Tongue pdf - د. احمد ابراهيم

Forth stage

Surgery

Lec-3

.أ

3/4/2016

Tongue Cancer



It is the sixth most common cancer.



Etiology : male > female (both smoker)
Age >60y old



Geographical: India 40% because tobacco chewers and spicy food.



Predisposing factors: chronic irritation (smoke, spirit,sepsis) but not necessary to lead to
cancer

Precancerous lesions:

 Erythroplakia

 Leukoplakia

 Chronic hyperplastic candidiasis

 Oral submucous fibrosis

 Oral lichen planus

 Discoid lupus erythematosis

 Discoid keratosis congenital

Pathology of tongue cancer

 Lateral margin of anterior 2/3 of the tongue (45-55%) ,

 Posterior 1/3 20% and

 Less common site the ventral 9%, dorsal 6%.

Grossly



Malignant ulcer raised, deep, irregular with necrotic floor and everted edge



Or raised oval white plaque that fungating, central necrosis or hard submucous
nodule or diffuse infiltrative (rare).

Microscopically

 Ant 2/3 well differentiated SCC >95%.

 Post 1/3 less differentiated



BCC and adenocarcinoma of minor salivary gland (rare

Spread

Direct: to nearby structure

 (ant 2/3 to lat) and
 (the post 1/3 to tonsil , pharynx ,larynx)

Lymphatic: to LN of the neck

 lat 1/3 to submandibular and then to deep cervical LN .
 Posterior 1/3 upper deep cervical directly.

Blood: rare mainly in the post 1/3

Hairy tongue

Clinical presentation

 Symptomless.

 Or persistent ulcer >4weeks

 Or deep indurated fissure

 Or oval raised papillated plaque and white keratin

 Or lobulated mass with overlying yellow patch of submucous necrosis.

Late stage

 Sore tongue the pain first due to infection then due to invasion of lingual n. it may

refer to ear.

 Salivation due to pain and decrease tongue movement may be blood stained and bad

smell.

 Enlarged cervical LN (usually painless).

Complications:

1.  Inhalation of necrotic tissue lead to bronchopneumonia
2.  Cachexia due to dysphagia and pain
3.  Bleeding due to invasion of lingual vessels or ICA in post      1/3 tumor
4.  Asphyxia due to enlarged LN or glottic edema .

Investigations

 Incisional biopsy for lesion >4weeks UGA or LA

 FNAC

 MRI or CT to see the invasion

Treatment

Lines of treatment: surgery and radiotherapy while chemotherapy as adjuvant in some
cases.

Surgery

1. CA in situ = local excision +1 cm safety margin in extent and 0.5 cm in depth ,the defect

closed directly or flap from floor of the mouth .

2. Partial or hemiglossectomy using cutting diathermy or laser. The defect closed by radial

flap or rectus abdominis or forehead flap.

3. CA post 1/3 = either total or external radiation

4. If LN metastases so excision of tumor with neck dissection (modified or radical).

Mandible invasion = hemiglossectomy +hemimandibulectomy +neck dissection

(commando operation

)

Radiotherapy

Tumor <4 cm equally benefit from RT or surgery

Palliative treatment

 Radiotherapy

 Palliative resection of 1ry to comfort the patient

 Analgesia+NG feeding,trachistomy

 Chemotherapy

 Radiofrequency thermal ablation(minimal invasive therapy)

 Gene therapy new treatment gene manipulation to change genetic code in persons

cells.

A.L.Y