Tongue cancer

Tongue cancer is a group of oncological diseases in the oral cavity, most often formed from squamous epithelium cells. According to statistics, tongue cancer accounts for no more than 2% of all oncological diseases, but this pathology is characterized by aggressive development and serious complications due to the anatomical structure and location of the affected organ. Most often, cancer cells are found in mature men (after 50-55 years), in women, tongue cancer is diagnosed 5-7 times less often.

The oncologic process is differentiated according to the following criteria:

1. Localization:
   • Root (18-20%).
   • Lateral surfaces of the tongue (65%).
   • Tip (3%).
   • Dorsum of the tongue (3-5%).
   • Sublingual zone (5-7%).
2. Types (histological):
   • Adenocarcinoma is a very rare type.
   • Squamous cell carcinoma – in 90-95% of cases.
3. Forms:
   • Ulcerative (bleeding ulcerated tumor).
   • Infiltrative.
   • Papillary form of cancer.
4. By development and growth:
   • An exophytic tumor protruding into the oral cavity.
   • An endophytic, diffuse tumor that grows into the deep layers of the tongue and oral cavity.
5. According to the path of metastasis growth:
   • Lymphatic pathway (to the lymph nodes).
   • Hematogenous route (into internal organs).

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Causes of tongue cancer

The exact causes and etiology of oncological pathologies of the tongue have not yet been established; the generally accepted version is the effect of external carcinogenic factors on the DNA structure of the tongue cell. These may be polycyclic hydrocarbons, ethyl compounds and other pathogenic irritants.

Also, the causes of tongue cancer are associated with chronic trauma to the epithelium, which gradually contributes to its hyperplasia, dysplasia and the development of the oncological process. Any ulcers, erosions, growths, especially those that do not heal for a long time and spread throughout the oral cavity, can be considered precancerous signals.

Risk factors and causes of tongue cancer:

• Nicotine addiction – smoking, use of tobacco mixtures, tobacco.
• Alcohol addiction.
• HPV – papillomas.
• Lichen planus - hyperkeratotic or ulcerative form.
• Systemic lupus erythematosus.
• Herpes virus.
• HIV.
• Plummer-Vinson syndrome.
• Leukoplakia – simplex (simple), erosiva (erosive) or verrucosa (warty).
• Intraepidermal cancer Bowen'S Disease - Bowen's disease, an obligate precancerous disease.
• Syphilitic glossitis.
• Professional factor of harmful production – contact with heavy metal salts.
• Chronic diseases of the oral cavity that develop as post-traumatic conditions when wearing dentures.

Some of the most dangerous factors are obligate, precancerous diseases, the probability of their malignancy is as follows:

• Leukoplakia – 5-15%, depending on the type.
• Erythroplakia – 30-35%.
• Dysplasia – 30-35%.

Any pathogenic systematic impact on the oral mucosa, on the epithelium of the tongue can be an oncoprovoking factor - from chronic stomatitis to harmful, pernicious habits, such as smoking or alcohol abuse.

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Symptoms of tongue cancer

Clinical manifestations of tongue cancer are conventionally divided into three stages - the initial stage, the development of the process and the period of neglect of cancer. Symptoms of tongue cancer in the initial stage are not obvious and can manifest themselves in the form of small cracks, ulcers, in the form of small foci of plaque. Most often, tongue cancer is localized on its sides, where the tongue comes into contact with the teeth, rarely the oncological process affects the root or lower zone. Primary symptoms in 90% of cases are not diagnosed as an oncological process, rarely they can be accurately determined only by histological examination if oncological pathology is suspected. If cancer is not detected, the tumor continues to develop and ulcerates intensively. Ulcers look like a depression with obvious thickening along the edges (crater-shaped ulcer). Painless erosion soon turns into a painful formation, bleeds and thus signals pathology. As a rule, at this stage, signs of cancer have already appeared, and the patient seeks help from a doctor. Less often, diagnostics are performed at the 3rd or 4th advanced stage of the process, when the tumor grows to the entire tongue, affects the soft tissues of the face, the muscles of the tongue, has metastases in the lymph nodes (under the chin, retropharyngeal and submandibular nodes). Distant metastases, including in bone tissue, occur only with adenocarcinoma of the tongue; squamous cell carcinoma does not metastasize to the liver and lungs.

Oncologists identify the following symptoms of tongue cancer:

• Primary signs are white focal plaques, ulcers, cracks, nodular indurations, papillomas.
• Pain when eating, burning or numbness of the tongue.
• Constant sore throat not associated with other diseases (tonsillitis, acute respiratory infections, flu).
• Pain in the ear area not associated with ENT diseases.
• Bleeding tongue.
• Toothache, loose teeth.
• Bleeding gums not associated with dental disease.
• Increased salivation.
• Increasing immobility of the tongue, difficulty in pronouncing words and certain sounds.
• Enlarged lymph nodes.
• An extremely unpleasant odor from the mouth, not associated with gastrointestinal diseases.
• Signs of exhaustion, weight loss.
• Signs of general intoxication.
• Secondary inflammatory diseases of the respiratory system, including the clinical picture of aspiration pneumonia.

Symptoms of cancer by localization and involvement of the lymphatic system can be presented in the form of a table:

Tumor localization	Signs, symptoms	Lymph nodes
Tip of the tongue	Ulceration, exophytic tumors. Pain and bleeding may begin in late stage II	5-10%
Floor of the oral cavity, localization of cancer under the tongue	Infiltrative tumors growing into muscle tissue. Pain in the lower jaw, under the chin, in the neck	T1 – up to 15% T2 – up to 30%
Lateral surfaces of the tongue	Ulceration, squamous cell carcinoma. Pain when eating, bleeding, pain symptoms in the face. Starting from stage III, tongue immobility, total ulceration of the oral cavity, exhaustion	From 30 to 70%
Root of the tongue	Aggressive, rapid development, dysphagia, bleeding, sore throat, regional lymph nodes. The tumor affects the auditory nerve, so the ear hurts. The last stage is characterized by intoxication symptoms, cachexia develops	65-80%

The first signs of tongue cancer

Unfortunately, the first signs of tongue cancer in 90% of cases are missed not only by the patients themselves, but also by doctors, when a cursory examination of the oral cavity results in a diagnosis of glossitis, stomatitis or other, less dangerous diseases.

Most often, a tongue tumor develops from squamous epithelial cells, i.e. it has the form of squamous cell carcinoma. The epithelial tissue of the tongue is, in principle, adapted to various irritants - mechanical, taste, temperature, therefore it is conventionally considered to be quite dense, adapted to traumatic impact. Most likely, the first signs of cancer are therefore not felt as alarming, especially if atypical formations are not visible on the tongue.

