Tongue cancer

Diagnosis

Tongue cancer is usually found first by a doctor, dentist or other member of your health care team during a routine checkup. A number of tests and procedures are used to help diagnose tongue cancer. Which ones are best for you depends on your medical history and symptoms.

Testing for tongue cancer may include:

• Examining the mouth and throat. In a physical exam, a member of your health care team looks at your mouth, throat and neck. That person checks for any lumps on the tongue and for swollen lymph nodes in the neck.
• Using a tiny camera to look at the mouth and throat. Called an endoscopy, this test uses a thin tube with a light and camera. The tube is inserted into the nose and passed down to the throat. It looks for signs of tongue cancer in the mouth and throat. It also may be used to see if the cancer has spread by looking at other parts of the throat, such as the voice box.
• Removing a tissue sample for testing. Called a biopsy, this test involves taking a sample of cells from the tongue. There are different types of biopsy procedures. A sample may be collected by cutting out a piece of the suspicious tissue or the entire area. Another type of biopsy uses a thin needle that's inserted directly into the suspicious area to collect a sample of cells. The samples are sent to a lab for testing. In the lab, tests can show whether the cells are cancerous. Other tests give more information about the cancer cells, such as if they show signs of HPV.

• Imaging tests. Imaging tests capture pictures of the body. The pictures can show the size and location of the cancer. Imaging tests used for tongue cancer may include X-rays and CT, MRI and positron emission tomography, also called PET, scans.

  Sometimes an X-ray involves a barium swallow. In this type of X-ray, a liquid called barium helps to check for signs of cancer in the throat. Barium coats the throat and makes it easier to see on X-rays. An ultrasound may be used to look for cancer in the lymph nodes. Ultrasound creates pictures using sound waves. It might show whether the cancer has spread to lymph nodes in the neck.

Treatment

Treatment for tongue cancer usually includes surgery followed by radiation, chemotherapy or both. Your health care team considers many factors when creating a treatment plan. These might include the cancer's location and how fast it's growing. The team also may look at whether the cancer has spread to other parts of your body and the results of tests on the cancer cells. Your care team also considers your age and your overall health.

Tongue cancer surgery

Surgery is the most common treatment for tongue cancer. Operations used to treat tongue cancer include:

• Surgery to remove some or all of the tongue. This surgery is called a glossectomy. The surgeon removes the cancer and some of the healthy cells around it, called a margin. Removing the margin helps ensure that all the cancer cells are removed. How much of the tongue the surgeon removes depends on the size of the cancer. The surgery might remove some of the tongue or all of the tongue. Sometimes surgery causes trouble with speaking and swallowing. This depends on how much of the tongue is removed. Physical therapy and rehab can help improve these issues.

  Surgeons use cutting tools to remove the cancer cells. The tools are put into the mouth to access the cancer. If the tongue cancer is in the throat, surgeons might put tiny cameras and special tools through the mouth and into the throat to get to the cancer. This is called transoral surgery. At some medical centers the tools are placed at the ends of robotic arms the surgeon controls from a computer. This is called transoral robotic surgery. Robotic surgery helps the surgeon operate in hard-to-reach areas of the mouth and throat, especially the back parts of the tongue. Many cancers at the front part of the tongue can be removed without robotic aid.

• Surgery to remove lymph nodes in the neck. When tongue cancer spreads, it often goes to the lymph nodes in the neck first. If there are signs that the cancer has spread to the lymph nodes, you might need surgery to remove some lymph nodes, called a neck dissection. Even if there are no signs of cancer in the lymph nodes, you may have some of them removed as a precaution. Removing the lymph nodes removes the cancer and helps your health care team decide if you need other treatments.

  To get to the lymph nodes, the surgeon makes a cut in the neck and removes the lymph nodes through the opening. The lymph nodes are tested for cancer. If cancer is found in the lymph nodes, other treatment might be needed to kill any cancer cells that are left. Options might include radiation or radiation combined with chemotherapy.

  Sometimes it's possible to remove only a few lymph nodes for testing. This is called a sentinel node biopsy. It involves removing the lymph nodes to which cancer is most likely to spread. The lymph nodes are tested for cancer. If there's no cancer detected, it's likely that the cancer hasn't spread. Sentinel node biopsy isn't an option for everyone with tongue cancer. It's only used in certain situations.

