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Tongue Cancer

A common oral cavity malignancy with distinct anterior (mobile) and posterior (base) tongue subsites.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Tongue Cancer?

Tongue cancer is a malignancy of the tongue, almost always squamous cell carcinoma. It is anatomically and clinically divided into two distinct entities: oral tongue cancer (anterior two-thirds, mobile portion) and base of tongue cancer (posterior third, oropharyngeal). These differ significantly in epidemiology, etiology, and treatment.

Oral tongue cancer typically affects the lateral border and is strongly associated with tobacco and alcohol use. It is increasingly seen in young non-smokers, particularly women, suggesting unidentified risk factors. Base of tongue cancer is part of the oropharynx and is increasingly HPV-related (particularly HPV-16), with rising incidence in middle-aged men.

Tongue cancer often presents with a non-healing ulcer, mass, or pain on the tongue. Diagnosis is by biopsy with imaging for staging. Treatment depends on subsite, stage, and HPV status. Oral tongue cancer is typically treated with surgery and reconstruction, while base of tongue cancer often receives chemoradiation as primary treatment, especially for HPV-positive disease.

Symptoms

Persistent tongue ulcer or sore not healing (over 2-3 weeks)
Lump, mass, or thickening of the tongue
Red or white patches (erythroplakia/leukoplakia)
Pain in tongue, often referred to ear (otalgia)
Difficulty moving the tongue (advanced disease)
Difficulty swallowing or chewing
Speech changes or slurring
Numbness of the tongue or jaw
Bleeding from tongue lesion
Bad breath (halitosis) with advanced disease
Painless neck lump (cervical metastasis)
Weight loss with progressive disease
Trismus (jaw stiffness) with deep invasion

Risk Factors

Tobacco use (cigarettes, cigars, pipes, chewing tobacco, snuff)
Alcohol consumption (synergistic with tobacco)
HPV infection (especially HPV-16, base of tongue)
Betel nut and areca nut chewing (high prevalence in South Asia)
Poor oral hygiene
Chronic mechanical irritation (sharp teeth, ill-fitting dentures)
Premalignant lesions: erythroplakia, leukoplakia, oral submucous fibrosis
Age over 50 (declining for HPV-related disease)
Male sex (3-4 fold higher)
Immunosuppression
Lichen planus, Plummer-Vinson syndrome
Fanconi anemia, dyskeratosis congenita
Previous head and neck cancer (field cancerization)
Genetic factors (rising in young women without traditional risk factors)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Tongue ulcer not healing within 2-3 weeks
  • Persistent tongue pain or ear pain
  • Lump or thickening on the tongue
  • Red or white patches on the tongue
  • Difficulty moving the tongue
  • Speech or swallowing changes
  • Numbness of tongue or mouth
  • Painless neck lump
  • Bleeding from tongue lesion
  • Smoker, drinker, or HPV-positive individual with any tongue changes

Treatment Methods

01
Smoking and alcohol cessation (essential)
02
Dental evaluation and oral hygiene optimization
03
Multidisciplinary head and neck tumor board review
04
Biopsy with HPV/p16 testing for base of tongue lesions
05
Imaging: MRI tongue, CT neck, PET-CT for staging
06
Oral tongue cancer: primary surgical resection (partial glossectomy, hemiglossectomy)
07
Reconstruction: primary closure, local flap, or free flap (radial forearm, anterolateral thigh)
08
Elective neck dissection: tumors with depth over 4 mm
09
Sentinel lymph node biopsy: alternative in select early cases
10
Adjuvant radiation: positive margins, perineural invasion, advanced T or N
11
Adjuvant chemoradiation: extracapsular extension or positive margins
12
Base of tongue cancer (HPV-positive): definitive concurrent chemoradiation
13
Transoral robotic surgery (TORS): selected base of tongue cases
14
Induction chemotherapy: select advanced cases
15
Immunotherapy (pembrolizumab, nivolumab): recurrent/metastatic disease
16
Targeted therapy (cetuximab): alternative to cisplatin
17
Speech and swallowing therapy: pre and post treatment
18
Long-term surveillance for recurrence and second primaries
19
Dental and prosthetic rehabilitation

Which Department to Visit?

You can visit our Onkoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.