Initial warning signs are the appearance of local plaque foci that do not disappear within a month, ulcers, cracks, growths. If such manifestations intensify, develop, periodic discomfort is felt, therefore, there is a direct indication of the need for examination. Severe pain is a sign of an already developed process, which is not only difficult and complicated to treat, but is also fraught with threatening consequences, up to and including disability and death.

Any form of tongue cancer is characterized by a rapid and aggressive course of the process, so ulcers and cracks on the tongue that cannot be treated independently should be entrusted to a specialist. It is better to prevent risk and play it safe than to undergo long-term, very painful and traumatic treatment of a tongue tumor.

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What does tongue cancer look like?

Most often, visible symptoms of tongue cancer appear in precancerous (obligate) conditions such as Bowen's disease, leukoplakia, HPV (papilloma), stomatitis caused by a course of chemotherapy, and lichen planus.

1. Cancer in situ – Bowen's disease. In the oral cavity, on the tongue, one spot appears, which quickly increases to large sizes (up to 5-6 centimeters). The spot has a smooth surface, uneven contours, a depression in the middle. It is in the depression area that erosion forms, then the entire spot ulcerates.
2. Leukoplakia translated from Latin means white growth, plaque, which determines the appearance of the sign. Leukoplakia as a process is a chronic, gradual total keratinization of the epithelial cells of the oral cavity, tongue. There are three studied types of leukoplakia:
   • Simple, which is visible as a small white spot, with clear contours, flat and not amenable to removal with a toothbrush. The spot does not hurt, does not cause discomfort.
   • Keratosis, which is a consequence of simple leukoplakia. The primary spot becomes covered with a plaque in the form of a wart. The plaque is sensitive to irritants, so it is often damaged, cracks and ulcers appear on it. Such phenomena already cause discomfort in the form of a feeling of rough growths in the mouth. Warty growths do not hurt, but can bleed with cracks and ulcers.
   • Erosive leukoplakia in turn is a pathogenetic consequence of the two previous forms. Warty formations begin to hurt when eating food, especially hot or spicy, sour.
3. Papilloma is noticeable because it is a clear epithelial growth. Papillomas are usually white, have a stalk, less often - a wide base. The size of papillomas can reach 2-3 centimeters, their structure can be quite dense and feel like a foreign formation on the tongue.
4. Glossitis is an inflammation of the tongue, the most dangerous type of rhomboid inflammatory process, when a compaction in the form of a geometric figure gradually forms on the tongue. Salivation increases, the tongue periodically hurts.

An advanced form of tongue cancer looks like a continuous, total erosive process, affecting not only all parts of the tongue, but also the mucous membrane of the mouth, soft tissues of the face and even bones.

How does tongue cancer manifest itself?

The first warning signs of tongue cancer are white spots or cracks that do not go away within a few weeks. How does tongue cancer manifest itself?

At the initial stage, the alarming symptoms should be seals on the epithelium of the tongue, ulcers, even painless nodules or erosions. As a rule, atypical formations quickly progress, increase in size and do not respond to home methods of removal. The first painful sensations, bleeding and enlarged lymph nodes are signs of cancer development, when its treatment will most likely take place in a hospital setting. Pain is possible not in the tongue area, but near the ear, in the throat, in the back of the head, under the jaw, which indicates enlarged lymph nodes and developing metastases. Tongue cancer is characterized by an aggressive course and the initial stage quickly transforms into the process of the II-III-th and final, terminal stage.

How does tongue cancer manifest itself at these stages?

• Severe pain when eating.
• Total ulceration of the oral cavity, visible erosions and lesions of the mucous membrane.
• Hyperemia of the oral cavity.
• Limited mobility of the tongue, difficulty pronouncing words.
• Weight loss, exhaustion.
• General intoxication of the body.
• Bad, unpleasant odor from the mouth due to the breakdown of the epithelium and soft tissues.
• Headache.
• Swelling and pain in the regional lymph nodes.

Cancer of the tip of the tongue

Tongue tip cancer is extremely rare and is usually diagnosed at early stages due to the visibility of clinical signs. According to statistics, tongue tip cancer accounts for no more than 4% of all types of tumors in this area of the oral cavity. This localization of the process is characterized by metastasis to the submental lymph nodes, when the tumor is diagnosed at stage III or IV. From the chin area, metastases quickly grow to the submandibular region, and then to the neck. Metastasis occurs bilaterally and is fraught with serious complications. With such a process, the prognosis of the tumor process is unfavorable, five-year remission is possible only in 30-35% of patients.

Primary signs are usually missed by the patient, as they look like symptoms of stomatitis, but the tip of the tongue is highly sensitive, so persistent erosions and cracks force the patient to see a doctor when the process can be considered reversible. Early diagnosis using biopsy helps not only to correctly and accurately establish a diagnosis, but also to determine a therapeutic strategy for curing cancer of the tip of the tongue. As a rule, this part of the tongue is affected by squamous cell keratinizing cancer, which is quite successfully treated with combined therapy, including radiation and surgical methods.

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Oral and Tongue Cancer

Malignant processes in the oral cavity, including the tongue, are most often caused by obligate precancerous pathologies, poor environmental conditions and, in 50% of cases, bad habits such as smoking, alcohol abuse, as well as STDs and venereal diseases.

Statistically, oral cavity and tongue cancer is localized as follows:

• 60-65% - tongue cancer.
• 13-15% - tumor of the buccal mucosa.
• 8-10% - floor of the mouth, cancer under the tongue.
• 6-7% - cancer of the mucous membrane of the alveoli of the upper jaw, palate.
• 3-4% soft palate cancer.
• 2-3% cancer of the alveoli of the mandible.
• 1% cancer of the uvula.
• 1% - anterior palatine arches.

Today, statistics have changed towards an increase in diagnosed cases of tongue cancer. 90-93% of all oncologic processes in the oral cavity are squamous cell carcinoma, in other cases lymphoma, adenocarcinoma, melanoma are determined.

Oral cancer, including the tongue, is classified according to ICD-10 within the range from C00 to C09, starting from malignant neoplasms of the lip and ending with malignant neoplasms of the tonsils. Tongue cancer is defined as C01 - malignant neoplasm of the base of the tongue (root of the tongue) and C02 - malignant neoplasm of other and unspecified parts of the tongue.

The diagnosis of the oncological process in the oral cavity and tongue is confirmed by histology, characteristic clinical manifestations are typical for late stages, when pain appears and lymph nodes enlarge. Metastasis occurs in 45% of patients with squamous cell carcinoma of the anterior zone of the tongue, and 55% with tumors of the floor of the oral cavity (sublingual zone).

