Cancer (oncology) of the tongue: tumor stages, first signs, types, causes, symptoms, treatment, photos of the initial stage

The epidemiology (prevalence) of tongue cancer is on average 5 cases per 100 thousand population.

Among the recorded cases of oral tumors, it accounts for up to 60%. Despite the relatively simple diagnosis of this disease, there are advanced cases - people often do not notice the signs or ignore the symptoms of tongue cancer.

Etiology - causes of tongue cancer

The main cause of tumors on the tongue, like any other cancer, is a genetic malfunction in the cells.

In this case, these are epithelial cells - the tissue that forms the mucosa. Several main factors contributing to this process have been identified:

Exposure to carcinogens. A huge amount of harmful substances is contained in cigarette smoke and chewing mixtures (nasvay, betel). It is in smokers and nasal users that cancer of this localization is most often diagnosed, and in men it is detected 3 times more often than in women. Alcohol increases the impact of carcinogens.
Occupational hazards. The incidence of tongue cancer in people employed in hazardous industries is much higher. Salts of heavy metals (mercury, lead), asbestos, and petroleum products can also be classified as carcinogens by their nature.
Photo: neoplasm on the tongue
Impact of viruses. Recent studies have proven a direct link between chronic viral infection and the incidence of cancer. Human papillomavirus, herpes simplex virus and HIV are capable of transforming the genome of cells, turning them into cancerous ones. According to statistics, up to 70% of women are carriers of HPV. The mechanism of oncogenic effects of viruses is associated with their ability to suppress antitumor genes.
Chronic oral injuries. They may be associated with improper installation of dentures, improper treatment of fillings, or chronic biting of the mucous membrane.

Long-term exposure to these factors on the mucosa is accompanied by damage to the DNA structure of epithelial cells. As a result, papillary hyperplasia (excessive growth) develops, which looks like a thickening at the sides, or dysplasia (improper development) of the mucous membrane.

Further exposure to these causes leads to the development of precancerous conditions: leukoplakia, Bowen's disease, hyperkeratosis and papillomas. Subsequently, these conditions transform into oncology.

Survival prognosis

Each type of cancer has its own prognosis, but it can be roughly represented as follows:

If a cancerous tumor is detected at the first or second stage, the survival rate is 75 percent
If a cancerous tumor is detected at the third stage, the survival rate is 50 percent
When a cancerous tumor is detected at the fourth stage, the survival prognosis is less than 30 percent. It should be noted that a period of time equal to five years is taken.

Those who promptly consult a doctor for medical help have every chance of recovery, since the earlier tongue cancer was detected, the easier it will be to cure.

Tongue cancer is one of the most dangerous diseases that develops rapidly. That is why, if you detect at least a few symptoms indicating cancer, you should not immediately contact a specialist in order to avoid the possible transition of the disease to the most severe stage.

Stages of tongue cancer

There are several stages of the disease, each of which has its own distinctive features.

Initial stage of tongue cancer (first)

Photo: this is what the initial stage of tongue cancer looks like

It is characterized by an asymptomatic course - practically nothing bothers patients. It appears as whitish spots on the mucous membrane, the so-called papillary growths. They are often mistaken for plaque, which is located on the lateral surface of the muscular organ.

When examined, doctors often mistake these formations for manifestations of other diseases: glossitis or stomatitis. There is no pain at this stage.

Stage of clinical manifestations (second)

As the disease progresses, the “plaque” gradually turns into a lump on the tongue, which, if left untreated, transforms into a tumor on the tongue. At this stage, a pain syndrome appears; the pain is diffuse or local in nature, very often radiating to nearby organs (neck, temple, ears).

Patients at this stage often complain of bad breath, which is caused by infection and suppuration of the tumor. The clinical picture is accompanied by difficulty swallowing, articulation disorder, swelling and numbness of part of the tongue. Metastasis to surrounding tissues and nearby lymph nodes - submandibular, cervical - is possible.

