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Tongue Cancer: Everything You Need To Know
Medically reviewed by John Carew, MD
Tongue cancer is a type of head and neck cancer that can develop in the front or back of the tongue. When tongue cancer originates in the front two-thirds of the tongue, it's thought of as oral or mouth cancer. If it originates in the back or base of your tongue, it's considered to be oropharynx or throat cancer.
Early-stage tongue cancer has symptoms that may be overlooked or confused with other conditions, like mouth ulcers.
Tongue cancer is relatively rare. According to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, tongue cancer cases accounted for 0.9% of all new cancers in 2023.
This article will discuss the causes, risk factors, symptoms, and treatments of this condition. It will also touch on prevention strategies and outlook.
What Does Tongue Cancer Look Like?Early-stage tongue cancer can take on the appearance of a red or white patch, grayish-pink or red mouth sore, or lump. If the lump is located on the side of your tongue, it may get large enough to touch your teeth. It may also bleed easily. Tongue cancer that starts near the base of the tongue may go unnoticed until symptoms progress.
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Tongue cancer is often discovered during a routine dental exam. Early detection of this condition is one reason why seeing your dentist for regular checkups is important.
Tongue Cancer SymptomsThe most common symptoms of tongue cancer are:
Patches on the tongue that are red, white, or dark in color
Ulcers or lumps that bleed easily and don't heal
Persistent sore throat pain
Pain when swallowing
Feeling of numbness in the mouth
The stage of your cancer is based on the tumor size and how extensively it has spread. The higher the stage's number and letter, the more severe the spread has become.
Knowing your cancer's stage is important. This information will be used to determine your treatment options and prognosis (likely course of the disease). A cancer specialist, such as an oncologist, will analyze every cancer characteristic and combination of characteristics to determine your cancer's stage.
If tongue cancer is caused by human papillomavirus (HPV), it is referred to as HPV-positive cancer. HPV-positive and HPV-negative oral cancers may be classified into stages differently.
The American Joint Committee on Cancer (AJCC) revised staging for oral cavity and oropharynx cancer in 2017. Newer staging versions are published when revised. The following is given as a general example. Discuss your staging with your oncology team.
In general, the stages of non-HPV-related tongue cancer include:
Stage 0 (carcinoma in situ): This very early stage is sometimes called precancer. In stage 0, the cancerous cells are confined to the top layer of the skin (epithelium). It has not yet spread to nearby lymph nodes or to distant sites.
Stage 1: The cancer is 2 centimeters (cm) or smaller. It isn't growing into nearby tissues. It has not yet spread to nearby lymph nodes or distant sites.
Stage 2: The cancer is larger than 2 cm (about three-fourths of an inch) but smaller than 4 cm (about 1.5 inches), It isn't growing into nearby tissues. It has not yet spread to nearby lymph nodes or distant sites.
Stage 3: The cancer is larger than 4 cm and includes cancer growing into the epiglottis (tissue beneath the tongue and at the back of the throat) that have not spread to nearby lymph nodes or distant sites. Or, the tumor is of any size, may have grown into nearby structures, and has spread to one lymph node, which is 3 cm or smaller and has not spread to distant sites.
Stage 4A: The tumor is of any size and is growing into nearby structures and possibly one or more lymph nodes. It has not spread to distant sites.
Stage 4B: The tumor is of any size and has grown into nearby soft tissues or structures and possibly one or more lymph nodes. It has not spread to distant sites.
Stage 4C: In this stage, the cancer is of any size, may have grown into nearby soft tissues or structures, and has spread to distant sites, such as the lungs.
Anyone can get tongue cancer. The most common demographic group for this condition is people who were assigned male at birth and are over 40 years old.
Most instances of tongue cancer originate in squamous cells. This type of cancer is referred to as squamous cell carcinoma (SCC). Squamous cells are flat, skin-like cells located in the epithelium, as well as other structures in the body.
If you have a family history of squamous cell carcinoma of the head and neck, you may be at a higher risk for tongue cancer and other types of oral cancer.
As mentioned, tongue cancer may result from HPV infection. The strains that are responsible for causing tongue cancer are HPV 16 and HPV 18.
Smoking cigarettes and drinking alcohol to excess are significant risk factors for this condition. Smokers have a 5 times greater risk of getting tongue cancer than nonsmokers. If you've already had tongue cancer, you're at a greater risk of getting it again if you continue to smoke cigarettes or drink to excess.
Chewing smokeless tobacco or betel nut (a plant stimulant from the areca palm chewed in Southeast Asia and the Pacific) is also a potential cause of this condition.
How Is Tongue Cancer Diagnosed?If a physical exam uncovers symptoms of tongue cancer, testing will be done to confirm the diagnosis or to uncover a different cause.
A specialist, such as an otolaryngologist (an ear, nose, and throat doctor, or ENT), will examine your entire head and neck region. They'll look for swollen lymph nodes and other symptoms, like tumors or lumps on the tongue.
