue (inexplicable means that it is not due to bites or self-made cuts);
• Sense of numbness in the tongue;
• Formation of a persistent stain, white or red, on the tongue;
• Presence of a sort of ulcer or lump on the tongue;
• Sensation of having something, like a protuberance, in the throat (typical of the tumor at the base of the tongue);
• Hoarseness (typical of the tumor at the base of the tongue). It is the change of tone (or timbre) of the voice;
• Weight loss. It is linked to pain during chewing and swallowing, pain that prevents the patient from eating properly;
• Ear pain (rare).

Characteristics of oral cancer

Those who suffer from an oral tongue cancer easily feel the symptoms of the condition in progress and this increases the chances of the so-called early diagnosis.

Characteristics of the tumor at the base of the tongue

The tumor at the base of the tongue produces a decidedly less evident symptomatology than the tumor of the oral tongue, and this makes its early identification much more unlikely.

When should I go to the doctor?

If symptoms such as pain during swallowing, chewing pain, hoarseness, sore throat, bleeding from the tongue, etc. they last for more than two weeks, without mentioning any improvement, it is advisable to contact your doctor and make an appointment to learn more about the situation.

Complications

If not subjected to adequate and timely treatments, tongue cancer can spread some of its malignant cells into the rest of the body, affecting the lymph nodes near and far as well as some organs (including the liver).

The process that sees any malignant tumor scatter its cells in the rest of the body takes the name of metastatic process or more simply metastasis (NB: this term also identifies the cells that are protagonists of the dissemination).

Diagnosis

In general, the diagnostic procedure for the detection of tongue cancer begins with a thorough physical examination and a thorough medical history ; therefore, it continues with some diagnostic imaging tests (endoscopy, X-rays, CT scans, etc.); finally, it ends with a tumor biopsy .

Physical examination and medical history

Physical examination and medical history allow the doctor to know:

• What are the symptoms and signs present. The knowledge of symptoms and signs is the result of a careful visit, but also of a doctor-patient interview, in which the first asks the second to describe the symptomatology;
• How and when disorders arose;
• How long the symptoms have been in place;
• If the symptoms have ever hinted to fade;
• The patient's lifestyle. This aspect is important due to the link between the onset of cancer of the tongue and smoking, alcohol abuse, poor oral hygiene, etc .;
• The profession performed by the patient. As previously stated, there are works associated with the appearance of tongue cancer.

Sometimes, in the case of oral cancer, a thorough physical examination of the tongue may suffice for a definitive diagnosis.

Diagnostic imaging tests

Imaging tests for images, such as endoscopy, X-rays or CT scans (the most practiced), are useful for the doctor to:

• Study the characteristics (size, position, etc.) of the tumor on the tongue. Above all, endoscopy and X-rays refer to the mouth-neck anatomical section;
• Determine if the tongue tumor has disseminated some metastases in nearby lymph nodes. This is permitted by previous examinations and also by a CT scan of the mouth-neck anatomical section;
• Determine if the tongue tumor has disseminated some metastases in distant lymph nodes or other organs. To make this possible, chest X-rays and a chest CT scan are available.

These investigations are particularly useful when tongue cancer is the basis of the latter and in all cases of late-stage tongue cancer.

Please note

The use of X-rays and CT scans exposes the patient to harmful ionizing radiations, which, in the first case (X-rays), are small; while, in the second case (TAC), they are quite conspicuous.

Tumor biopsy

The tumor biopsy consists in the collection and subsequent analysis in the laboratory of a sample of cells belonging to the tumor.

Tumor biopsy is the confirmation diagnostic test as well as the one that allows to establish an important characteristic of a malignant tumor: staging .

What is staging of a malignant tumor?

The staging of a malignant tumor includes all that information, collected during biopsy, which concerns the size of the tumor mass, its infiltrating power and its metastasizing capacities.

For a malignant tumor like that of the tongue, the staging can be subdivided into 4 levels of increasing gravity, levels that are called stages and which are identified with the first 4 Roman numbers. Thus, stage I (less severe), stage II (medium-mild gravity), stage III (medium-severe gravity) and stage IV (the most serious) exist.

Treatment

Tongue cancer therapy depends on:

• The site of the tumor mass ;
• The size of the tumor mass and the involvement of nearby lymph nodes (tumor stage);
• The patient's health status .

