Oral Cancer Awareness: Understanding Tongue Cancer

Tongue cancer is a type of oral cancer or mouth cancer characterized by a malignant transformation of the cells that make up the tongue. The tongue is the organ that allows us to speak, to chew, to taste and swallow. These are essential functions in everyday life. This organ is divided into two parts: one is the mobile tongue and the other, called the base of the tongue, is in the back of the throat. Thus there are two types of cancer of tongue: those that are on the mobile part, highly visible and easy to detect, and those that are at the base of the tongue. The former accounts for 85% of the cases (the vast majority being men). As for cancers of the base of the tongue, they are diagnosed in most cases at an advanced stage.

Overview of the symptoms of the disease

This disease has a good prognosis for recovery if detected in time. Therefore, it is important to know what are the early signs and symptoms of tongue cancer, especially if you are in the risk group.

1. The appearance of sores on the tongue

Sores on tongueOne of the first signs of cancer of the tongue is having small ulcers that seem to never want to go away, besides that these eruptions will be painful and not a simple type of pain, but one that will be difficult to ignore, as it will be uncomfortable even for those who are tolerant of pain. Beware of this warning sign as it can easily be confused with sores or oral herpes, which unlike the sores that appear when you have tongue cancer, last less time and are not so painful.

2. The appearance of white or red spots on the tongue

LeukoplakiaIf you have a spot on the tongue for some time and it is red (erythroplakia) or white (leukoplakia), it is best to check with your doctor as it may be one of the first manifestations of this type of cancer. If leukoplakia or erythroplakia is more than 2 weeks, it is very likely that your doctor will decide to have a biopsy. Red spots or erythroplakia are less common than white spots but have a higher potential to become cancerous.

This symptom although usually always appears but very few people identify it since the spots can appear in any area of the tongue, even in those areas to the sides, bottom or to the very bottom that you cannot see on your own and with ease. For that reason, it is recommended to go to the dentist at least once every 6 months

However, usually the spots that appear have a raspy texture, so you are likely to feel it when brushing your cheeks.

3. Pain in the tongue

Tongue cancer causes discomfort in the mouth and throat even for simple activities like drinking water or chewing food, so this will be another important indicator to take into account to know if you could or would not be suffering from this type of cancer in particular, although it is important to take into account that discomfort when swallowing and pains in the mouth can be due to various reasons, from throat infections, allergies, and even poor oral hygiene.

So you should not panic if you feel this type of symptom in particular. First, try to find out the cause of pain and discomfort. If you cannot, it is likely to be tongue cancer and therefore the best thing to do is to go to a specialist that can carry out the relevant exams to leave the doubt.

4. It is possible to suffer from bad smell in the mouth

After the above symptoms, it will not be strange to point out that you are likely to experience bad odors inside the mouth. These bad odors usually decrease a little after brushing, however, whether you have or have not eaten the bad smell will come back and it is possible also along with a taste of blood in the mouth.

5. Appearance of blood on the tongue

There are people who experience bleeding in the tongue, but usually this sign is confused with bleeding gums or bleeding from mouth ulcers, however, it is important that if you are experiencing blood in your mouth, if you feel a taste of blood in your mouth, after eating a few minutes, you may be able to determine where that blood is coming from.

You can pass a clean cotton ball on your tongue to know if it is from there blood is coming out. For this, it important that you rinse your mouth very well with water to clean the accumulated blood before passing the cotton and not confuse the source.

6. Pain in one or both ears

This may be one of the less experienced signs, but it is manifested in several patients who have tongue cancer, so it is important that you take into account every small detail.

It is important to warn that if you suffer from any of these symptoms, you must not try to remove or squeeze ulcers or sores on your tongue in order to make them smaller, as many people do. It is best to consult your doctor as soon as possible, discuss your concerns and he/she can perform the necessary tests to identify what is causing these manifestations similar to those that arise from a carcinoma of the tongue.

Remember this disease can be controlled and it is important that you submit to a treatment as soon as possible so that it does not expand in the whole internal area of the mouth, cheeks, throat and neck.