They may use small mirrors or tools like an endoscope to get a full view of the back of your tongue. An endoscope is a flexible tube with a camera on the end that can be inserted into the mouth or other orifice.
If you smoke and drink heavily, your healthcare provider may also check for lung and esophageal cancer (cancer of the esophagus, the food tube) since these cancers sometimes accompany tongue cancer. This is done with an endoscope during a surgical procedure called a panendoscopy.
As a next step, you'll undergo a biopsy. The location of the suspicious area will determine whether the biopsy is done in a doctor's office or as a surgical procedure.
During the biopsy, a tiny piece of tissue will be extracted from the suspicious area. A pathologist (specialist in anatomic and laboratory medicine) will view the tissue under a microscope to look for cancer cells. They will also test for evidence of an HPV infection.
If cancerous cells are found, imaging tests may be done to determine whether the cancer has spread nearby or into distant areas of the body. Several tests may be done, including:
How Is Tongue Cancer Treated?If testing uncovers tongue cancer, a treatment plan will be put in place for you. Factors that may determine your treatment include:
Location of the tumor or tumors
Cancer stage (how much it has spread)
Type of cancer
Cancer grade (how abnormal the cells appear microscopically)
Your overall health and age
How treatment side effects may affect you
In many instances where the cancer has not spread to distant sites, surgical removal of the cancer will be used as a first-line treatment. In some instances, a portion of the tongue may be removed. When this level of surgery is needed, the removed area may also be reconstructed.
Additional treatments may be recommended, either alone or with other therapies. They include:
Chemotherapy: Medications that kill actively growing cells are given. Chemo may be done before surgery to shrink the tumor. It may also be used instead of surgery or afterward to combat the spread of cancer.
Radiation: Radiation treatment (high energy particles delivered to the area of the tumor) may be done alone or along with chemo (chemoradiotherapy).
Targeted therapy: This treatment uses drugs that precisely target proteins that control cancer cells.
Immunotherapy: This treatment uses drugs that work with your immune system to fight and control cancer.
If you smoke, use tobacco products, or drink alcohol to excess, you're putting yourself at increased risk for tongue and other types of cancer. It can be hard to give up unhealthy habits, but doing so is a powerful way to reduce your risk for this disease.
When you're ready, talk to your healthcare provider about smoking cessation aids, like nicotine patches, that can help.
If you suspect that you may have alcohol use disorder, or if you drink heavily and wish to stop or cut down, treatments can help. They include medications, behavioral therapy, and 12-step programs like Alcoholics Anonymous.
Getting vaccinated against HPV is another powerful preventative. HPV vaccines are available for people ages 9 through 45.
Other preventive measures include:
Reduce sun exposure.
Don't use tanning beds or other forms of ultraviolet (UV) light.
Eat a healthy diet high in fruits and vegetables.
See your dentist regularly to check for cancer and precancerous growths.
Replace ill-fitting dentures that cause irritation.
When caught early, tongue cancer can be cured. There is always a chance for recurrence, especially if you continue to smoke or drink alcohol.
The stage and type of cancer you have will both affect your post-treatment outlook. So will your body's response to treatment. Tongue cancer can be fast-growing, so early detection and treatment are pivotal to outlook and prognosis.
Tongue cancer caused by HPV tends to produce a better prognosis than tongue cancer caused by other factors.
Data from the SEER database gives these five-year relative survival rates for tongue cancer:
Localized cancer: 84%
Regional spread: 70%
Distant spread: 41%
Keep in mind that these are based on averages for all people with tongue cancer. Your individual prognosis will be based on factors specific to your case. These percentages are also based on the experiences of people who were diagnosed with tongue cancer at least five years ago. The statistics do not reflect improvements in treatments.
SummaryTongue cancer is a type of head and neck cancer. It can affect either the front or base of the tongue.
Often, tongue cancer is discovered during regular dental checkups. If you or your healthcare provider suspects tongue cancer, testing will be done to confirm or eliminate the diagnosis.
The stage and type of cancer you have will play a role in your prognosis. Cure or remission is possible, especially when the cancer is caught at an early stage.
Cigarette smoking and drinking alcohol to excess are strong risk factors for this disease. HPV infection can also be a cause.
Read the original article on Verywell Health.
Dad, 44, Who Noticed Three Red Flags In His Throat Was Diagnosed With Incurable Cancer
A dad-of-three has been given a "heartbreaking" diagnosis after experiencing three symptoms (Image: David Davies)David Davies, 44, from Shrewsbury, didn't think too much of his symptoms at first. The dad-of-three just thought he was feeling "under the weather" with a virus.
However, the 44-year-old, who previously worked as a technician at Mercedes Benz, received "heartbreaking" news after he went to see a doctor. He was diagnosed with incurable throat cancer.
His oldest son, Jack Davies, 17, told Express.Co.Uk that his first symptoms were difficulty swallowing, a lump on the side of his neck, and a hoarse voice.
