The tongue is important for many reasons. Speech and swallowing are its most important function. Benign and malignant tumors of the tongue destroy the lining and the deep muscle tissue and no matter what the treatment is we cannot undo that. But most patients can still be very functional. Benign tumors are usually excised with surgery. Some rare tumors may occasionally be observed and followed closely in certain select patients. For cancers, the most common is squamous cell carcinoma. As for all squamous cell carcinomas, radiation and surgery are the treatment modalities that have the potential to cure them. Chemotherapy may help radiation work better in advanced cancers or in non-surgical candidates. HPV (human papillomavirus) has been implicated as a causative factor in an increasing number of cancers of the pharynx (throat) and base of the tongue. HPV positive cancers have a better prognosis. For treatment purposes, we divide the tongue into the front two thirds (the part that sits in the mouth) and the back third (so-called base of tongue). Squamous cell carcinoma of the tongue is potentially curable in many cases as long as it has not spread outside the head and neck region. We perform imaging (PET scan, CT, MRI) to determine if it has.
Generally, cancers involving the front two-thirds of the tongue are treated with surgery initially and radiation offered after surgery to advanced or high-risk cases. Cancers of the base of tongue are usually treated with chemotherapy and radiation and surgery is reserved only for cases where it does not work. The reason for this is the cure rate is equivalent but the expected side effects of chemoradiation are better than those of surgery for the base of tongue cancers and the opposite is true in terms of side effects and effectiveness with cancers of the front two-thirds of the tongue where surgery is preferred.
Radiation therapy is generally given daily as on outpatient five days a week for 6-8 weeks (exact amount determined by radiation oncology). Chemotherapy, if given, is done intermittently again on an outpatient basis. Surgery focuses on two things equally: removing the cancer and reconstruction. Most of the time we can remove these tumors through the mouth and avoid external scars. Occasionally, there is a need to make incisions around the chin. Once the cancer is removed, we then focus on tongue volume. You must have volume to be able to swallow even spit or speak at all. I always tell patients to accumulate some saliva in their mouth and then try to swallow without touching the tongue to the roof of the mouth. It is not possible. So, if there is enough volume of the remaining tongue, we try to close it on itself. If there is not enough volume then, depending on how much tissue is needed, we will bring in tissue (a transplant where tissue with its blood supply is brought into the head and neck to provide healthy tissue with a blood supply) from somewhere else in the body. The site of the tissue transplanted depends on the volume needed and could be from the forearm, chest wall, abdominal muscle, back skin or thigh skin. Often it is necessary to remove some lymph nodes from the neck or parotid region (neck dissection and parotidectomy respectively) due to the risk of spread to these areas. Immunotherapy has had an increasing but not perfectly well-defined role as an adjunctive treatment. The cure rate obviously will improve as the cancer is picked up earlier. Most patients are able, once healed, to eat by mouth and speak.