This page was reviewed under our medical and editorial policy by
Beomjune B. Kim, DMD, MD, FACS, Head and Neck and Microvascular Reconstructive Surgeon
This page was reviewed on June 14, 2023.
Tongue cancer, a type of oral cancer, originates in the long, flat, muscular organ in the mouth known as the tongue.
In this article we will cover:
Health experts divide tongue cancer into two types, depending upon where it occurs:
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.
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 cancer. In 2023, about 18,040 people in the United States are expected to be diagnosed with tongue cancer, and 2,940 people are expected to die from it.
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 that HPV infection is partially responsible. HPV is the most common sexually transmitted infection, affecting 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 U.S. 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.
The risk for developing tongue cancer is approximately five times higher among those who smoke compared to people who don't use tobacco. People who smoke and also drink alcohol face a 30 times higher risk for developing head and neck cancers, including tongue cancer, than those in the general population.
In addition to tobacco and alcohol use and HPV infection, other risk factors for mouth and throat cancers are listed below.
To help reduce the risk of developing tongue cancer:
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. People who are 27 to 45 years old and haven’t been vaccinated should ask a doctor if it would be beneficial to get the shot. Limiting the number of sex partners may also help people reduce the risk for developing HPV.
A common first sign of tongue cancer is an ulcer, sore or bump on the tongue that doesn’t heal or fade away, and it may bleed easily. Tongue cancer may be painful or feel as if the person's tongue is burning. Tongue cancer symptoms include:
About 90 percent of mouth or oral cancers start in squamous cells. Less frequently seen cancers originating in the mouth are:
The care team will first perform a visual and physical examination of the patient's tongue, throat and neck. A biopsy of the suspect ulcer or tumor will be performed to gain a small tissue sample for laboratory analysis of its cells. Biopsies of oral tongue tumors may be performed 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 in the area. A contrast dye 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.
How the care team treats the patient's cancer depends upon its stage of progression. In early stages, tongue cancer can be treated by surgical removal or radiation therapy. One surgery, called a glossectomy, may be performed to remove part or all of the tongue. 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.
The cancer has not spread from the tongue’s surface. Surgery is performed 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.
The tumor hasn’t spread far, but it has begun penetrating beneath the surface layer of the tongue. The tumor is removed by surgery, and lymph nodes in the neck may also be taken out and examined for the presence of cancer cells. Radiation therapy or chemotherapy may be used if the patient's oncologist thinks the cancer may return or that surgery didn’t remove all of the malignant cells. Radiation may be used instead of surgery if the patient is not healthy enough to undergo surgery.
The 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.
The tumor has infiltrated adjoining tissues and may also have spread to lymph nodes and distant sites in the body. Surgery may not be used if the tumors are inoperable or the patient is too ill to undergo surgery. Chemotherapy, radiation, immunotherapy or a combination may be used.
If the patient has metastatic or recurrent cancer, the care team may propose participating in a clinical trial. These trials give the patient access to advanced new treatments and help researchers determine their safety and usefulness.
The patient may experience side effects of treatment.
Surgery carries the risk of infection and bleeding.
Radiation therapy 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 the digestive tract and those in the 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.
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 don't have that cancer type. Instead of using stages of progression, this database employs a rating of localized, regional and distant cancers to demarcate how far the disease has spread. Survival rates are indicators of how groups of patients in the past fared on average. In general, early diagnosis and treatment may lead to better outcomes.
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. 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.
Keep in mind that the survival rate for tongue cancer depends on a variety of factors, including the patient's age, overall health and the extent of disease, so always talk to the care team about the patient's individual prognosis.