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Tongue cancer

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on May 31, 2022.

Tongue cancer, a type of oral cancer, originates in the long, flat, muscular organ in your mouth known as the tongue.

What is tongue cancer?

Health experts divide tongue cancer into two types, depending upon where it occurs:

  • Tumors in the front two-thirds of the tongue, located in your mouth, are categorized as oral tongue cancer.
  • Tumors in the base of the tongue, the rear third located in your throat or oropharynx, form the second type.

Oral tongue tumors are often noticed by patients or by their dentists or primary care physicians. Therefore, patients with oral tongue tumors may receive treatment in earlier stages than those with base of tongue cancers.

How common is tongue cancer?

Tongue cancer is relatively rare, representing nearly 1 percent of newly diagnosed cancer cases in the United States, according to the National Cancer Institute (NCI). However, it’s one of the more frequently diagnosed forms of head and neck cancers. In 2021, about 17,960 people were diagnosed with tongue cancer, and 2,870 people died from it.

What causes tongue cancer?

Most tongue cancer develops from the flat squamous cells that line the surface of the tongue. When they begin dividing into a cluster of abnormal cells, that creates a tumor. Like many mouth and throat cancers, tongue cancer is associated with heavy tobacco and alcohol use, as well as with the human papillomavirus (HPV).

This disease primarily affected older men in the past, but rates among women and younger people have risen in recent decades—and it’s thought HPV infection is partially responsible. HPV is the most common sexually transmitted disease, infecting nearly all sexually active people. Some strains cause genital warts. Others have been linked to cancers of the cervix, genitals, anus, mouth and throat.

HPV infection may cause about 70 percent of oropharyngeal cancers, including cancers of the base of the tongue and tonsils, according to the Centers for Disease Control and Prevention (CDC). The virus has not been proven to cause head and neck cancers in the salivary glands, lips, nose or larynx.

Other tongue cancer risk factors

In addition to tobacco and alcohol use and HPV infection, other risk factors for mouth and throat cancers include:

  • Age: Being older than 45
  • Gender: Being male
  • Poor nutrition: Eating a diet low in fruits and vegetables and sources of vitamin A
  • Weakened immune system
  • Some genetic syndromes
  • Graft-versus-host disease
  • Lichen planus, an inflammation of mucous membranes
  • Marijuana use (some studies suggest higher risk)

To help reduce your risk of developing tongue cancer:

  • Don’t smoke or chew tobacco.
  • Limit alcohol consumption.
  • See your dentist regularly.
  • Get vaccinated against HPV.

The CDC recommends everyone aged 11 to 26 be vaccinated against HPV. Vaccination after exposure to HPV isn’t as protective, but it may guard against new infections. If you’re 27 to 45 years old and haven’t been vaccinated, ask your doctor if it would be beneficial to get the shot. You can also reduce infection risk by limiting your number of sex partners.

Tongue cancer symptoms and signs

A common first sign of this cancer is an ulcer, sore or bump on your tongue that doesn’t heal or fade away, and it may bleed easily. Tongue cancer may be painful or feel as if your tongue is burning. Symptoms include:

  • White or red patch on the tongue
  • Thickened area on tongue
  • Persistent discomfort or pain in tongue and/or jaw
  • Burning sensation in tongue
  • Numbness in tongue
  • Bleeding from tongue that’s not from an injury
  • Lump in your neck
  • Sore throat or persistent feeling that something is caught in the throat
  • Swallowing or chewing problems
  • Difficulty moving tongue or jaw
  • Trouble speaking
  • Bad breath
  • Weight loss
  • Fatigue

About 90 percent of mouth or oral cancers start in squamous cells. Less frequently seen cancers originating in the mouth are:

  • Lymphoma
  • Melanoma in pigment cells
  • Adenocarcinoma inside salivary glands
  • Sarcoma in muscle, bone, cartilage and other tissues

How is tongue cancer diagnosed?

Your doctor will first perform a visual and physical examination of your tongue, throat and neck. A biopsy of the suspect ulcer or tumor will be done to gain a small tissue sample for laboratory analysis of its cells. Biopsies of oral tongue tumors can be done under local anesthesia, while growths in the base of the tongue may require use of a laryngoscope or a fine-needle aspiration in some cases and may require general anesthesia.