• Reconstructive surgery. Reconstructive surgery may be needed when parts of the face, jaw or neck are removed during surgery. Healthy bone or tissue may be taken from other parts of the body and used to fill gaps left by the cancer. This tissue can replace part of the lip, tongue, palate or jaw, face, throat, or skin. If reconstruction is used to replace parts of the tongue, it is usually done at the same time as surgery to remove the cancer.

Other tongue cancer treatments

Other treatments for tongue cancer include:

• Radiation therapy. Radiation therapy uses powerful energy beams to kill cancer cells. The energy can come from X-rays, protons or other sources. During radiation therapy, a machine directs beams of energy to specific points on the body to kill the cancer cells there.

  Radiation therapy is sometimes the main treatment for tongue cancer. It also can be used after surgery to kill any remaining cancer cells. Sometimes radiation therapy and chemotherapy are used at the same time to treat other parts, such as the lymph nodes, if the cancer has spread.

  Radiation for tongue cancer can make it hard to swallow. Eating can become painful or difficult. Your health care team will work to keep you comfortable and help you get nutrition during treatment.

• Chemotherapy. Chemotherapy uses strong medicines to kill cancer cells. Chemotherapy may be used before surgery to control the growth of the cells. It also may be used after surgery to kill any remaining cells. Sometimes chemotherapy is done at the same time as radiation therapy because it makes the radiation work better.
• Targeted therapy. Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die. Targeted therapy is used to treat tongue cancer that comes back or spreads.
• Immunotherapy. Immunotherapy is a treatment with medicine that helps your body's immune system kill cancer cells. Your immune system fights off diseases by attacking germs and other cells that shouldn't be in your body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells. Immunotherapy might be used when the cancer is advanced and other treatments haven't helped.
• Clinical trials. Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask a member of your health care team if you might be able to be in a clinical trial.

Treatment for advanced tongue cancer can impact your ability to speak and eat. Working with a skilled rehabilitation team can help you cope with changes that result from tongue cancer treatment.

Coping and support

Facing a serious illness might make you feel worried. With time, you'll find ways to cope with your feelings, but you may find comfort in these strategies:

• Ask questions about tongue cancer. Write down questions you have about your cancer. Ask these questions at your next appointment. Also ask your health care team for reliable sources where you can get more information.

  Knowing more about your cancer and your treatment options can help you more comfortable about making decisions about your care.

• Stay connected to friends and family. Your cancer diagnosis can be stressful for friends and family too. Try to keep them involved in your life.

  Your friends and family will likely ask if there's anything they can do to help you. Think of tasks you might like help with, such as caring for your home if you have to stay in the hospital or just listening when you want to talk.

  You may find comfort in the support of a caring group of your friends and family.

• Find someone to talk with. Find someone you can talk to who has experience helping people facing a life-threatening illness. Ask your health care team to suggest a counselor or medical social worker you can talk with. For support groups, contact the American Cancer Society or ask your health care team about local or online groups.

Preparing for your appointment

Start by making an appointment with your usual doctor, dentist or other health care professional if you have symptoms that worry you.

If your health care team is concerned that you may have tongue cancer, you may be referred to:

• A doctor who treats problems of the face, jaw and mouth, called an oral and maxillofacial surgeon.
• A doctor who treats problems in the ears, nose and throat, called an ENT specialist.
• A doctor who uses medicines to treat cancer, called a medical oncologist.
• A doctor who uses radiation to treat cancer, called a radiation oncologist.

Because appointments can be short, and because there's a lot of information to discuss, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, as well as any vitamins or supplements, that you're taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information you get during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask.

Your appointment time may be limited, so prepare a list of questions to help you stay focused. List your questions from most important to least important in case time runs out. For tongue cancer, some basic questions include:

• What is my stage of tongue cancer?
• Can you explain the pathology report to me? Can I have a copy of my pathology report?
• Will I need more tests?
• What are the treatment options for my tongue cancer?
• What are the benefits and risks of each option?
• Is there one treatment option you recommend over the others?
• What would you recommend to a loved one in my same situation?
• Should I get a second opinion from a specialist? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared, don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Be ready to answer some basic questions about your symptoms and your health, such as:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?