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