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Squamous cell keratinizing cancer of the tongue

Among all malignant neoplasms of the oral cavity, squamous cell carcinoma is most often diagnosed, including this type, which affects the tongue in 90-95%.

Tongue cancer is histologically divided into 4 types:

1. Carcinoma in situ is an intraepithelial carcinoma that is extremely rare.
2. Squamous cell keratinizing cancer of the tongue is a tumor that grows into the adjacent connective tissue in the form of warty carcinoma. The tumor is characterized by large keratinized zones, similar to the so-called "cancer pearls." The process develops rapidly, destroying all adjacent structures.
3. Squamous cell keratinizing carcinoma characterized by the proliferation of atypical epithelium.
4. A poorly differentiated tumor with specific spindle-shaped cells – sarcoid cells.

Cancer planocellulare cornescens (squamous cell keratinizing cancer of the tongue) is clinically divided into superficial and deep, which develops from the glands of the mucous tissue. The course of the process is characterized by aggressiveness, the ulcers that appear quickly become overgrown with dense, keratinized edges. The affected area of the tongue protrudes noticeably above the entire surface, has a grayish tint, is dense to the touch, painless. The warty form of keratinizing cancer is divided into plaque and warty types. The warty variety is the most dangerous due to the high probability of malignancy.

Squamous cell keratinizing cancer is differentiated from tumor basalioma, which preserves a smooth surface of peripheral zones during ulceration. Exophytic squamous cell cancer of the tongue grows papillary, without any smooth, even areas. Often, minipapillomas are accompanied by a purulent infection in the central part of the plaque, which provokes a characteristic foul odor from the mouth.

Treatment of keratinizing cancer depends on the localization and the degree of neglect of the process, but in most cases, excision of cancerous formations within healthy tissues is performed. Close-focus radiation therapy is performed before the operation, and after excision it is repeated to stop the oncological process. Currently, laser technologies are used in surgery for squamous cell keratinizing cancer, which helps to avoid severe consequences and prolongs the period of remission. The prognosis for patients with squamous cell cancer of the tongue in stages I - II is 90% of five-year remission and survival, if there are metastases in the lower jaw, the survival rate is halved.

Cancer under the tongue

Cancer under the tongue is a tumor of the floor of the oral cavity, which accounts for about 15% of all cases of malignant processes in this area. The floor of the cavity is formed by a combination of different structures that are located between the hyoid bone and the tongue. The main support of the floor of the oral cavity is the mylohyoid muscle. This area is most often affected by a tumor under the influence of carcinogenic factors - smoking, heavy metal salts, constant mechanical or temperature trauma. Also, the causes of cancer under the tongue can be HPV - papilloma, leukopenia and other precancerous diseases. Most often, the tumor is localized near the frenulum of the tongue, less often - at the mouth of the salivary duct. Cancer under the tongue is determined in men, on average, for every female patient there are 4 male patients over 55 years old. The initial stage of the process occurs without symptoms and signs of tumor development. The patient consults a doctor already with pain at stage III. Pain in cancer of the floor of the oral cavity is a signal of tumor growth into deep structures and is most often a symptom of metastasis. If metastases penetrate into bone tissue, they are localized in the lower jaw, causing significant limitation of the tongue mobility, its root. In addition, the tumor obstructs the salivary glands, which is accompanied by their inflammation, enlargement and salivation disorder.

How is cancer under the tongue diagnosed?

• The first examination is carried out visually – the oral cavity is examined.
• Palpation of the submandibular area and neck.
• Digital examination of the oral cavity, including the tongue, tonsils and floor of the mouth.
• Ultrasound examination of the neck.
• X-ray of the cervical region, lower jaw.
• Orthopantomography.
• Tumor biopsy.
• Throat swab.
• Tomography as indicated.
• OAC (complete blood count).
• Determination of Rh factor.

The prognosis for treating sublingual cancer is unfavorable. Five-year remission is possible in 85% of patients, provided that the tumor is detected at an early stage. Unfortunately, the remaining patients live no more than a year and a half.

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Squamous cell carcinoma of the tongue

Squamous cell cancer is a malignant neoplasm formed from keratinocyte cells. Cancer development is provoked by carcinogenic factors:

• Exposure to carcinogenic resins.
• Heavy metal salts, ethyls.
• Inorganic arsenic compounds.
• Ionizing radiation.
• Constant traumatic mechanical factor.
• Outgrowing of scar formations.
• Obligatory precancerous diseases.

Squamous cell carcinoma of the tongue has many synonyms - squamous cell epithelioma, epidermal form of squamous cell carcinoma. Such a variety of definitions is due to the fact that squamous cell tumors can, in principle, develop in those parts of the body where there is squamous epithelium. Flat epithelial cells cover internal organs that have a serous membrane, performing a kind of protective function.

Symptoms of squamous cell carcinoma of the tongue:

• The first stage of tumor development is asymptomatic.
• Initial clinical signs are white plaque, growths, erosions, and, less commonly, cracks in the tongue.
• Pain when swallowing food or liquid.
• A periodic sensation of numbness in the tongue, which increases as cancer progresses and completely immobilizes the tongue.
• Bleeding from ulcers, cracks, and growths on the tongue.
• Severe pain when eating and talking.
• As a consequence of pain during eating and communication, exhaustion and dysphagia develop.

Most often, patients seek medical attention. At the second or third stage of the disease, when the symptoms become obvious. Treatment of squamous cell carcinoma of the tongue depends on the location of the tumor and the period of seeking medical care.

The main tumor area is the lateral parts of the tongue, where cancer develops in 70% of cases. In 15-20%, the tumor forms at the base of the tongue (oropharynx), under the tongue - in 5-8%, on the tip of the tongue very rarely - in 2-3% of all diagnosed pathologies of the oral cavity. At the time of receiving oncological care, more than 50% of patients have all the symptoms of regional metastasis, distant metastases are not typical for squamous cell tumors, metastases to the liver, lungs provoke carcinomas and other types of tongue cancer.

Upon examination, the tumor is revealed as a small grayish plaque with a finely tuberous structure, in the form of a growing papilloma. The tumor is clearly delimited, noticeably protruding above the surface of the epithelium of the tongue. The neoplasm can also be in the form of a nodule or an irregularly shaped erosion. If the process is ulcerative, the formations have a reddish-gray tint, the ulcer borders are surrounded by pronounced infiltrates.

Squamous cell cancer of the tongue is difficult to treat, and the prognosis is most favorable when the tumor is detected at the first stage. As a rule, the standard prescription is radiation therapy as an independent treatment method or as part of a comprehensive strategy, a palliative method. Also, at the initial stages, contact gamma therapy is effective, at later stages it is used remotely (DHT). Radiation therapy is carried out until the tumor is reduced by more than half, if this tactic does not give results, the question of using other more radical treatment measures is decided.

