tongue cancer

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 lesion :

Erythroplakia
Leukoplakia
Chronic hyperplastic candidiasis
Oral submucous fibrosis
Oral lichen planus
Discoid lupus erythematosis
Discoid keratosis congenital

Pathology

lateral margin of anterior 2/3 of the tongue (45-55%) ,post 1/3 20% and less common site the ventral 9%,dorsl 6%.

Grossly

malignant ulcer raised,deep,irregular with necrotic floor and everted edge or raised oval white plaque that fungate ,central necrosis or hard submucous nodule or diffuse infiltrative(rare).

Spread

Direct :to nearby structure (ant 2/3 to lat) and (the post 1/3 totonsil,pharynx,larynx)
Lymphatic: to LN of the neck (ca lat 1/3 to submandibular)and then to deep cervical LN .ca post 1/3 upper deep cervical directly.
Blood : rare mainly in the post 1/3

Microscopically

Ant 2/3 well differentiated Scc >95%.
Post 1/3 less differentiated
Bcc and adenocarcinoma of minor salivery gland (rare).



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 referred to ear .
Salivation due to pain and decrease tongue movement may be blood stained and bad smell.
Enlarged cervical LN (usually painless ).
Complications :
-Inhalation of necrotic tissue lead to bronchopneumonia
- Cachexia due to dysphagia and pain
-Bleeding due to invasion of lingual vessels or ICA in post 1/3 tumor
-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

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 .
Partial or hemiglossectomy using cutting diathermy or laser. The defect closed by radial flap or rectus abdominis or forehead flap.
Ca post 1/3 = either total or external radiation
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.