Tongue cancer pictures


To confirm or exclude the diagnosis of tongue cancer, the doctor performs thoroughly a test in the area of the mouth and pharynx. The anterior two-thirds of the tongue can be assessed with the naked eye. Finally, with the help of a mirror, the base of the tongue can be seen. When tongue cancer is suspected, the doctor takes a tissue sample (biopsy) of the affected areas of the tongue, thus ensuring the diagnosis.

To determine how far the cancer of the tongue has spread from its original location, the doctor uses imaging scanning procedures such as computed tomography (CT) or magnetic resonance tomography (MRT). In this way, it can be determined if branched tumors (metastases) are found in the lymph nodes of the throat. However, sometimes it is enough to make an ultrasound of the lymph nodes.

The staging of carcinoma of the tongue is classified according to the TNM system, acronyms in English representing the extent of the primary tumor (T), the presence of regional lymph nodes (N) and the presence of distant metastases (M). This classification is very important for the doctor since, through this information, the adequate treatment can be established as well as the evaluation of the prognosis of the disease.

Overview of the treatment of tongue cancer

The choice of treatment depends on:

– The size and location of the tumor.
– The degree of invasion of cancerous cells.
– The personal characteristics of the patient (age, family history).
– The general state of health and life choices of the patient.

The different treatments

Like most cancers, the treatment combines surgery, chemotherapy, and radiotherapy. The combination of these treatments is defined on a case-by-case basis.

The main treatment remains the surgery with resection (that is to say the removal) of part or all of the tongue. Depending on the situation, size and location of the tumor, the surgeon can perform the reconstruction of a new tongue with fragments taken usually in the neck. This heavy operation, with disabling consequences for the patient, requires a long rehabilitation. Tongue cancer surgery is usually combined with other forms of treatment (radiation or chemotherapy) to ensure that all cancer cells have been eliminated.
Note that tongue cancer tends to spread in the upper aerodigestive tract. It can also metastasize, especially to the lungs, the liver, the bones.
Surveillance is necessary for about ten years (recurrence, other localization, complications …).

Who to consult?

– An oncologist: for all matters relating to the general treatment of cancer. Make sure of his specialty is “tongue cancer”.
– An otolaryngologist (ENT physician): for all matters relating to the removal of the tumor. Make sure of he is specialized in tongue cancer.

What are the causes and risk factors

Alcohol and TobaccoTongue cancer rather affects:
– men
– over 40 years (with a peak between 55 and 66 years)
– heavy smokers (tobacco multiplies by 6 to 25 the risk of tongue cancer),
– and heavy drinkers (alcohol has an influence, it is mainly the tobacco/alcohol combination that multiplies the risks).
80% to 90% of cancers of the tongue are estimated linked to smoking and alcoholism.
– Poor oral hygiene and teeth and gums in bad condition also are risk factors for its development.
– Oral leukoplakia: a mucous condition characterized by the appearance of white patches or plaques that do not disappear when scratched. It is a precancerous lesion that can degenerate into cancer in the presence of risk factors such as tobacco and alcohol.
– Oral erythroplakia: a premalignant condition that causes superficial red plaques on the mucous membrane of the mouth that can turn into cancer if not treated.

Can tongue cancer be prevented?

The prevention is directly towards the risk factors. It is therefore recommended to ensure good oral hygiene (prevention of gum infections), to stop smoking and to limit the consumption of alcohol.
Finally, any lesion of the tongue which lasts longer than 3 weeks, and especially in presence of ganglions in the neck, must lead to consultation without delay.

What are the latest advances in tongue cancer?

Currently, the research attempts to unravel the genetic mechanism that causes tongue cancer. It is known that alteration of the suppressor oncogene encoding the p53 protein is closely related to the onset of many squamous cell carcinomas of the head and neck. In addition, other genes such as ErbB1 and c-myc are involved.

There is increasing evidence that viral infections may play a role in the origin of tongue cancer. The virus most frequently found in these tumors is human papilloma virus (HPV-16).

Future research will reveal the cause and mechanism of origin of tongue cancer and this will allow doctors to apply more effective and less aggressive treatments.

Where to find more information?

Do not hesitate to ask your doctor or any other member of your healthcare team. It is important that you learn as much as possible about your illness or treatment so that you know what to expect and especially how to stay as healthy as possible despite your illness. Your doctor knows all the details of your case, he/she is the best person to whom you can address your questions.