Treatment

Tongue cancer is usually treated by surgery and in many cases post-operative radiotherapy.  The extent of surgery is determined by the stage of the tumour.  Stage is basically a description of the extent of the tumour and consists of 3 parts:
            T stage – the size and degree of tongue involvement by the tumour
            N stage – the degree of neck nodal involvement
            M stage – whether there is spread to other sites such as the lungs, liver etc.
Surgery is therefore planned following the biopsy and CT scan.
Fortunately very few tongue cancers have spread beyond the neck at time of presentation although most will have involved neck nodes. 

Surgery

Small cancers (<1cm) are usually treated by simple excision under general anaesthetic.  A small segment of the tongue is removed and the tongue sewn up to leave little change in the appearance of the tongue or speech.

Small cancers between 1cm-2cm in diameter have a significant risk of neck nodal involvement and are usually treated by excision of a segment of tongue as well as removal of the neck nodes on that side (neck dissection).

Cancers greater than 2cm in diameter are best managed with removal of most of one side of the tongue together with a neck dissection.  One can imagine that this can severely impact on speech and swallowing but with modern reconstructive techniques the functional outcome is very good.  The vast majority have normal swallowing and only a slight change in speech.

When tongue cancers get over 3cm or extend deeply into the tongue the functional impact after surgery is greater but still very good articulation can be obtained.

Radiotherapy

Radiotherapy is employed after surgery where tongue cancers demonstrate overly aggressive features such as nerve or lymphatic vessel invasion.  It is also employed when there is significant neck node involvement defined as more than one node involved or spread through the capsule of the node.

Radiotherapy is given for 5-6 days each week for 6 weeks.  It is generally more difficult to tolerate than surgery as the effect is cumulative with the peak of the acute reaction around the end of the treatment course.  The patient experiences a severe “sunburn” of the neck and mouth that usually becomes obvious 3 weeks into the treatment, reaches its peak at the completion of treatment, resolving over the next 3 weeks.

The long-term effects of radiotherapy are significant.  The patient may experience a dry mouth, reduced taste, and dental problems.  However, when indicated by the stage of the cancer, radiotherapy definitely reduces recurrence and maximizes the cure rate.

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