Tongue Cancer

Tongue cancer is a type of oral (mouth) cancer that can start anywhere on the tongue, from the front part that’s in your mouth to the back of your tongue, near your throat. Where it starts affects both your symptoms and treatment.

This page provides an overview of tongue cancer, including symptoms, causes, diagnosis, treatment, and ways to support your body during treatment and recovery.

Tongue cancer develops when abnormal cells on your tongue grow and divide uncontrollably. Doctors divide tongue cancer into two types, depending on where it starts [1]:

• Oral tongue cancer starts in the front part of your tongue, in your mouth. It can develop on the top, underside, or along the sides of your tongue.
• Oropharyngeal tongue cancer starts in the far back part of your tongue, near your throat.

Most tongue cancers start in squamous cells, the flat cells lining the surface of your tongue. Doctors call this type of tongue cancer squamous cell carcinoma. Other types are rare [1].

If it’s not treated, tongue cancer can spread to other parts of your mouth, throat, or eventually, throughout your body.

Tongue cancer is a common form of oral cancer, but it’s still rare, making up about only about 1% of new cancer diagnoses [2]. It’s more common in men than women, and is often diagnosed after age 65.

Rates vary by region, with the highest numbers in South-Central Asia, North America, and Northern Europe. Smoking, heavy alcohol use, and infection with human papillomavirus (HPV) are the major risk factors [3].

Doctors don’t know the exact cause of tongue cancer, but these factors can increase your risk (1):

• Regular tobacco use (smoking and smokeless)
• Drinking large amounts of alcohol
• Being over 45
• HPV infection
• Poor oral hygiene
• Family history

Signs and symptoms can vary depending on where tongue cancer starts. Cancer on the front of your tongue is often more obvious and easier to detect, while early signs of oropharyngeal tongue cancer may be harder to notice.

Tongue cancer symptoms can include [1]:

• Sores or ulcers on your tongue that don’t heal
• Red or white patches on or under your tongue
• Tongue pain, swelling, lumps, or numbness
• Unexplained bleeding on your tongue
• Difficulty moving your tongue, which affects eating or speaking
• A persistent sore throat or feeling that something is caught in your throat
• Unintentional weight loss
• A lump in your neck
• Swelling in your jaw
• Ear pain

Dentists can often spot early signs of tongue cancer during a routine dental exam or cleaning. You can also check your tongue at home and look for signs of tongue cancer. If anything looks suspicious, your healthcare provider may order:

• A biopsy or small tissue sample, which checks cells under a microscope for cancer
• A nasendoscopy, which uses a thin, flexible tube with a light and camera to examine the back of your tongue and throat
• Imaging tests, like an ultrasound, MRI, or CT, to see if tongue cancer has spread

If you are diagnosed with tongue cancer, doctors will stage and grade it to help guide your treatment and predict your outlook.

Staging describes how large the tumour is and whether it has spread:

• Stage 0 - Cancer cells are only in the lining of the tongue
• Stage I - A very small tumour (less than 2 cm) that hasn’t spread to lymph nodes or nearby tissues
• Stage II - A larger tumour (2-4 cm) or deeper invasion that hasn’t spread to any lymph nodes
• Stage III - A larger (more than 4 cm) or deeper tumour or an early tumour that has spread to a local, same-sided lymph node
• Stage IV - Advanced cancer that has spread to multiple lymph nodes, or other parts of your mouth or body

Grading describes how abnormal the cancer cells look under a microscope and how quickly they might spread.

• Grade I (low grade) - Cancer cells look close to normal and are likely to grow and spread slowly.
• Grade II (intermediate grade) - Cancer cells look slightly different than normal cells and grow at a moderate pace.
• Grades III and IV (high grade) - Cells look very abnormal and tend to grow aggressively.

Your treatment plan depends on the cancer’s stage, grade, and location, as well as your overall health. Your doctor may recommend one or more of the following treatments:

• Surgery, called a glossectomy, to remove part or all of the tongue. Depending on how much is removed, you may also need reconstructive surgery using tissues from other parts of your body. Nearby lymph nodes or other tissues may be removed if the cancer has spread.
• Radiotherapy, which uses high-energy beams to destroy cancer cells
• Chemotherapy, which uses strong medicines to kill cancer cells and shrink tumours
• Immunotherapy or targeted therapy, which use drugs to help your immune system attack cancer cells, or to target specific proteins in cancer cells so they can’t spread.

Survival rates for tongue cancer depend on factors such as your age, overall health, whether the cancer has spread, and your treatment. Follow-up screening is also important, because some types of tongue cancer can come back years after treatment [4].

As with all cancers, early detection, treatment, and follow-up often lead to better outcomes.

Your doctor can give you specific information about your cancer and outlook.

Tongue cancer treatments can affect swallowing, speaking, and oral health. During and after tongue cancer treatment, your medical team will support you with speech and swallowing therapy, medical nutrition therapy and oral care.

Rehab support is important to regain lost mouth and tongue function or address treatment side effects, which might include:

• Mouth and tongue sores or pain
• Dry mouth
• Loss of appetite, nausea, or vomiting
• Taste changes
• Difficulty chewing or swallowing
• Difficulty speaking
• Tooth loss or other dental complications

Many of these side effects can make it hard to eat well at a time when good nutrition is critical for maintaining your strength and supporting recovery.

An oncology dietitian can guide you on the best foods to meet your calorie, protein, and other nutrient needs. They may recommend soft or pureed foods that are high in protein, such as:

• Yoghurt
• Pudding
• Oatmeal
• Cream soups
• Scrambled eggs or tofu

Many people with tongue cancer also benefit from oral nutrition supplements to help fill nutrition gaps. These medically formulated foods provide high amounts of calories, protein, and key nutrients your body needs during treatment and recovery.