Tongue Cancer

Excerpt

Oral cavity malignancy, excluding non-melanoma skin cancer, is the most common carcinoma of the head and neck. 90% of these neoplasms are squamous cell carcinoma (SCCA), with minor salivary gland malignancies and other rare tumors comprising the rest. The tongue, along with the lip and the floor of the mouth, represents one of the most commonly involved subsites within the oral cavity. Importantly, while the anterior two-thirds of the tongue is considered part of the oral cavity, the posterior third (base of tongue) is considered a subsite of the oropharynx. Although histologically similar to conventional oral tongue carcinoma, a base of tongue malignancy has certain important implications that make it a different disease entity in terms of treatment, prognosis and follow up. Despite advances in diagnosis and management of oral cancer in recent decades, the long term prognosis of patients with advanced-stage SCCA of the tongue is generally poor, with 5-year survival rates around 50%.

Imaging is necessary for characterizing, staging the disease, and assessing the tumor’s relationship with surrounding structures. The draining lymph nodes of the neck are also radiologically assessed, as locoregional spread of tumor via the lymphatics, specifically to the submandibular and jugulodigastric chains, is common. Treatment is tailored to individual patients and, in general, consists of primarily surgery, with chemoradiation also having an important role in select patients. The goal of therapy consists of a complete cure while preserving or restoring functionality. Long term follow-up is essential, as locoregional recurrence of disease is not uncommon and should be promptly addressed.