Tongue Carcinoma: Symptoms, Types, Causes and Treatment

Tongue carcinoma is a significant and potentially life-altering disease, impacting essential functions like speech, swallowing, and taste. As the most common site of oral cancer, carcinoma of the tongue demands awareness of its signs, risk factors, and treatment options. This article provides a comprehensive overview, synthesizing current research to empower patients, caregivers, and healthcare professionals with up-to-date knowledge.

Symptoms of Tongue Carcinoma

Early detection of tongue carcinoma can dramatically improve outcomes, yet many cases are diagnosed late due to subtle or overlooked symptoms. Understanding the early warning signs and how they vary based on the tumor's location is crucial for prompt intervention.

Symptom	Description	Location Specificity	Source(s)
Pain/Discomfort	Persistent soreness or pain	Oral tongue	1 3
Ulcer/Nodule	Ulcerated or nodular lesion	Both oral and base	2 3 7
Dysphagia	Difficulty swallowing	Base, sometimes oral	1 3
Neck Lump	Enlarged lymph node/mass in neck	Base of tongue	1 3
Weight Loss	Unintentional weight loss	Advanced/base cases	1
Ear Pain	Referred pain to the ear	Base of tongue	1

Table 1: Key Symptoms

Symptom Variability and Presentation

Tongue carcinoma symptoms are often site-dependent:

• Oral Tongue (front two-thirds):

  • Most patients notice localized pain or discomfort, often associated with a visible lesion—typically ulcerative or nodular in character 1 2 3.
  • Ulcerated lesions are the most common presentation, with the lateral border of the tongue frequently affected 3.
  • These symptoms often prompt earlier medical attention.

• Base of Tongue (back one-third):

  • Symptoms tend to be more insidious and include:
    • Dysphagia (difficulty swallowing)
    • Neck masses due to lymph node involvement
    • Referred ear pain
    • Weight loss 1 3
  • These tumors are often detected at a more advanced stage.

When to Seek Medical Attention

If you experience a persistent tongue ulcer, pain, or difficulty swallowing lasting more than two weeks, seek evaluation by a healthcare professional. Early diagnosis can prevent progression and metastasis, improving survival and quality of life 11.

Types of Tongue Carcinoma

Tongue carcinomas encompass several histological subtypes, each with distinct behaviors and prognostic implications. Understanding these types helps tailor treatment and anticipate outcomes.

Type	Description	Prevalence	Source(s)
Squamous Cell Carcinoma (SCC)	Malignant epithelial tumor; keratinization	Most common (>90%)	1 3 5 7
Basaloid-Squamous Carcinoma	Aggressive, basaloid & squamous features	Rare, highly malignant	4
Epithelial-Myoepithelial	Biphasic, glandular origin, rare	Very rare, poor prognosis	6

Table 2: Main Types of Tongue Carcinoma

Squamous Cell Carcinoma (SCC)

• Overview:

  • SCC accounts for the vast majority of tongue cancers. It arises from the mucosal epithelium, showing squamous differentiation with features like keratinization and intercellular bridges 1 3 5 10.
  • SCC itself can be:
    • Well-differentiated (resembles normal tissue, slower growth)
    • Moderately or poorly differentiated (more aggressive) 1 3 7

• Variants:

  • Basaloid-squamous carcinoma is a rare but highly malignant subtype, characterized by small crowded cells and association with conventional SCC. It shows a high rate of metastasis and requires aggressive treatment 4.
  • Epithelial-myoepithelial carcinoma is extremely rare in the tongue, usually arising from minor salivary glands. It carries a poor prognosis if metastatic 6.

Anatomical Subtypes

• Oral tongue carcinoma (front two-thirds):
  • Typically well-differentiated SCC.
  • Presents earlier due to more obvious symptoms 1 3.
• Base of tongue carcinoma (back one-third):
  • More likely to be poorly differentiated.
  • Presents later, often with advanced disease 1 3.

Other Rare Types

While almost all tongue cancers are SCC, rare tumors like epithelial-myoepithelial carcinoma have been reported, often with worse outcomes 6.

Causes of Tongue Carcinoma

Tongue carcinoma arises due to a complex interplay of environmental, behavioral, and genetic factors. While traditional risk factors dominate, recent research highlights evolving trends, particularly among younger adults.

Cause	Description	Risk Group	Source(s)
Tobacco Use	Smoking and smokeless tobacco	Older adults	1 3 8
Alcohol Consumption	Heavy, long-term use	Older adults	1 8
Betel Nut Chewing	Common in some populations	Socio-cultural groups	3
HPV Infection	Human papillomavirus (esp. HPV-16)	Some younger adults	9
Mechanical Trauma	Chronic irritation (e.g., sharp teeth)	All ages	11
Genetic Mutations	TP53 mutation, other molecular changes	Individuals/families	7
Unknown/Other	Idiopathic, emerging risk factors	Young non-smokers	8

Table 3: Major Causes and Risk Factors

Traditional Risk Factors

• Tobacco and Alcohol:
  • Long-standing tobacco use (smoking or chewing) and heavy alcohol consumption have long been established as the primary risk factors for tongue carcinoma, especially in older adults 1 3 8.
  • In some populations, betel nut and leaf chewing significantly increases risk, especially with prolonged use 3.