Clarified on the basis of which criteria are chosen, the treatments that can be used by doctors in case of tongue cancer are:

• Tumor removal surgery ;
• Radiotherapy ;
• Chemotherapy .

Surgery: tumor removal

For the benefits it can bring, tumor removal surgery is the most important treatment; unfortunately, however, it is feasible only in certain circumstances, which are:

• When the tumor is in the early stages (stage I and stage II). For stage III and IV tongue tumors, surgery, in those few junctures where it is practicable, is limited to playing the role of palliative care (therefore it serves only to alleviate the patient's suffering);
• When the tumor is in locations reachable by the surgeon's hand. Oral tongue tumors are more easily removed than tumors based on the tongue;
• When the patient, apart from tongue cancer, proves to be in good health, so much so that he can face surgery.

It is quite common that, to consolidate the benefits deriving from surgery, doctors also resort to radiotherapy; in other words, the combination of surgery and radiotherapy is fairly widespread to cure a tongue tumor.

TYPES OF INTERVENTION

The surgical practices adopted in the presence of tongue cancer include:

• Glossectomy . It is the removal of the part of the tongue on which the tumor is located; depending on whether the tumor mass is on the oral tongue or at the base of the tongue, the doctor can perform it, respectively, passing through the mouth or making an incision on the neck and operating through it.

  Practiced under general anesthesia, glossectomy is an invasive procedure, which must be followed by an operation to reconstruct the tongue.

• The dissection of the neck : consists in the removal of the lymph nodes of the neck, in which the metastases were received.

  Neck dissection is essential when the tumor on the tongue has contaminated the aforementioned lymph nodes with its malignant cells.

Radiotherapy

Radiation therapy involves exposing the tumor mass to a certain dose of high-energy ionizing radiation (X-rays), which are intended to destroy neoplastic cells.

In case of tongue cancer, radiotherapy can represent:

• A form of post-surgical treatment ( adjuvant radiotherapy ). It is the combination surgery-radiotherapy referred to above.

  The purpose of adjuvant radiotherapy is to destroy cancer cells with ionizing rays that the surgery has not removed.

• A form of alternative treatment to surgery, when the latter is impractical due to an advanced or unreachable tumor. Normally, in these situations, radiotherapy plays the role of symptomatic therapy, aimed at lightening the patient's suffering.

Chemotherapy

Chemotherapy consists of the administration of drugs capable of killing rapidly growing cells, including cancer ones.

In the presence of tongue cancer, chemotherapy may constitute:

• A form of treatment for relapses . At this juncture, the term recurrence means the reformation of the tumor, after a treatment that seemed to have been successful.
• A form of pre-surgical treatment ( neoadjuvant chemotherapy ) or pre-radiotherapy . The purpose of this chemotherapy is to reduce the size of the tumor mass, to facilitate its surgical or radiotherapy treatment, which is scheduled later.

Among the most widely used chemotherapy drugs in case of tongue cancer are carboplatin, bleomycin and methotrexate.

Side effects of radiotherapy and chemotherapy

Radiotherapy and chemotherapy are not free from side effects; here is a quick summary of the latter in the following table:

Some important tips

To those who have developed a tongue tumor and are undergoing appropriate treatment, doctors strongly advise quitting smoking and drinking alcohol, as tobacco (especially) and alcohol slow down the healing of surgical wounds, negatively affect therapy ( that is, they reduce the beneficial effects), favor the appearance of other tumors and recurrences, and, finally, make any chemotherapy drugs less tolerable.

Prognosis

The prognosis in case of tongue cancer varies in relation to:

• Timeliness of diagnosis . An early diagnosis increases the chances of success of the therapy, therefore also the chances of recovery.

  Through early diagnosis, tumor identification occurs when the latter is in the early stages, therefore when it is more easily removed;

• The site of the tumor mass . Tongue tumors in positions that are comfortable for the surgeon to reach (eg, oral tongue tumors) have a generally better prognosis than tongue tumors that are difficult to reach with surgical instruments (eg tumors at the base of the tongue);
• The patient's general health status . If the patient is in good health, he is more likely to endure the therapy, which in some cases can be very trying.

Prevention

Do not smoke or stop smoking, do not abuse alcohol or drink at all, eat fruit and vegetables daily, treat your oral hygiene and, finally, adequately protect yourself from human papilloma virus are the main rules, recommended by doctors, for prevention purposes of tumor to the tongue.