Resection is indicated as a surgical method for diagnosing a primary tumor of stage III; its type is determined by the localization of the process. Squamous cell carcinoma is characterized by deep invasive growths along the fibers of muscle tissue and vessels, so radical removal of all muscle tissue affected by metastases is often used.

Cancer of the root of the tongue

Anatomically, the tongue is divided into two main zones – the base (root) and the body.

The body of the tongue can be seen by anyone if they stick their tongue out in front of a mirror, the root is more difficult to see, its condition is often determined by a doctor during examinations. The base of the tongue is located near the pharynx, so cancer of the root of the tongue is considered an oncological process of the oropharynx. Statistically, cancer in this area is less common than cancer of the lateral surfaces, but such localization is more difficult to treat due to the inaccessibility and connection with the nasopharynx, pharynx, palate.

Clinical manifestations of cancer of the root of the tongue:

• The initial stage of cancer is characterized by sluggish, unmanifested symptoms.
• The first signs appear 2-3 months after the onset of the tumor process.
• A feeling of irritation in the throat when eating.
• A feeling of difficulty when swallowing food or liquid.
• Pain deep in the mouth, in the throat area.
• Increased salivation due to tumor growth into the chewing muscles.
• Enlargement of regional lymph nodes.

Early manifestations of tongue root cancer are periodic discomfort in the form of a sore throat when eating; if the initial symptoms are diagnosed in time as a malignant process, the prognosis and remission periods can be quite favorable. Late detection of clinical manifestations is fraught with a fatal outcome.

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Symptoms of Tongue Root Cancer

Tongue root cancer is defined as a tumor of the oropharynx. The following are the main symptoms of tongue root cancer:

• Small areas of erosion, nodules, cracks.
• No pain in the early stages.
• Pain when eating and swallowing at stage III of the process.
• Pain in the tongue, in the throat.
• Pain in nearby organs, areas - in the ear, neck, under the jaw.
• Trismus of the masticatory muscles (spasm).
• Increasing immobility of the tongue.
• Speech defects.
• Bad breath.
• Enlarged lymph nodes - neck, submandibular nodes, back of the head, less often the clavicular region.
• Exhaustion, weight loss.

Tongue root cancer progresses very quickly, it is characterized by infiltrative growth, rapid metastasis by the lymphatic route. In clinical practice, adenocarcinomas of the tongue root are encountered, which develop from the salivary glands, accompanied by a clear sign of this form - tongue immobility.

Treatment of tongue base cancer is performed using radiation therapy, followed by complex treatment, including brachytherapy, tracheostomy, and lymphadenectomy in case of metastases. If after 4 weeks the dynamics are negative, excision of the affected area of the tongue to the epiglottis is performed, and the area of the neck affected by the tumor is excised in parallel. Prognosis of tongue base cancer:

• 5-year survival rate at stages I and II (up to 70%).
• 3-5 years of life after surgery in 50% at stage III.
• Less than 30% survival rate at stage IV.

Stages of tongue cancer

Almost all oncological pathologies develop in certain stages - from the initial, most often asymptomatic to the final, metastasizing and ending in death. The prognosis - the period of remission and survival of patients - depends on the stage of tongue cancer at which diagnosis was made and treatment was started.

Clinically, the stages of tongue cancer are determined as follows:

• Stage I, when the tumor does not manifest symptoms, is small in size (up to a centimeter) and does not develop beyond the tongue. The tumor is clearly localized in the epithelial tissue, does not metastasize and is rarely diagnosed at this stage.
• Stage II, when the process begins to develop deep into the muscle tissue, the tumor increases in size and can give rise to initial metastases, usually in the area under the chin or jaw. Primary signs of the process appear - burning of the tongue, ulceration or nodular formations on it.
• Stage III. The tumor develops and occupies more than half of the entire tongue and part of the sublingual area. Obvious clinical symptoms appear in the form of periodic numbness of the tongue, limited mobility and a neoplasm visible to the naked eye. Metastases grow into the lymphatic system of the occipital area, behind the ears, in the armpit area.
• Stage IV, when the tumor metastasizes to many internal organs and bone tissue. First of all, metastases appear in regional lymph nodes, then they affect the brain, lungs and liver, and later - bone tissue.

The stages of tongue cancer are classified according to the generally accepted TNM system:

1. T – tumor, its size.
2. N – presence of nodes, lymphatic lesions.
3. M – presence of metastases.

The aggressive course of the process is due to the constant impact on the tongue, abundantly supplied with lymph and blood. A person eats food every day, including hot, spicy, sour, which contributes to injury, activation of existing erosions, and the development of cancer. In addition, smoking and alcohol are considered to be almost the main culprits, trigger factors that accelerate the transition of cancer from the initial stage to the subsequent ones, complicated by metastases.

Early stage tongue cancer

It is believed that the most favorable in terms of treatment prognosis and survival statistics is the initial stage of exophytic tongue cancer, the endophytic process develops faster and more aggressively. Like other oncologic processes, tongue cancer does not manifest itself clinically at the first stage of development, the initial stage does not cause alarming symptoms or discomfort. The only signs may be small ulcers in the mouth, focal plaque, cracks in the tongue that do not have clear boundaries, when palpating, the detected nodules can be felt as small seals. Often, secondary infections in the form of stomatitis join the damage to the epithelium of the tongue, an atypical odor from the oral cavity appears. Salivation increases, teeth may bleed or the throat may hurt. The initial stage is characterized by three paths of development, it is most pronounced in the exophytic form, when signs of cancer are noticeable during a careful examination of the external oral cavity

Anatomical forms of development of the initial stage of tongue cancer:

1. Ulcerative, erosive form.
2. Nodal form.
3. Papillary form.

Unfortunately, the asymptomatic nature of the initial stage of tongue cancer is the cause of further development of the process, which spreads to the palate, alveolar processes, and muscle tissue. Therefore, if white spots, seals, cracks, papillomas, and other atypical signs appear in the mouth or on the tongue, you should immediately consult a doctor - a therapist, a dentist, who will conduct a primary diagnosis, and refer you to a specialist for more detailed examination of the oral cavity. It should be noted that superficial examinations reveal only about 7% of the symptoms that tongue cancer demonstrates in the initial stage, therefore, timely diagnosis depends on the attentiveness of the patient and the doctor conducting the diagnosis.

