In this type of cancer the tumoral cells grow on the tongue.
Tongue cancer is usually grouped with other oral cancers such as tongue, palate, cheek, moth floor and gum cancer, known as oral cavity cancers.
- Which are its symptoms?
- Non painful tongue ulcers or wounds that will not heal in 15 days on a male patient smoker and drinker with poor dental hygiene or some dental piece in bad conditions or a grazing prosthesis must be consulted with a doctor and subsequently a specialist. The earlier it is diagnosed, the higher are the probabilities of recovery.
- Swallowing difficulties.
- Numb tongue.
- Changes on the speech due to the impoverished mobility of the tongue.
- Other symptoms as: local pain, ear pain, mandible pain and a lump on the neck. These symptoms are usually related to bigger lesions, hence the prognosis is worse.
- How is it diagnosed?
The specialist will perform a biopsy to extract affected tissue which will be examined through microscope by a pathologist who will confirm the presence of cancerous cells. Radiologic imaging will be required (Tomography, MRI, PET) to verify in which stage the tumour is.
- Tongue cancer staging
- Stage I: the tumour is smaller than 2 cm and there is no metastasis.
- Stage II: Tumour between 2 and 4 cm without metastasis.
- Stage III: Tumour bigger than 4 cm, or smaller with metastasis.
- Stage IV: The cancer has spread towards the surrounding tissues or the metastasis is bigger than 3 cm.
- How is it treated?
Small oral cavity or oropharynx tumours will be treated with surgery if possible, as long as the resection required by the tumour does not entail the impossibility of restoring deglutition (swallowing).
In these cases the use of CO2 laser transoral microsurgery facilitates the removal of tumours with less loss of healthy tissues and usually does not need sectioning the jaw, practicing tracheotomy or rebuilding the defect created using the usual flaps, which shortens the postoperative period and leaves less after-effects.
The neck ganglions will be treated by regular surgical dissection. In most of the cases it will be convenient a complementary chemo-radiotherapy after 3-4 weeks to increase the percentage of recovery. If the tumour is very advanced and its resection may endanger deglutition, chemo-radiotherapy will be applied. In case of partial persistence of the tumour CO2 laser transoral microsurgery will be performed to remove it.
Microsurgery through the mouth requires a long formation: the surgeon, first of all, needs to have mastered traditional open surgery in case the tumour is not accessible through the mouth (anatomic problems, extension of the tumour to vital tissues, etc.).
The surgeon must also develop their abilities in the use of the surgical microscope with highly amplified images that help to tell the healthy tissues apart from the tumoral tissues (which allows to sear the tumour adjusting with more precision the resection of the surrounding healthy tissues).
This surgery requires a learning curve (with a gradual increase of the difficulty of the case): the more experience and ability the surgeon possesses, the more complicated cases that surgeon will be able to solve.
In some cases the surgical removal of the tumour must be needed, including all or part of the vocal cords (laryngectomy). Many patients also need deglutition therapy after the treatment in order to help them get used to the changes in the structure of their throat.
Radiation is used to kill cancerous cells and shrink tumours. The method is more frequently used when the cancer is behind the tongue. The patient must receive external radiation and a brachytherapy implant to heal the cancer. Sometimes chemotherapy is combined with radiation especially when the cancer has spread to the lymphatic glands.
Rehabilitation after tongue cancer is mostly based on therapies to make tongue movement, chewing and swallowing easier.
- What does the patient have to do one the treatment is over?
Once the treatment is over the patient must have periodic checks made in order to detect relapses as soon as possible in order to treat them immediately.
Imaging techniques performed by the oncologist may be needed alongside with the usual medical explorations.
Dr. Máiz has a wide experience in the treatment of tongue tumours both by conventional surgery and CO2 laser transoral microsurgery.
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