Advanced degree (third)

It is possible to bring the disease to this stage if you completely ignore the symptoms of the initial and second stages of tongue cancer. It manifests itself as aggressive invasive (penetrating into the thickness of the organ and surrounding tissues) growth, accompanied by tissue decay.

Terminal stage (fourth)

In this phase, distant metastases occur - in the bones, liver, lungs. Treatment of advanced tongue cancer is not very successful and the prognosis is very doubtful. Patients who progress the disease to the terminal stage rarely live more than a year.

Treatment is only palliative - the fight against pain and cancer intoxication.

Symptoms

When any growth forms on the tongue, pain and discomfort in the mouth occurs.
Problems with chewing food, speaking, and swallowing are often observed. Sometimes swelling and redness of the tissue occurs, and one or more papillae become enlarged. But all pronounced symptoms are absent in the initial stages; they appear when the tumor is of a significant size. Sialadenitis is manifested by general weakness, fever, pain and burning, swelling of the affected area, and an unpleasant taste appears in the mouth.

If the structure or color of the growth changes, it begins to grow rapidly - this may be a sign that the growth has degenerated into a malignant tumor.

Reference! In children, papillomas on the tongue occupy large areas, often the neoplasms are covered with a white coating.

Types of tongue cancer

The disease is classified by localization - the location of the tumor on the tongue:

Cancer of the tongue body accounts for more than 2/3 of all cases of this pathology.
Cancer of the root of the tongue - 1/5 of all cases.
Lower surface cancer – all remaining cases (about 10%).

Photo: squamous cell carcinoma of the tongue

Based on the principle of tumor growth, the following clinical forms of the disease are distinguished:

Exophytic – the tumor grows mainly in the oral cavity. Sometimes this form of the disease is called papillary.
Endophytic (infiltrative) – growth is directed into the thickness of the organ. Endophytic growth is a characteristic symptom of tongue root cancer. Very often, this form of the disease leads to swelling and difficulty in moving the tongue or to its complete immobility.

Tongue cancer is classified as squamous cell in 95% of cases, and only in 5% is it another histological form: carcinoma or basal cell carcinoma.

Based on the appearance of the tumor, papillary and ulcerative forms are distinguished. Papillary cancer is the most common type of disease.

It looks like a dense growth, somewhat elevated above the mucous membrane and covered with “warts”.

In the ulcerative form of the disease, an ulceration appears on the surface of the tongue on the side or back, surrounded by a ridge. A characteristic property of an ulcer at an early stage is its complete painlessness. As the ulcer grows, pain appears and bleeding is noted. The addition of an inflammatory component masks cancer and complicates diagnosis.

Photo of tongue cancer

Pictured is papillary tongue cancer

The photo shows a tumor on the side of the tongue

The photo shows an ulcerative form of cancer

Pictured is tongue root cancer

What could it be

The most common types of growths on the tongue are lipomas, fibroids, papillomas, hemangiomas, and polyps.