Tongue cancer stage 3

Stage III tongue cancer manifests itself with pronounced symptoms that are difficult not to notice or not to feel:

1. Pain, periodically unbearable, localized in the affected part of the tongue. The pain can radiate upwards – to the ear, the back of the head, to the temples.
2. The tongue becomes numb, loses mobility, problems with eating and communication appear (it hurts to talk).
3. My throat hurts from time to time.
4. Symptoms of general intoxication of the body appear.
5. The breakdown products of the epithelial and muscle tissue of the tongue provoke hypersalivation – increased salivation.
6. An unpleasant smell appears from the mouth.

Stage 3 tongue cancer is already clearly manifested by anatomical signs, which are divided into forms:

1. Exophytic - papillary, warty or ulcerative (most common).
2. Endophytic form is often ulcerative-infiltrative.

It is the endophytic development of a tongue tumor that is considered the most malignant and is classified as follows:

• IIIA, when the tumor reaches a size of more than 2 centimeters, infiltration extends beyond the middle of the tongue and affects the oral mucosa. Primary regional metastases may be detected (in 5-7% of cases).
• IIIB, when the tumor has obvious multiple metastases – collateral or regional.

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Tongue cancer stage 4

Stage IV tongue cancer is clinically very severe. The tumor spreads to almost the entire tongue, capturing nearby and distant soft tissues, including facial bones. When the process is advanced, multiple metastases are clearly visible during diagnosis, immobile regional and distant, including in bone tissue.

Stage 4 tongue cancer is classified as follows:

• IVA, when the tumor is localized throughout the entire anatomical zone of the tongue, metastases are rarely detected.
• Stage IVB, when the tumor has clinically manifested distant metastases and spreads not only to the tongue, but also to neighboring structures - the skin and tissues of the face, facial bones, maxillary sinus, deep muscles of the tongue.

Tongue cancer develops in three clinical stages and, if in the initial period it can proceed without signs and symptoms, and in the advanced stage it is accompanied by secondary clinically expressed manifestations, then the advanced period (stage IV) proceeds aggressively and is characterized by the following symptoms:

• The tumor infiltrative formation is totally covered with ulcers.
• Severe pain occurs when eating, often making this process impossible in principle.
• The patient loses weight and signs of cachexia appear.
• Complete immobility of the tongue develops due to the growth of the tumor and its penetration into the masticatory muscles (trismus of the masticatory muscles).
• Constant bleeding of gums and tongue.
• Progressive tissue necrosis causes extremely unpleasant breath odor.
• Secondary inflammatory processes in the respiratory organs may develop due to aspiration of infected saliva.

Stage 4 tongue cancer as a process is characterized by an aggressive malignant course and has an extremely unfavorable prognosis.

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Classification according to ICD-10

C002.0-C002.9 – Malignant neoplasms of tongue

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Metastases in tongue cancer

Metastasis is typical for tongue cancer at stages III and IV of development. Metastases begin to appear at early stages, 3-4 months after the onset of tumor formation, but do not manifest themselves clinically and, as a rule, are not detected during diagnostics. The spread of regional metastases in 99% of cases occurs through the lymph flow, the hematogenous route of metastasis to internal organs and bones is extremely rare. Metastases in tongue cancer spread through the lymphatic outflow, the center of which is considered to be the nodes in the neck area (carotid artery area). The number of lymph vessels in the area of the base of the tongue increases significantly, where oropharyngeal cancer is localized, it is this type of tumor that gives aggressive growth of metastases.

The exophytic form of tongue cancer metastasizes less frequently and much later than endophytic neoplasms, which affect regional lymph nodes in 70% of cases. In addition, oncological practice has already accumulated information that low histological differentiation of the tumor is characterized by early and very extensive development of metastases. The frequency of damage to regional nodes with a certain localization of cancer is:

• Lateral surfaces of the tongue – 43.5%.
• Root of the tongue, floor of the oral cavity – 44.5%.
• Tip of the tongue – 15-20% (submandibular nodes).

Clinicians believe that about half of patients may not have metastases, which is confirmed by long-term observations and statistics. However, the complexity of detecting lymph node lesions, due to both anatomical specificity and late diagnostic times, leads to the fact that in some cases there may be diagnostic errors both in the direction of hyperprognosis and hypodiagnosis. Such errors occur despite cytology and histological studies.

How are metastases detected in tongue cancer? The general stages of diagnosis are as follows:

• Careful palpation of the neck and submandibular area on both sides.
• Visual examination of the oral cavity.
• Digital examination of the oral cavity, including the floor, tongue, and tonsils.
• Ultrasound examination of the cervical-shoulder girdle.
• Chest X-ray.
• X-ray of the lower jaw.
• Orthopantomography.
• Computed tomography.
• Indirect lymphoscintigraphy.
• Biopsy of the neoplasm.
• Throat smear for cytology.
• Blood, urine and saliva tests.

The main informative method that helps to identify metastases at early stages of development is ultrasound and indirect lymphoscintigraphy. If the tumor has already been diagnosed and is subject to surgical excision, regional lymph node dissection of the neck is used during the procedure, which allows determining the presence or absence of metastasis in intact lymphatic zones.

Diagnosis of tongue cancer

In most cases, the tumor is detected already at the late stages of the development of the oncological process in the oral cavity. Situations are extremely rare when the diagnosis of tongue cancer determines stage I or II, which are asymptomatic. The main indicative and informative method in clarifying the nature, form and type of cancer is histology. A biopsy of the tumor is performed, and the lymph nodes, both nearby and distant, such as axillary, are necessarily examined.

Diagnosis of tongue cancer includes the following measures:

1. Physical methods:
   • Visual inspection.
   • Internal examination - palpation of the tongue, floor of the mouth, including the tonsils.
   • Palpation of the neck and the area under the lower jaw.
2. Instrumental examination of the tumor and the whole organism:
   • Ultrasound of the cervical region.
   • Ultrasound of abdominal organs.
   • Chest X-ray.
   • X-ray of the jaw, including orthopantomography.
   • Biopsy of the neoplasm.
   • Smears for cytology.
   • MRI or CT scan of the skull.
   • Positron emission tomography as indicated.
   • Radioisotope method for studying neoplasms.
   • Laryngoscopy.
   • Nasopharyngoscopy as indicated.

Not all of the above methods are always used in cancer diagnostics, since the late stages of the disease are so pronounced that it is enough to conduct cytology or take a scraping from the epithelial part of the tongue. The most important action is considered to be the differentiation of the tumor from other oncopathologies similar in external symptoms. This may be epithelial dysplasia, hemangioma, tuberculosis of the tongue, syphilitic gumma, oral myoma, leukoplakia. Often, erythroplakia, which is a precancerous condition, but not a full-fledged tumor process, resembles tongue cancer. In addition, diagnostic difficulties are possible in differentiating the tumor and mixed tumor processes characteristic of the oropharynx. Mixed tumors most often form from the salivary glands, are localized in the back of the base of the tongue, less often on the side. Atypical tumors develop slowly, have a round shape, dense uneven consistency, such formations include mucoepidermal formations, Abrikosov's tumor, cylindromas. Diagnosis of tongue cancer is confirmed or excluded by morphological studies - cytology and biopsy.