Emerging and Non-Traditional Factors

• HPV Infection:

  • Human papillomavirus (HPV), particularly type 16, has been implicated in a subset of tongue squamous cell carcinomas, especially in younger adults and males 9.
  • The exact role of HPV remains under study, but it is confirmed in a minority of cases.

• Mechanical Trauma:

  • Chronic irritation from dental issues, such as sharp or broken teeth, can contribute to carcinogenesis by causing persistent mucosal injury 11.

• Genetic Susceptibility:

  • Mutations in tumor suppressor genes (e.g., TP53) and other molecular alterations can predispose individuals to tongue cancer, sometimes even without traditional risk factors 7.

Changing Patterns

• Rising Incidence in Young Adults:
  • Recent studies show increasing cases among younger adults (<40 years), many of whom do not have a history of smoking or alcohol use, suggesting that additional, as yet unidentified, risk factors are contributing 8.
  • This underscores the need for research and vigilance even in seemingly low-risk populations.

Treatment of Tongue Carcinoma

Treating tongue carcinoma requires a multidisciplinary approach, often combining surgery, radiotherapy, chemotherapy, and emerging therapies. Treatment is tailored based on tumor type, size, stage, location, and patient health.

Treatment Modality	Main Application	Notes/Outcomes	Source(s)
Surgery	Mainstay for early-stage, accessible	Transoral, partial, or full resection	5 13
Radiotherapy	Alone or with surgery/chemo	Often for advanced/base tumors	1 5
Chemotherapy	Adjunct or palliative	Standard agents, new combinations	5 15
Photodynamic/Photothermal	Non-invasive, novel	Promising, under research	5 16
Targeted/Adjunct Therapies	Plant-derived, nanocarriers, immunotherapy	Enhances effectiveness, reduces side effects	12 15 16

Table 4: Treatment Options Overview

Surgical Approaches

• Early-Stage Tumors:

  • Transoral surgical resection with adequate margins is the standard for small, localized tumors, especially those of the oral tongue 13.
  • Surgical planning considers the intricate tongue anatomy and potential functional impact.

• Advanced or Base of Tongue Tumors:

  • May require more extensive surgery (e.g., hemiglossectomy), often combined with neck dissection for lymph node management 1 5.

Radiotherapy and Chemotherapy

• Radiotherapy:

  • Used alone for early-stage lesions or as an adjunct to surgery in advanced disease 1 5.
  • Brachytherapy (localized radiation) is sometimes favored for specific cases.

• Chemotherapy:

  • Applied in advanced or metastatic disease, or alongside radiation (chemoradiation) 5.
  • New combinations, such as capsaicin with cisplatin, are being explored to improve efficacy and reduce toxicity 15.

Emerging and Adjunct Therapies

• Photodynamic and Photothermal Therapies:

  • These minimally invasive treatments use light and heat to selectively destroy cancer cells, with lower toxicity and resistance 16.
  • Nanoparticle-based delivery systems enhance targeting and effectiveness.

• Plant-Derived and Nanoemulsion Therapies:

  • Agents like lovastatin in nanoemulgel formulations, often with essential oils, show promise for local control and reduced side effects 12.
  • Capsaicin, from chili peppers, may enhance chemotherapy effects and inhibit metastasis 15.

• Immunomodulation and Chemoprevention:

  • Dietary agents (e.g., black raspberries in animal models) and immunotherapies are being studied for their ability to prevent recurrence and boost anti-tumor immunity 14.

Prognosis and Follow-Up

• Outcomes:
  • Five-year survival rates vary by stage and location: 43% for oral tongue SCC, 27% for base of tongue 1.
  • Early-stage, well-differentiated tumors have the best prognosis (>80% 5-year survival) 1.
• Surveillance:
  • Regular follow-up is critical due to recurrence risk, especially in genetically predisposed individuals 7.
  • Comprehensive oral examinations and imaging may be required.

Conclusion

Tongue carcinoma is a complex and multifactorial disease with evolving patterns and therapeutic options. Early recognition and a personalized treatment strategy are key to improving patient outcomes. Here are the main takeaways:

• Symptoms: Common presentations include persistent ulcers, pain, and difficulty swallowing; symptoms depend on tumor location.
• Types: Squamous cell carcinoma is by far the most prevalent, but rare aggressive subtypes exist.
• Causes: Traditional risk factors are tobacco and alcohol, but HPV, genetic mutations, mechanical trauma, and unknown factors are increasingly recognized.
• Treatment: Surgical resection is standard for early disease, with radiotherapy, chemotherapy, and emerging therapies offering additional options for advanced or recurrent cases.

Staying informed about the symptoms, risk factors, and available treatments empowers individuals and healthcare providers to act swiftly—potentially saving lives and preserving quality of life.