Type of growth	What does it look like
Papillomas	Flat - noticeably rise above the epithelium, wide, light in color. They are formed one at a time. Pointed (condylomas) are light-colored neoplasms in the form of papillae with a sharp end. They often merge into groups, grow, and increase in size. Externally similar to the comb or inflorescences of cauliflower. Thread-like - thin, protruding noticeably above the surface of the epithelium, colored bright red. Form groups.
Polyps	The neoplasm is flat or convex in shape in the form of a lump, formed from ectopic gastric mucosa. Most often it appears on the root of the tongue.
Adenomas	Formed from the glands of the mucous membrane of the tongue, it looks like a small ball. Localized on the tip and root of the tongue.
Lipomas	Consist of fat cells. They have a soft, lobed structure, located on the root of the tongue or under it. They grow slowly and do not hurt. Flap lipoma is flat. Can grow deep into tissues. Vulgar - a small bulge on the tongue.
Fibroids	Consist of connective tissue. Elastic, painless neoplasms are round in shape and sometimes have a stalk. They do not differ in color from the mucous membrane, sometimes they have a pale yellow or white tint. Neurofibroma contains nerve fibers and is therefore painful. It forms on the root of the tongue and does not differ in appearance from a regular fibroma.
Myomas	Growths on the surface of the tongue with a dense structure, up to 1 cm in size, are covered with a mucous membrane. Formed during the proliferation of muscle cells.
Hemangiomas	Vascular neoplasms look like red or blue spots. Sometimes they bleed.
Cysts	A retention cyst consists of muscle fibers and forms on the inner surface, the frenulum of the tip of the tongue. This is a small ball with liquid inside.
Botriomycomoma	The tumor is flat or spherical, reaches 10 cm in size, sometimes consists of several lobules. The shade varies from red to burgundy, the surface is smooth or covered with crusts.
Lymphangioma	Congenital benign neoplasm. Grows from the walls of lymphatic vessels. The surface is covered with bubbles, growths are located on the upper surface and tip of the tongue. They often become inflamed and are often accompanied by problems with bite and speech.
Struma	It is rare and consists of thyroid tissue cells. This is a small node up to 3 cm in size, formed at the root of the tongue.
Sialadenitis	The tumor appears against the background of inflammation of the saliva and sublingual gland. Causes: infectious pathologies, tuberculosis, mumps, syphilis.

Clinical case – condylomas on the tongue:

Growths on the tongue in adults and children

Neoplasms in children and adults are equally common. In adults, these are mainly papillomas, adenomas, cysts, and lipomas.

In a child, papillomas are presented in the form of epithelial hyperplasia - the tissues of the tongue mucosa grow greatly. The active growth of HPV most often begins after influenza, sore throat, or a viral disease. Lymphangioma is diagnosed mainly in children under one year of age. Hemangiomas often occur in girls.

Diagnostics

On your own, you can only suspect the first symptoms of oncology in a given localization. Strangely enough, the doctors who most often encounter this pathology are not oncologists, but dentists. This is due to the specifics of their activity - in the course of their professional activities, they may be the first to notice signs of an early stage of cancer in the form of a lump on the side of the tongue or at the root.

The similarity of the first symptoms of tongue cancer with other diseases of the oral cavity leads to its late diagnosis - most often at the second stage, when a malignant neoplasm of the mucous membrane takes the form of an ulcer or a pronounced tumor.

Specific diagnostics consists of the following examinations:

Examination of a fingerprint smear to detect signs of squamous cell carcinoma.
Tumor biopsy followed by histological examination under a microscope.
Ultrasound of the tongue and soft tissues of the lower jaw, as well as ultrasound of the neck to search for metastases.
X-ray of the skull or computed tomography - if there is a suspicion of tumor growth into the bone.

In order to exclude distant metastases, it is necessary to do an X-ray of the lungs, CT (MRI) of the brain and ultrasound of the liver.

Despite the fact that squamous cell carcinoma of the tongue is less common in women, the frequency of its detection at an early stage is much higher in them. This is due to the more sensitive attitude of women to the condition of the oral cavity.

List of sources

Alieva. S.B., Alymov Yu.V., Kropotov M.A., Mudunov A.M., Podvyaznikov S.O. Cancer of the oral mucosa. Oncology. Clinical recommendations / Ed. M. I. Davydova. – M.: Publishing group RONC, 2015, pp. 27-37.
Romanov, I.S. Features of regional metastasis of squamous cell carcinoma of the oral cavity, detected during preventive lymph node dissections. / Romanov, I.S., Yakovleva L.P., Udintsov D.B., Dzhumaev M.G., Tsiklauri V.T. // Dentistry. – 2012. – T.91, No. 4. — P. 28-31.
Romanov I. S., Yakovleva L. P. Issues in the treatment of oral cancer. Farmateka 2013; (8):59–63.
Paches A.I. Tumors of the head and neck. 5th ed., supplemented and revised M.: Practical Medicine, 2013. P. 119‒146.
Romanov I. S. Prospects for the use of cetuximab in the treatment of squamous cell carcinoma of the head and neck / Oncology. Hematology. Chemotherapy. - 2015. - No. 17/1.