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Treatment of tongue cancer

The tactics and determination of the treatment strategy are directly related to the stage at which the tumor is developing and how extensive and deep the metastasis is. The main method that involves the treatment of tongue cancer is radiation therapy. It is used both as an independent stage in the process management and in combination with other methods of tumor treatment. The degree of neglect of the oncological process must be taken into account when choosing the mode and number of procedures. For example, at stages I and II, contact radiation therapy is indicated, at later stages accompanied by metastases, remote irradiation is used. The first 3 sessions of radiation therapy show the effectiveness and the need to continue using this method. If observation does not show positive dynamics, radiation therapy is canceled and other combined methods of treatment are prescribed. With persistent positive dynamics, the dose of radiation therapy can be increased up to 2 times and the course is continued. Treatment of tongue cancer is carried out for a long time, using many modern techniques, but the most effective is a combined strategy, including surgery. The scope of surgical intervention is determined by the stage of the oncological process and can be as follows:

• Stages I and II – tongue resection, usually half.
• Stage III – extensive extended surgery.
• After the stage of resection of the primary tumor focus, excision of the neck tissue is performed.
• In case of multiple metastases, the Krail method is used, when the fascia of the cervical, suprahyoid, and supraclavicular lymph nodes are removed together with the removal of part of the submandibular salivary gland.
• Also, in case of extensive metastasis, Vanach's operation or cervical lymphadenectomy can be performed. The essence of the surgical intervention consists of fascial removal of the lymph nodes located under the jaw, under the chin together with part of the salivary gland. Vanach's method is indicated for cancer of the anterior third of the tongue surface in stages III and IV.

Treatment of tongue cancer also includes chemotherapy as a palliative method, helping to increase the effectiveness of previously used methods. Combined therapy is much more effective than monotherapy and allows to increase the percentage of survival, remote results of remission up to 55-60%. The most favorable prognosis is in the treatment of exophytic neoplasms, which are localized in the anterior zone of the tongue, especially in the early stages. Despite the complications, after radiation therapy in the form of purulent inflammation in the oral cavity, aesthetic deformation problems, speech impairment, the prognosis for five-year survival approaches 60%. Those patients who were diagnosed in the late, advanced period, live no more than 12-18 months after surgery, they are given a gastrostomy.

The recovery period is also included in the treatment of a tongue tumor, it is quite difficult and long. Since the process of eating is a serious problem after organ resection, plastic surgery may be necessary. It is also very difficult to restore normal speech and the general psycho-emotional state. At this time, the patient needs moral support not only from the attending physician and medical staff, but also from people close to him.

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Treatment methods for tongue cancer

Modern methods of treating tongue cancer are developing rapidly due to the latest achievements in the study of atypical cells, their pathogenetic mechanism of development and developments in the field of equipment for monitoring oncopathologies. Early stages of tongue tumors are subject to radiation therapy and organ-preserving surgeries. Today, the method of burning neoplasms using focused ultrasound is successfully used, resection is performed with a gamma knife, excision of affected tissues is carried out by the method of thermocoagulation or with a laser. All these methods are low-traumatic and allow maximal preservation of tongue functions, including not damaging the speech apparatus in principle. Operations last a short period, much more time is required for recovery and rehabilitation of the patient. Late stages of tongue cancer are subject to more extensive operations, when a significant area of the organ is removed, less often the tumor is excised and the tongue and lymph nodes are completely removed. After such radical measures, the functions of the tongue are partially restored with the help of plastic surgeries, when donor material from the patient's own tissues is used. Also, after removal of the lymph nodes affected by metastases, the patient is shown reconstructive therapy, which helps to regulate the process of eating, speech. Correction of defects of appearance is not so significant in the treatment of tongue cancer, however, after several years of remission, facial plastic surgery is possible, provided that the body is ready for the next surgical intervention.

In addition to surgery, tongue cancer is treated with radiation and chemotherapy. Primary stages are treated with contact gamma therapy (2-5 centimeters from the body), more advanced stages are treated with distance radiation therapy - a radioactive method that destroys not only tumor cells, but also healthy cells. Chemotherapy may be prescribed, which helps to accelerate the suppression of tumor growth and combines well with radiation methods as a palliative element. In general, treatment methods for oral neoplasms are planned jointly, the oncologist closely cooperates with dentists, orthodontists, physiotherapists, speech therapists, plastic surgeons and nutritionists.

Treatment of tongue root cancer

Malignant neoplasms of the oropharynx usually begin to be treated in the late stages. More than 80% of patients are admitted to the hospital with an already developed oncological process and extensive metastases. This type of tongue cancer is considered the most unfavorable, a five-year remission is possible only in 10-15% of patients. Perhaps such a low percentage of survival is associated not only with the neglect of the pathology, but also with the lack of a single standardized, optimal treatment regimen. Also, the difficulty of treating cancer of the root of the tongue is the total spread of the tumor, extensive damage to the tissues of the oral cavity, which makes it impossible to perform a radical operation. There is another obstacle - the anatomical and physiological specificity of the localization of the base of the tongue, to stop the cancer, it is necessary to carry out a wide excision of the deep layers of tissue, as a result, almost all functions of the tongue are disrupted and multiple serious complications are possible.

The main method that involves the treatment of tongue root cancer is radiation therapy, which is indicated as an independent stage, but is also used in combination with cytostatic drugs. Gamma therapy is very effective in stages I and II of cancer development, especially in combination with X-ray radiation performed in a close-focus way. Left treatment is also used in late stages, both preoperative preparation and postoperative course. Wide block excision of the tumor and metastasis in the lymphatic apparatus is carried out in any case, regardless of the presence or absence of metastases. Surgery is indicated even in the initial period of tumor formation, since it is the removal of atypical cells that helps to stop the process and prevent it from spreading to nearby tissues. Lymph node dissection is currently indicated for 90% of patients with tongue root cancer, this helps to prolong the remission period and increase the chances of survival in principle.

Treatment methods for cancer of the base of the tongue:

• Radiation therapy.
• Cryotherapy, laser.
• Thermocoagulation.
• Surgical intervention.
• Chemotherapy.
• Radiotherapy.
• Prescribing cytostatic drugs in tablet form.
• Biotherapy, administration of drugs containing monoclonal antibodies, inhibitors of atypical cell growth.