These red flags prompted the dad to go for an emergency appointment on January 26. From there, the doctors quickly referred him to the head and neck department as they suspected the lump in his neck was cancerous.
A series of tests, ranging from endoscopy to MRI scans, confirmed the diagnosis of throat cancer. But that wasn't the end of the dad's ordeal.
The dad has three sons, including the oldest, Jack (Image: David Davies)After receiving this already devastating news, the 44-year-old's consultant wanted him to have a PET scan. Sadly, this revealed that his cancer had spread from his head and neck to his right iliac lymph nodes, becoming incurable.
Jack said: "When my dad attended his first appointment with the head and neck consultant, he was quite positive about the fact he could be treated with a course of radiotherapy, chemotherapy and surgery to remove the affected tonsil.
"[But] when he heard the news that his cancer is now incurable, he felt like his whole world had ended. [He was] angry, [and] confused; and felt like he was now unable to have the future and retirement he had always hoped for."
The dad's cancer was initially supposed to be treated with three cycles of induction chemotherapy and then radiotherapy, but he is now being moved to a palliative course of treatment with immunotherapy.
David and his wife Rebecca (Image: David Davies)In the hope to slow the spread of the cancer, David started this immunotherapy course which will last for up to two years on Monday, March 25.
His son added: "He now feels he has been given a little added time with the hope that immunotherapy will suppress the cancer and stop it spreading any further and hopefully will give him a bit more time.
"We hope this gives us time as a family to create memories and moments we can cherish. We are trying to remain positive.
"Cancer has already taken so much away from us and we are determined it doesn't take away the love, laughter and happiness that holds us together as a family."
The 17-year-old has set up a fundraiser for his dad on GoFundMe to relieve some of the financial pressures that his family have been faced with during this difficult time. Due to his diagnosis, the dad is no longer able to work and his wife, Rebecca Davies, 38, will also lose her income as she will become his full-time carer.
Jack penned for the fundraiser: "He is the most kind, caring and supportive person I have met and to see him go through this diagnosis and to come to terms with this has been very tough.
"I want him to see this support of others as not only the negative burdens of his diagnosis are affecting him, but he also is feeling the pressure in a financial way."
You can visit and donate to the GoFundMe page here.
While the signs and symptoms of throat cancer depend on the specific type you have, Rachel Rawson, Lead Cancer Nurse at Perci Health, outlined the possible red flags to be aware of for Express.Co.Uk:
The cancer nurse warned that the symptoms can be often mistaken for less serious conditions, making seeking medical advice vital.
She added: "The earlier a cancer is picked up, the easier it is to treat it and the more likely the treatment is to be successful. So, it is important that you go to your GP as soon as possible if you notice worrying symptoms."
Mark Steel: Comedian 'immensely Relieved' To Be Cancer-free As He Praises Doctors
Comedian Mark Steel has spoken of his "immense relief" of being cancer-free after being given the all-clear from doctors.
Steel, 63, shared his throat cancer diagnosis last October and told the BBC his treatment has been successful.
He shared his experiences and also praised the staff at University College London Hospital (UCLH).
"They have been astoundingly fantastic," Steel told BBC Radio 4's Today programme.
Previously, Steel revealed he noticed his neck was "looking much bigger than normal" while shaving.
The Have I Got News For You and Mock the Week regular wrote on his website that at first, he thought it was an infection which would go away by itself.
When it didn't, he sought medical advice, "talking in the blokey way that men often talk to a doctor, saying 'I'm sure it's nothing, I'm sorry for coming'."
He was sent for a biopsy but was later told his results had been lost in transit.
Steel only discovered he had cancer when someone called to arrange another biopsy and told him it was "to see what stage of cancer you have".
A consultant later told him he had throat cancer that had spread to his lymph gland. But, earlier this week Steel was given the all-clear by doctors.
"On Tuesday morning in the most mundane fashion someone rang from the hospital - I knew they were going to ring - and they said 'it is all alright'.
"But of course - and I don't know why - they don't tell you straight away. So there was about five minutes of 'how are you, how have you been, what have you been up to?'
"I just stayed calm and they mundanely said it is good news.
Steel - who has a new series of Mark Steel's in Town coming up on BBC Radio 4 - had successful rounds of chemotherapy and radiotherapy to help treat his cancer.
"I don't recommend chemotherapy or radiotherapy as recreational drugs. It is quite brutal, but you have to think this is the way they cure it - and it does.
"There were several weeks when everything went. I had no voice at one point and I was just coughing up industrial levels of mucus. Barrages of it into a little Tupperware salad bowl."
Steel praised the facilities at UCLH which were also visited by King Charles in his first public-facing engagement since his own diagnosis.
The comedian said the chemotherapy room is "one of the most positive places" he has ever been to.
"You just have to get through it," Steel added. "It is an immense relief and it is luck.
"It is partially the magnificence of the health service and you have to get yourself in the right frame of mind, mostly it is luck."
If you have been affected by any of these issues in this story you can visit BBC Action Line.
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