Condition & Treatment – Tongue Cancer

Introduction

  • Tongue cancer is the 2nd most common cancer in India
  • Ratio of men & women 3:1
  • Seen in elderly, age > 60 years

Risk Factors

  • Smoking, chewing tobacco and chewing betel
  • Alcohol
  • Humanpapilloma virus (HPV) infection
  • Poor diet and poor oral hygiene
  • Constant irritation from jagged teeth or ill-fitting dentures


Investigations

History and Physical examination
  • History of addiction
  • Oral cavity and neck node examination
Biopsy from tongue lesion
Imaging
  • CECT scan to see neck nodes
  • MRI to see soft tissue extension and nerve involvement

Treatment

Treatment may be Surgery alone or combination of Surgery/ Radiotherapy/ Chemotherapy which depends upon staging and pathological prognostic factors

Surgery
  • As a primary treatment
  • Complete excision of primary, three dimensionally with R0 (microscopically clear) margins
  • Reconstruction of tissue loss to provide rapid healing, restoration of function & appearance to improve quality of life

Radiation therapy
  • Usually done after surgery depending upon staging and pathological prognostic factors
  • Dose may vary from 60-66 Gy in 30-33 fractions

Chemotherapy
  • Usually given along with radiotherapy commonly as a weekly schedule
  • Cisplatin is the standard chemotherapy agent used
  • The absolute indications for adding chemotherapy with radiotherapy are tumor margin positive and extra nodal extension (ENE) as seen in pathological report of specimen

Targeted therapy
  • Usually given in advance cases as palliative intent
  • Commonly used drug is Cetuximab

Follow up

  • 1-3 months during 1st year
  • Every 2-6 months during 2nd year
  • Every 4-8 months during 3, 4, 5 years
  • Every 12 months thereafter
  • Thyroid profile is done every 6-12 months
  • Baseline Chest X-Ray 6 months, Post op- then yearly Chest X-Rays

Prevention

  • Don’t smoke or chew tobacco or chew betel
  • Don’t drink alcohol
  • Eat lots of fruits and vegetables in diet
  • Make sure to brush teeth daily and floss regularly
  • See a dentist once every six months, if possible


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