Surgery for tongue cancer

The type and extent of surgical intervention for tongue cancer directly depend on the stage of the process, the size of the tumor, the extent of metastasis and its localization. If atypical cells do not affect adjacent tissues, the operation is performed using the most gentle method; such interventions are called organ-preserving. More serious stages of the process require extensive operations, including excision of the nearby lymphatic apparatus, as well as soft tissues of the face or neck. As a rule, the beginning of treatment is radiation therapy, which shows the extent of the tumor and the curability of the oncological process in principle. If the tumor continues to grow, recurs, surgery is inevitable and contributes not only to the neutralization of the proliferation of squamous cell carcinoma, but also to some relief of symptoms. The amount and sector of tissue that is excised are determined by the localization of the tumor. It is also necessary to remove part of the healthy tissue, since the anatomical location of the tongue is very specific and does not allow for radical intervention within the boundaries of the normal tissue structure.

Surgery for tongue cancer can be local and performed using a laser or thermocoagulation (cauterization); as a rule, such gentle interventions are indicated when the tumor is detected early and there is no metastasis to regional lymph nodes. Endophytic deep neoplasms require more radical measures, such as resection of more than half of the tongue, excision of lymph nodes affected by metastases. Why can't you do without surgery? Arguments in favor of surgical intervention:

1. Today, surgical treatment of the oncological process in the oral cavity is the most reliable and effective way to stop the process. Surgical intervention is rarely indicated as a monomethod, more often it is used in combination with radiotherapy, chemotherapy and other methods of cancer management.
2. Surgery for tongue cancer can provide the highest percentage of probability of stable remission and increases life expectancy to 5 years. This does not so much prolong the patient's life as give him hope for a cure, because every year new, modern methods of cancer therapy appear. It is quite possible that in five years scientists will finally be able to defeat cancer.
3. It is incorrect to compare the effectiveness of radiation therapy and surgery in the treatment of tongue cancer. The first method is effective for small exophytic tumors, but is ineffective for infiltrative neoplasms, especially in the late stages.
4. At stages III and IV of tongue neoplasm, treatment without surgery is simply impossible.
5. Modern surgical technologies today allow performing surgical interventions in the most gentle ways possible; in addition, after resection, excision, the probability of complete reconstructive restoration of the skin-muscle complexes approaches 95%.

Radiation therapy for tongue cancer

Radiation therapy is considered one of the most reliable methods of treating the initial stages of malignant processes in the oral cavity. The effect of rays on the tumor is ionizing X-ray irradiation of atypical cells, most often stratified squamous epithelium. However, in addition to the effective neutralization of tumor growth, radiation therapy for tongue cancer can be accompanied by a number of complications, since it destroys not only cancerous tumors, but also some healthy tissue. Therefore, the therapeutic strategy takes into account the age, condition of the patient, localization of the neoplasm and the feasibility of using the gamma method. Usually, stages I and II cancer are treated by contact, when the rays are exposed from a close distance (intrasternal irradiation). More advanced stages III and IV are subject to remote radiation therapy.

Radiation therapy for tongue cancer can be called radiotherapy and is conventionally divided into radical, that is, an independent method of treatment, but is also carried out as an adjuvant method, helping to reduce the risk of relapse after surgery. Radiation therapy is also used in combination with chemotherapy (chemoradiation therapy), which activates and accelerates the process of stopping the tumor and the development of metastases.

Radiotherapy of tongue tumors is indicated in different variants and modes, procedures are performed using special equipment that is capable of focusing the radiation beam in accordance with the contours of the tumor, the method is called RMI (radiotherapy with modulated intensity). This property of new devices helps to minimize damage to healthy tissue cells.

Radiation therapy is very effective for patients after surgery that included cervical lymphadenectomy. Indications for the radiation method in such patients may be the following conditions:

• Multiple foci of metastasis in the cervical spine.
• A large node (more than 3 centimeters) affected by metastases.
• A poorly differentiated type of tongue cancer.
• Development of metastases beyond the lymph node.

Complications and consequences of radiation therapy in the treatment of tongue cancer:

• Inflammatory process in the oral mucosa (mucositis), xerostomia.
• Pain in the throat when eating or drinking liquids.
• Feeling of dry mouth.
• Ulceration of the mucous membrane.
• Impaired sense of taste and smell.

As a rule, complications after radiotherapy are neutralized with the help of additional treatment, all symptoms disappear after a maximum of 6 months after the course.

Chemotherapy for tongue cancer

Chemotherapy helps suppress the activity of proliferation of atypical squamous epithelial cells. Chemotherapy for tongue cancer is performed by intravenous administration of cytostatics. Cytostatics are a category of antitumor drugs, they are able to disrupt and damage the nucleus, membrane of the atypical cell and provoke its necrosis. Chemotherapy is rarely used as an independent course in the treatment of malignant neoplasms of the oral cavity, more often it is prescribed in combination with radiation therapy and surgery. Like many other methods of oncological process management, chemotherapy has its pros and cons. Side effects after a chemotherapy course affect the bladder, nervous system, skin, kidneys. The patient may feel the following symptoms:

• Periodic nausea, vomiting.
• Hair loss, temporary baldness.
• Disorder of the digestive system.
• Constipation or diarrhea.
• General fatigue.
• Pain in the mouth.

What is the mode of chemotherapy for tongue cancer?

• As a pre-treatment before starting a course of radiotherapy.
• Before surgery.
• After radiation therapy.
• After tumor resection surgery.
• In case of extensive, generalized metastatic process affecting internal organs and bone tissue.

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Treatment of tongue cancer with folk remedies

At first glance, it seems that treating tongue cancer with folk remedies is a myth and useless. However, even oncologists are not against using herbal preparations as an adjuvant therapy, provided that folk remedies are agreed with them.

Of course, treating tongue cancer and other oncological processes with folk remedies is always a risk. The reasons for the ineffectiveness of such therapy:

• Uncontrolled intake of herbal decoctions and tinctures.
• Failure to follow the recipe for preparation, it is especially dangerous to use those plants that are toxic. Having a history of tumor, any folk recipe should be agreed with the attending physician.
• False hope for a herbal panacea. When a person falls ill, especially when tongue cancer is discovered, relying on herbs or homeopathy alone is, at the very least, foolish; often such experiments only prolong and aggravate the pathological process, and lead to the loss of precious time.
• Purchasing herbal infusions in places not intended for the sale of medicines (markets, online stores). If the herbal remedy is agreed upon and approved by a doctor, it must be purchased at a pharmacy.
• Phytotherapy cannot replace any conventional method of treating oral cancer. Treatment with folk remedies should only be an auxiliary element in the whole complex of therapeutic actions.

All herbal mixtures should be composed taking into account the patient's health condition. As a rule, potent plants containing alkaloids are used in the treatment of tumors - celandine, meadowsweet, Icelandic cetraria, chaga.