In addition, a computed tomography (CT) scan of the neck may provide more information on the tumor’s location and size, as well as on the condition of lymph nodes that drain the area. A contrast medium may be injected into a vein to improve visualization during the scan. Magnetic resonance imaging (MRI) or positron emission tomography (PET)/CT scans may also be ordered.

Tongue cancer treatment

How your care team treats your cancer depends upon its stage of progression. In early stages, tongue cancer can be treated by surgical removal or radiation therapy. Cases in more advanced stages may have surgery followed by radiation therapy and chemotherapy. If the cancer has spread far from the original site, doctors may suggest chemotherapy, chemoradiation or immunotherapy.

Stage 0 (carcinoma in situ)

The cancer has not spread from the tongue’s surface. Surgery is done to remove the tumor and some surrounding tissue. This could be Mohs surgery, in which thin sections are cut away and each layer is examined under a microscope to determine when all of the tumor and its margins have been removed. It removes less surrounding tissue than a standard excision. Radiation therapy may be used if the cancer returns.

Stages 1 and 2

The tumor hasn’t spread far, but it has begun penetrating beneath the surface layer of your tongue. The tumor is removed by surgery, and lymph nodes in your neck may also be taken out and examined for the presence of cancer cells. Radiation therapy or chemotherapy may be used if your oncologist thinks your cancer may return or that surgery didn’t get all of the malignant cells. Radiation may be used instead of surgery if you’re not healthy enough to undergo surgery.

Stages 3 and 4A

Your tumor has grown in size and spread into neighboring tissues and may also have involved nearby lymph nodes. Surgery with subsequent radiation or chemotherapy and radiation (chemoradiation) may be tried.

Stages 4B and 4C (metastatic cancer)

Your tumor has infiltrated adjoining tissues and may also have spread to lymph nodes and distant sites in your body. Surgery may not be used if the tumors are inoperable or you’re too ill to undergo surgery. Chemotherapy, radiation, immunotherapy or a combination may be used.

If you have metastatic or recurrent cancer, your care team may talk with you about participating in a clinical trial. These trials give you access to advanced new treatments and help researchers determine their safety and usefulness.

You may experience side effects of treatment.

  • Surgery carries the risk of infection and bleeding.
  • Radiation may cause inflammation, fibrosis, neuropathy, hypothyroidism and bone damage.
  • Chemotherapy and immunotherapy both produce side effects that vary depending on the specific drugs used. Chemotherapy tends to target fast-growing cells and may damage hair follicles, cells lining your digestive tract and those in your bone marrow, resulting in hair loss, nausea and weakness. Immunotherapy’s side effects range from pain and itchiness to fever and chills to swelling, vomiting, blood pressure changes, heart palpitations, dizziness and severe allergic or inflammatory reactions.

 

Tongue cancer survival rates

The NCI’s Surveillance, Epidemiology, and End Results (SEER) Program tracks how many patients with a specific type of cancer are alive at the end of five years as compared with people who aren’t cancer patients. Instead of using stages of progression, this database employs a rating of localized, regional and distant to demarcate how far cancer has spread. Survival rates are indicators of how groups of patients in the past fared on average. In general, early diagnosis and treatment lead to better outcomes.

  • For tongue cancer, the NCI calculates the five-year relative survival rate as 82.9 percent for localized, 69.4 percent for regional and 41 percent for distant, with a combined rate of 68.1 percent for all stages.
  • For oropharynx cancer, which includes those on the back third of the tongue, the American Cancer Society gives the five-year relative survival rate as 59 percent for localized, 59 percent for regional and 28 percent for distant, with a combined rate of 50 percent for all stages.
  • For oral cavity cancers (which includes the front of the tongue) and pharynx cancers combined, the NCI calculates the five-year relative survival rate as 85.2 percent for localized, 67.9 percent for regional and 40.2 percent for distant, with a combined rate of 66.9 percent for all stages.

Significantly, squamous cell cancers of the back of the tongue and tonsils that test positive for HPV have better outcomes than those that aren’t HPV-related, with a reported 80 percent undetectable disease over three years after treatment. In light of this, people with these tumors may benefit from a more targeted or reduced amount of radiation than other patients with oropharyngeal cancers, which may spare them some side effects.

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