Tongue cancer causes diagnosis and treatment


 Tongue cancer causes diagnosis and treatment


Introduction

The tongue is a muscular structure its surface covered by nonkeratinizing squamous epithelium the tongue has two parts anterior part which include anterior two third of the tongue such as both sides of the tongue and its tip its called oral part or oral tongue which appear when you protruded your tongue outside, cancers occur in this part are called mouth or oral cancers and the second part is the posterior part or base of the tongue which is related to the pharynx and cancers occur in this part are called oropharyngeal cancers
The tongue is composed of eight muscles four intrinsic and four extrinsic muscles and is separated at the midline by the median fibrous lingual septum
What are the causes of cancer tongue
There are many risk factors which may predisposing for tongue cancer these factors such as
smoking sepsis spirits spices syphilis alcohol recurrent trauma from sharp tooth chronic superficial inflammation of the tongue (glossitis) and leukoplakia white patches of the tongue these factors causing chronic irritation of the tongue which lead to change in its epithelium covering and by time causing tongue cancer also human papilloma virus has a role in cancer tongue formation also benign tongue tumor such as papilloma may undergo malignant changes to carcinoma
Tongue cancer pathology

Tongue cancer common sites are presents at the side of the anterior two third of the tongue this is the commonest site
Age and sex
Tongue cancer are common in old aged male than female
Types of tongue cancer
Tongue cancer may appear on naked eyes such as malignant ulcer with indurated base and everted raised edge and necrotic floor or appear as malignant nodule or fissure or papillary type or woody tongue when cancer causing diffuse infiltration of the tongue and the tongue become so hard like wood
Commonest microscopic picture of tongue cancer is squamous cell carcinoma
  
What are symptoms and signs of tongue cancer
  • In the early stage the patient may be asymptomatic the patient usually presents when he discovers there is ulcer or white or red patches on his tongue
    •  The patient may complaining from sore throat which not relieved by usual treatment
    • The patient may feel by pain during swallowing called adenophagia
    • The patient may complaining from inability to swallowing which called dysphagia
    • The patient may complaining from difficulty in speech
    • The patient may complaining from bad odour from his mouth called foeter oris
    • The patient may complaining from inability to protruded his tongue completely outside and his tongue become deviated to the affected side this is called ankyloglossia  this due to infiltration of the muscles of the tongue and floor of the mouth by cancers cells
    • The patient may complaining from profuse or excessive salivation which be blood stained
    • The patient may feel pain in his tongue or referred to his ear called earache due to involved the lingual nerve by cancer cells
    • The patient may complaining from bleeding from the mouth this is either mild bleeding from irritation of the tongue ulcer or may be profuse bleeding due to erosion of the lingual artery  in case of cancer anterior two third or internal carotid artery in case of cancer posterior third of the tongue but this very rare to occurs
    • The patient may feel by tingling and numbness of the mouth
    • The patient may complaining from mass or swelling in his neck due to cancer spread to cervical lymph node but this considered as late stage of cancer
    • The patient may complaining from loss of taste sensation
Investigations of  tongue cancer

Biopsy

Either excisional biopsy means complete excision of the tumor for small tumor or incisional biopsy means excision of small part of the tumor for large tumor

Fine needle aspiration cytology may bee used for lymph node biopsy
  
Computerized tomography CT scanning
For the head and neck  to showing tumor extension and its spreading to other structures
MRI scanning
For the head and neck to show also tumor extension and its spreading to other structures
Other investigations according to the patient cancer
How tongue cancer spread or invasion to other structures
Tongue cancer like any cancer can be spread to other organs by process called metastasis which may spread direct to the remaining part of the tongue or to the floor of the mouth or gums in case of cancer of anterior two third or to soft palate and tonsil in case of cancer of posterior third
Lymphatic spread of the tongue is common and occur early to the surrounding lymph node such as mental sub mandibular lymph nodes and to cervical lymph nodes
 Blood spread of tongue cancer very rare
Treatment of tongue cancer

Treatment of tongue cancer can be divided into treatment of the primary tumor of the tongue and treatment of the neck lymph nodes

Treatment of the primary tongue cancer

Surgical treatment

Surgical excision of the tumor by V- shaped excision for tumor on the tip of the tongue

For tumor on the side or lateral margin of the tongue can be treated by partial excision of the tongue by operation called partial glossectomy
Tumor on the anterior two third of the tongue can be treated by excision of the half of the tongue by operation called hemiglossectomy
If the tumor infiltrating to the mandible can be treated by excision of the tongue (glossectomy) and removal of the half affected part of the mandible ( hemimandibulectomy) and total block neck dissection for lymph nodes these operation is called commando operation
This is followed by plastic reconstruction using either free rib graft or composite pectoralis myocutaneous flap MCF

Radiotherapy of tongue cancer

Radiation therapy may used before surgery either as primary treatment or to decreased cancer size or can be used after surgery to avoid cancer recurrence
Chemotherapy for tongue cancer
Can be used in combination of radiotherapy as chemotherapy alone has no effect on primary cancer and can be given after surgery to avoid risk of cancer recurrence
Treatment of the neck lymph nodes
This is done by operation called total block dissection of the neck which means complete removal of the lymph node on the affected neck side but if both sides of the neck lymph nodes are affected then do selective block dissection on one side with preserve of the internal jugular vein for brain drainage and do total block dissection on the opposite side
 Palliative treatment of tongue cancer

these are indicated in case of patient inoperable these palliative measures depend on patient complaining such as give analgesic for pain ryle,s feeding in advanced cases when patient unable to swallow or eating palliative radiotherapy to relieve of pain obstruction in severe cases with air way obstruction patient may need for tracheostomy this an operation in trachea done by making artificial opening in the trachea and special device inserted through which the patient can be take its breathing
What are the complications of tongue cancer
these complications can be divided into complications related to tongue cancer itself and complications related to surgical operations or radiotherapy and chemotherapy these complications such as infection and air way obstruction or asphyxia and edema of the glottis
inflammation of the lung and bronchus called broncho-pneumonia
  bleeding starvation anemia and cancer cachexia
inability to speech or to eating

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