The herbs are mixed in strictly defined proportions and the decoction is also prepared exactly according to the instructions. It should be remembered that sometimes the use of herbal infusion can lead to more serious consequences than a course of radiotherapy or chemotherapy.

The safest way to rinse your mouth is to follow the recipe below, this procedure will reduce the feeling of dryness and inflammation after radiation or chemotherapy:

• Take a teaspoon each of sage, calendula, thyme and nettle.
• Pour a liter of boiling water over the herbal mixture and leave in a thermos for 6 hours.
• Strain the broth.
• Dilute the resulting decoction with boiled cooled water in a ratio of 1/1.
• Rinse your mouth three times a day after each meal (more often is possible).
• The rinsing procedure should last at least 3 minutes.

A mucous decoction of flax seeds also effectively relieves irritation in the tongue area.

1 tablespoon of seeds is poured with 0.5 liters of cooled boiled water, infused for 10 hours, filtered, but not stirred. At the bottom of the container where the flax was infused, a mucous sediment should remain, this is what is needed for rinsing. A teaspoon of sediment is placed in the mouth and held there for at least 5 minutes, the procedure should be repeated 3-4 times, so that the entire period of stay of the flax sediment in the mouth is about 20 minutes.

It is very important to remember that treatment with folk remedies, recipes read in the press of dubious quality, in relation to oncological processes is very dangerous. Any recipe that promises immediate healing should be categorically rejected, the necessary course of herbal preparations can only be selected by the attending physician.

Nutrition for tongue cancer

Considering that tongue cancer is accompanied by painful symptoms that interfere with eating and drinking, the diet should be specific.

Nutrition for tongue cancer should be as fractional and gentle as possible, hot, spicy, sour, pickled, fried dishes are strictly unacceptable. Alcohol and smoking should be forgotten forever, as they are among the most important factors that provoke tumors.

Food should have a puree consistency, meat should be steamed in the form of minced meat products. Solid foods, including those containing bones, are excluded from the menu, and changes are made in favor of vitaminized, high-calorie, but at the same time easily digestible food.

Often after courses of radiotherapy and chemotherapy, the patient develops digestive problems, and if the patient is also lying down, constipation is almost inevitable. Vegetables containing coarse fibers, such as zucchini, cabbage, carrots, beets, and pumpkin, boiled in water can help solve this problem. In fact, these products can be the basis for any side dish, but it is better to put off potatoes and pasta until better times, since starchy foods do not contribute to strengthening the immune system and normal digestion. It is useful to add raisins, prunes, and chopped walnuts to boiled, mashed vegetables.

List of prohibited foods that should be excluded from the diet for tongue cancer:

• Animal fats, margarine.
• Semi-finished meat products, smoked and cooked sausages.
• Mushrooms.
• Rich broths.
• Milk with a high percentage of fat.
• Hard cheeses.
• All smoked foods, marinades.
• Foods cooked in aluminum cookware.
• Limit salt, replace regular salt with sea salt.
• Limit sweets.
• All artificial instant and carbonated drinks, including instant coffee, are excluded.
• All canned foods.
• Legumes.
• Potatoes (can be replaced with Jerusalem artichoke).
• All products containing soda.
• Vinegar.
• Yeast bread.
• Alcoholic beverages.

What can be done with a tumor process in the oral cavity?

• Boiled vegetables, excluding potatoes.
• Freshly squeezed juices (not sour).
• Liquid porridges made from buckwheat, oatmeal, and rice with water.
• Rosehip and rowan berry decoction.
• Dried fruit compote.
• Boiled Jerusalem artichoke.
• Lean pork, boiled and chopped veal.
• Boiled sea fish.
• Grated and baked cottage cheese.
• Natural low-fat yogurt.
• Pureeed fruits (not sour).

Tongue cancer prognosis

The prognosis for tongue cancer depends on the stage at which the process was detected and how successful the treatment was. Complete recovery of health with such a disease is almost impossible due to the nature of the tumor, the anatomical location of the affected organ and the consequences of radiation therapy, chemotherapy. Obviously, long-term remission is possible at the initial stages of tongue cancer, according to statistics, it is about 80% of cases at stage T1 and 55-60% at stage T2. If cancer is diagnosed at stage III or IV, five-year remission is no more than 35% of patients who have undergone combination therapy. The prognosis for tongue cancer is directly related to the presence and number of metastases in the lymphatic system, this is the most significant prognostic criterion. If regional nodes are affected by metastases, survival and duration of remission are reduced by at least 2 times.

In general, a doctor can give prognostic information only after six months of treatment and dynamic observation. It is very important to follow all the instructions and not lose faith in healing, then the chances of stable remission and survival in principle increase many times over, an example of this can be the fates of many people who do not lose their spirit.

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Prognosis for tongue root cancer

An indicator that can clarify the prognosis for tongue root cancer is the stage and extent of the process. Tongue root cancer or oropharyngeal cancer is considered one of the most difficult to treat with both radiation methods and surgery.

The prognosis for tongue root cancer is directly related to the period of tumor detection; the earlier the diagnosis and treatment, the more favorable the outcome of therapeutic efforts.

In general, prognostic information is determined by the classification of tongue root cancer. The following classification of oropharyngeal tumors is generally accepted:

• Tis – carcinoma.
• T – tumor up to 2 centimeters.
• T2 – a tumor measuring from 2 to 4 centimeters in diameter.
• T3 - tumor larger than 4 centimeters.
• T4 – a tumor larger than 4 centimeters with deep growth into the soft tissues of the root of the tongue, neck, and jaw bone.

Five-year remission and survival in patients with tongue root cancer is noted within 50-60% of all described cases, the prognosis is especially favorable at stage T, when the tumor is small. If the patient is diagnosed with stage T4, the prognosis is no more than 20% remission within 3-5 years.

It is believed that the deeper the localization of the tongue tumor, the more likely the unfavorable outcome, cancer of the lateral surfaces of the tongue or its tip has a better prognosis than neoplasms in the root zone. The most dangerous is the infiltrative-ulcerative form with an aggressive course and extensive metastasis.

Tongue cancer occupies a fairly large sector among all oncological processes in the oral cavity - up to 70%, but among the entire list of malignant tumors, its frequency is noted only 3 percent. Nevertheless, tumor neoplasms of the tongue are serious and threatening pathologies that at least lead the patient to disability, and in advanced cases - to death. It is possible to avoid a deadly disease, you just need to get rid of bad habits that provoke cancer, regularly monitor oral hygiene, and undergo medical examinations. Early diagnosis of cancer always has a favorable prognosis, you just need to see a doctor in time at the first alarming symptoms.