Carcinoma of the Tongue: Causes, Clinical Features, Diagnosis, and Treatment Strategies

Tongue Cancer

 

Answer. Carcinoma of tongue is mostly epidermoid carcinoma.

Carcinoma of tongue Responsible Features Or Causes

• Poor oral hygiene
• Pipe smokers
• Chronic alcoholic
• Chewing of betel nut
• Chronic irritation by sharp tooth
• Syphilis
• Leukoplakia
• Erythroplakia.

“Causes Of Tongue Cancer”

Carcinoma of tongue Pathological types

• Non-healing ulcer
• Proliferative growth
• Frozen tongue or indurated plaque
• Fissure variety.

“Symptoms Of Tongue Carcinoma”

Carcinoma of tongue Clinical Features

• A bleeding ulcer is seen over the tongue.
• Pain in the tongue is due to involvement of lingual nerve.
• Pain can refer to the ear and lower temporal region.
• Disarticulation—diffilty in talking is due to disability of the tongue to move freely.
• Dysphagia is a common presentation from the carcinoma of posterior one-third.
• Fetor oris is due to infected necrotic growth.
• Ankyloglossia restricted mobility of the tongue. It is due to infitration of the mouth or mandible.

“Comprehensive Overview Of Tongue Cancer Symptoms”

• Bilateral massive enlargement of lower deep cervical nodes in an elderly patient is suggestive of carcinoma of posterior one-third.
• Painless ulcer or swelling is present on the tongue which later becomes painful.
• Excessive salivation is present and saliva is blood tinged.
• Visible ulcer can be seen on anterior two-third of tongue.
  Ulcer can bleed on touch; edge, base and surrounding areas are indurated.
  Often indurated area is more extensive than
  primary tumor.
  Edges are everted.
  Ulcer may cross the midline and extend to the florormouth/alveolus/mandible.
• Features of bronchopneumonia due to aspiration during lying down sleeping mainly to lower segment of lung.

“Risk Factors For Developing Tongue Cancer”

Carcinoma of tongue Investigations

• Wedge biopsy
• FNAC of lymph nodes
• Indirect and direct laryngoscopy to see posterior third growth
• CT scan to see the extension of posterior third growth or to see status of lymph node secondaries.
• MRI to assess extent of primary tumor
• Chest X-ray to see bronchopneumonia
• Orthopantomogram

“Early Signs Of Tongue Carcinoma”

Carcinoma of tongue Management

Following is the management of the carcinoma of tongue:

• Wide excision with l cm clearance in margin and depth is done in tumor less than l cm in size or in carcinoma in situ.
  Laser (CO2/diode) can be used.
• Tumor between 1–2 cm in size, partial glossectomy is done with 2 cm clearance from the margin with removal of l/3rd of anterior two-third of the tongue.
• Tumor larger than 2 cm, hemiglossectomy is done with removal of anterior 2/3rd of tongue on one side up to sulcus terminalis.
• Raw area in these procedures can be left alone when area is wide allowing it to granulate and heal by epithelialization.
  lf area is small like in wide excision it can be closed by primary suturing. Wide raw area can also be covered with PMMF or quilted split-skin graft.
• Larger primary tumor can be given preoperative radiotherapy then later hemiglossectomy is done.
• Same side palpable mobile lymph nodes are removed by radical neck block dissection.
• Bilateral mobile lymph nodes are dealt with one side radical block and other side junctional block dissection with essentially retaining internal jugular vein (on opposite side) to maintain the cerebral venous blood flow.
  Other option is doing same side radical neck dissection and on opposite side suprahyoid block dissection.

“Understanding The Causes Of Tongue Carcinoma”

• Wide excisionis done whengrowthis inthe tip ofthe tongue.
• Posterior third growth can be approached by lip split and mandible resection, so as to have total glossectomyKochers approach. It is not done commonly as it carries signifiant morbidity and mortality due to difficulty in speech, swallowing, aspiration, sepsis.
• When mandible is involved hemimandibulectomy is done.
• The procedure that involves wide excision or hemiglossectomy, hemimandi bulectomy and radical neck dissection together is called as Commando Operation.
• Reconstruction of tongue and other area after surgery: By deltopectoral flp, forehead flap, pectoralis major muscle flp, skin grafting.
• Prophylacticblockdissectionis becoming popular at present.

“Best Practices For Managing Tongue Cancer Treatment”

Carcinoma of tongue Radiotherapy

• In small primary tumor-brachytherapy using caesium or iridium needles.
• In large primary tumor initial radiotherapy is given to reduce the tumor size so that resection will be bettr later.
• Advanced primary, as well as secondaries in neck, are controlled by palliative external radiotherapy.
• Postoperative radiotherapy is given in large tumors to reduce the chances of relapse.
• In case of growth in posterior one-third of tongue radiotherapy is of curative as well as palliative mode.

“The Role Of Biopsies In Detecting Tongue Carcinoma”

Carcinoma of tongue Chemotherapy

• It is given in post-operative period and also for palliation.
• Price-Hill regimen is commonly used. Drugs are methotrexate, vincristine, adriamycin, bleomycin and mercaptopurine.
• It is either given intra-arterially, as regional chemotherapy through extemal carotid artery using arterial pump or through IV. It can be given orally also.