During routine dental examinations, you may have noticed that your dentist has you stick out your tongue. The dentist grasps it with a gauze and examines it carefully, both visually and by palpation. It’s not a comfortable procedure. Do you wonder why this happens so often?
Tongue cancer is not one of the more common cancers but it is a devastating disease. When not caught early, the treatment often involves extensive, debilitating surgery. Your dentist is looking for any suspicious lesions or masses, essentially looking for cancer on tongue.
- Tobacco – The major cause of cancer of tongue is tobacco. About 90% of those who develop this cancer use tobacco in one form or another. The risk of this cancer in tobacco users is 6 times that of non-users.
- Alcohol – The correlation is mainly between cancer of tongue and hard liquor, especially in those who consume more than 4 drinks a day. In people who drink and smoke, the risk increases to 15 times that of people who don’t.
- Betel nut chewing – A common habit in India and other parts of Asia, the betel nut is an irritant and carcinogenic.
- HPV – Human Papilloma Virus – A sexually transmitted virus, it has been associated with precancerous lesions.
In the United States cancer of the tongue only accounts for 2% of all cancers each year. In Europe the rate is lower, except in France, where it ranks third among all cancers in males and is the second leading cause of death from cancer. It also occurs more frequently in India and areas of Asia where chewing Betel nuts is common.
Most cancers of the tongue are of the type called squamous cell carcinoma. And most tongue cancers tend to cause no symptoms until they become quite large. That is why your dentist pulls on your tongue, trying to get a good look and feel to insure that there are no developing lesions.
- Dental x-rays – These can show bony involvement of the jaw.
- MRI – Magnetic Resonance Imaging is an excellent study for looking at soft tissues, like the tongue. It can show the size and depth of the lesion.
- CT scan – This test is useful for looking at lymph nodes to determine spread of the cancer.
- PET scan – Positron Emission Tomography essentially evaluates inflammation at the cellular level. It is generally used to evaluate a patient in whom cancer is suspected. It can also appraise the effects of treatment.
Biopsy of the lesion will reveal the type.
Treatment of tongue cancer depends on the size, type and infiltration of the tumor, in other words, the stage. There are two types of treatment.
- Radiation – Radiation therapy is used by itself when the tongue cancer is small. But head and neck oncologists generally prefer not to use radiation in young patients. The treatment is known to cause serious problems later in life. Radiation is also used in conjunction with surgery in larger lesions.
- Surgery – Small tumors are removed without difficulty. Larger cancers may require extensive resection, even including part of the jaw.
- Chemotherapy – Chemotherapy is generally only used in cases with distant metastases.
The major challenge at this time is reconstruction of the tongue. The tongue has so many uses. It is essential to speech, taste, eating and swallowing. No one has managed a satisfactory restoration as yet.
The tragic aspect to cancer on tongue is that it is preventable. Tobacco causes the cancer. Not smoking, not chewing tobacco will not guarantee avoidance of this devastating disease but it makes the odds a great deal better.
Now that you know about cancer of the tongue, make sure you check in with your dentist for regular cleaning every six months. Not only will this regimen keep your mouth and teeth bright and healthy but you’ll be reassured that you don’t have any suspicious lesions in your mouth as well.