Case Study:
“Mr. Gu, a 52-year-old with a 20-year smoking history and chronic alcohol use, noticed an ulcer on the right side of his tongue six months ago. Initially mistaken for a common mouth ulcer, it failed to heal despite repeated topical treatments. The ulcer gradually enlarged, accompanied by swallowing pain and speech difficulties. Medical evaluation confirmed ‘tongue cancer’ via biopsy, with CT scans revealing cervical lymph node metastasis. Treatment involved partial tongue resection, neck lymph node dissection, radiotherapy, and chemotherapy. His condition is now stable, but long-term follow-up is required.”

 

What is Tongue Cancer?
Tongue cancer, the most common type of oral cancer, originates from squamous epithelial cells on the tongue’s surface. It is categorized as:

• Anterior two-thirds tongue cancer (oral tongue cancer):More common, with noticeable early symptoms.
• Base-of-tongue cancer (oropharyngeal cancer):Often diagnosed at advanced stages due to its hidden location.

Tongue cancer is highly invasive and prone to metastasis (especially to cervical lymph nodes), but early detection significantly improves cure rates.

Symptoms of Tongue Cancer:
Early signs may mimic common ulcers. Warning signals include:

• Non-healing oral ulcers:Ulcers or red patches persisting over two weeks.
• Pain or numbness:Discomfort while eating, speaking, or localized numbness.
• Abnormal lumps:Thickened tongue texture, hard masses, or cauliflower-like growths.
• Difficulty swallowing:Common in advanced stages.
• Unexplained bleeding:Easily triggered by touching ulcers or lumps.
• Worsening bad breath:Caused by tumor necrosis or infection.
• Neck lumps:Indicative of lymph node metastasis.
• Voice changes:Hoarseness if the tumor invades the tongue base.

Risk Factors:

• Smoking and alcohol:Synergistically increase risk by over 15-fold.
• HPV infection:Particularly HPV16, linked to base-of-tongue cancer (rising in younger patients).
• Poor oral hygiene:Chronic periodontitis, sharp teeth, or ill-fitting dentures causing mucosal damage.
• Dietary habits:Consuming extremely hot, pickled, or betel nut products.
• Genetics:Family history of oral cancer.

Diagnosis Methods:

• Physical examination:Visual inspection and palpation of lesions.
• Oral endoscopy:Detailed examination of the tongue and throat.
• Biopsy:Pathological analysis of tissue samples.
• Imaging:
  • CT/MRI:Assess tumor size, depth, and lymph node involvement.
  • PET-CT:Detect systemic metastasis.
• HPV testing:Guides treatment and prognosis; HPV-related tumors often respond better to therapy.

Treatment Approaches:

1. Early-stage (I-II):
   • Surgery:Primary treatment with tumor excision and safe margins. Minimally invasive robotic surgery for base-of-tongue cancer.
   • Radiotherapy:For small, superficial tumors or patients unsuitable for surgery.
2. Advanced-stage (III-IV):
   • Combined therapy:Surgery + radiotherapy ± chemotherapy.
   • Targeted therapy:Anti-EGFR agents (e.g., cetuximab).
   • Immunotherapy:PD-1 inhibitors for recurrent/metastatic cases.
3. Functional and aesthetic reconstruction:
   • Flap reconstruction:Uses autologous tissue (e.g., forearm flap) to repair defects.
   • Speech and swallowing rehabilitation:Post-surgical training.
4. Follow-up and recurrence prevention:
   • Regular oral exams and imaging (every 3-6 months for the first two years).
   • Smoking/alcohol cessation and oral hygiene maintenance.
   • HPV vaccination (preventive measure).

Early detection is critical! Seek immediate medical attention if tongue ulcers persist beyond two weeks. For ENT concerns, contact ENT Head and Neck Surgery Centre or call 3100 0555 for specialized care.

Source:

HK ENT Specialist Ltd.

ENT Head and Neck Surgery Centre

For ENT Services, Audiology & Speech Therapy,

Sleep Disordered Breathing Management,

Hearing Aid Prescription & Medical Cosmetic Services

https://www.hkentspecialist.hk