Treatment methods for tongue cancer

Regardless of the cause of tongue cancer, combination therapy is used to treat it, including the following methods:

Surgery. The operation is aimed at radical removal of a malignant tumor: either partial resection (excision) of the tongue or its complete removal (glossectomy) is performed. In advanced cases, when the tumor has grown into the surrounding tissues, they are resected down to the bones of the lower jaw.
Radiation therapy. There are remote therapy, when the tumor is irradiated at a distance with X-rays, and contact therapy (brachytherapy), when the radiation source (radioactive isotopes) is placed deep within the organ. Radiotherapy is performed both before and after surgery. The doctor determines how many sessions are needed.
Polychemotherapy. It is used in advanced cases in the presence of distant metastases, when other methods cannot be used, or their effect is insufficient. Patients are treated with Cisplatin, Methotrexate and other drugs.

Surgeries in the later stages of the disease are often mutilating in nature - in some cases it is necessary to remove almost the entire lower jaw. After surgery, patients live with some restrictions. In order to create a satisfactory quality of life, they undergo reconstructive medical operations.

Diet

Diet for tongue cancer

Efficacy: therapeutic effect for a month
Timing: constantly
Cost of products: 1300-1500 rubles per week

Difficulties with swallowing in the patient before and after surgery force the installation of a nasoesophageal tube. Through it, broth with meat and eggs beaten in a blender, sour cream, cream and other high-calorie liquid products are introduced. A nutritional mixture must be prescribed in addition to the main diet . This is a liquid high-calorie and high-protein mixture enriched with micronutrients. This can be Nutrizon Advance , Nutrizon Protein Advance , Nutrizon Energy , Nutrizon Protein Intense , Supportan Mixture for enteral nutrition, Fresubin original , Fresubin Energy , Nutricomp . With the transition to natural nutrition, a diet table with liquid dishes is organized - puree soup, boiled fish and meat (veal), poultry (turkey, chicken), whipped in a blender, meat and fish soufflé, liquid omelet, yoghurt, milk, cauliflower, broccoli in the form of mashed potatoes, mashed potatoes.

Prevention methods, prognosis of tongue cancer

You can reduce the likelihood of developing the disease by giving up bad habits: smoking, drinking alcohol and chewing tobacco. If there is dental pathology that contributes to chronic injury to the mucous membrane, the oral cavity is sanitized: dentures are reinstalled, fillings are treated, and the bite is corrected.

Maintaining basic oral hygiene can significantly reduce the risk of developing cancer. In terms of prognosis, regular preventive examination by a dentist is important, during which the first signs of cancer can be noticed, which allows a person to be referred to an oncologist in a timely manner.

With radical combined treatment of tongue cancer in the early stages, the five-year survival rate approaches 90%; in advanced cases it drops to 60%. If treatment is started at the metastatic stage, the five-year survival rate is less than 35%, even in Moscow.

Preventive measures

The main methods of prevention are strengthening the immune system and maintaining good hygiene.

How to prevent growths from appearing:

to refuse from bad habits;
exercise regularly, spend more time outdoors;
avoid stressful situations, learn to relax, master meditative techniques;
wash your hands frequently and thoroughly, especially after going outside or visiting the toilet;
Always use only your own towels and personal items;
adjust your diet - give up unhealthy and heavy foods, eat more vegetables and fruits, fermented milk products, cereals, lean meat and fish;
observe the drinking regime - you need to drink 1.5-2 liters of clean still water per day;
promptly identify and treat dental diseases and pathologies of internal organs.

An effective method for preventing the formation of papillomas on the tongue is HPV vaccination. The Cervarix and Gardasil vaccines have contraindications and side effects, so they are not suitable for everyone. Vaccination does not completely protect against infection, but it does promote the production of antibodies that help the body fight infection more quickly.

It is advisable to vaccinate up to 26 years of age. The protective effect is designed for 8 years. Contraindications: pregnancy and breastfeeding, any gum problems.