Treatment Options for Tongue Cancer

Overview of Treatments for Tongue Cancer

Treatment options for tongue cancer will depend upon the stage of the disease. Cervical lymph node involvement is not uncommon in patients with tongue cancer and distant metastases, most commonly to the lungs, may occur if local control of the tumor has not been adequately achieved.

In general, Stage I tongue cancer (T1N0) can be effectively treated with either surgery or radiation therapy. Some experts also advocate elective neck treatment even for Stage I disease because the incidence of occult (hidden) metastases is about 20% to 33%.

Treatment for Stage II disease is surgery to remove the primary tumor and most experts advocate elective treatment of the neck (neck dissection) because the risk of occult metastases is higher in Stage II disease.

For Stage III and Stage IV disease, a combination of surgery and radiation therapy are most often used.

Surgery

Surgery is often the primary mode of treatment for tumors of the anterior two-thirds of the tongue (T1 and T2 tumors)

Surgery combined with radiation therapy may be used for larger (T3 or T4) tumors that are located on the posterior aspect of the tongue.

A major concern with tongue cancer is the possibility of spread of the tumor to the cervical lymph nodes. Occult metastases have been reported in 20% to 33% of tongue cancer patients with no clinical evidence of neck involvement (N0 neck). For this reason, an elective neck dissection may be recommended and considered as a treatment option. Radiation therapy plus neck dissection is used for the treatment of advanced tongue cancer that has spread to the cervical lymph nodes.

Surgical removal of the tongue (glossectomy) is usually performed for advanced cancer involving the base of the tongue. Total glossectomy is a major surgical procedure that may be associated with severe functional impairment such as impaired speech and swallowing difficulties. Patients who undergo a total glossectomy also may require a laryngectomy (excision of the larynx) to prevent aspiration when swallowing. The long-term prognosis (outlook) after total glossectomy remains guarded with some studies reporting survival rates of less than 50% after 3 years.

Radiation Therapy

Radiation therapy (radiotherapy) may be used as the only treatment modality for small tongue tumors or may be used postoperatively as an adjunct to surgery for larger size tumors after the tumor has been surgically excised. Radiation therapy for tongue cancer may be delivered by either external beam radiation or by local radioactive implants (brachytherapy). Sometimes a combination of both types of radiation therapy is used.

External Beam Radiation

External beam radiation therapy is the use of beams of high energy radiation from an external source (outside a patient's body) to target the cancer cells within the body. The high energy beams of radiation are focused on the area of the tumor in order to destroy the cancer cells. Typically, treatments are given once or twice a day, five days a week for 6 weeks, however, the treatment schedule selected by your radiation oncologist may vary. Potential side-effects of external beam radiation for the treatment of tongue cancer may include:

  • Oral mucositis - painful inflammation, ulceration, swelling, and irritation of the oral mucosa
  • Oral candidasis - an oral fungal infection caused by Candida albicans
  • Xerostomia - dry mouth due to reduced saliva production and secretion
  • Mandibular osteoradionecrosis - destruction of the bone of the lower jaw (mandible) that may be exposed to the external beam of radiation
Brachytherapy

Brachytherapy involves the placement or implantation of radioactive "seeds" directly adjacent or into the tumor. The radioactive "seeds" deliver radiation directly to the tumor resulting in death of the tumor cells while sparing normal, healthy surrounding tissue. Brachytherapy is usually performed on an outpatient basis as a "same-day" procedure and may be done under spinal or general anesthesia. Brachytherapy is more effective for the treatment of smaller tongue tumors (T1 and T2) than for larger size tumors.

Chemotherapy

Chemotherapy is rarely used as the primary treatment modality for tongue cancer but may be as an adjunct to surgical and/or radiation therapy in the treatment of advanced disease. Examples of chemotherapeutic agents that may be used to treat cancers of the head and neck include:

  • cisplatin
  • carboplatin
  • 5-fluorouracil (5-FU)
  • bleomycin
  • methotrexate