CARCINOMA TONGUE-A CASE SERIES

Dr. Anuja Satav

3 r d year PG Resident, Department of ENT
Dr. D. Y. Patil Medical College and Hospital
Email Id – anusatav@gmail.com

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 INTRODUCTION TO CARCINOMA TONGUE
 Carcinoma of the tongue is constitutes about 3% of all cancer affecting the
human population globally. Tobacco use mainly in the form of cigarettes or
smokeless form is one of the predominant factors affecting the patients with
tongue cancer.[1]
 With increasing consumption of tobacco and alcohol, there has been an
increased incidence of carcinoma tongue, and also there has been a decrease in
the male to female ratio of carcinoma tongue. [2]
 Lateral aspect is the most common site, followed by ventral aspect. Only 4-5 %
occur on the dorsum of the tongue.
 More common between 6-8 decades, and more frequent in males, with tobacco
and alcohol being the major risk factors.[3] 2
 Presentation-common symptoms that the patients present with
includes pain, ulceration or a lump on the tongue. Lesions on anterior
2/3rd are more symptomatic than the base of the tongue, hence most
of the anterior 2/3rd cancers present with stage I or II disease while
the base of the tongue presents most commonly in the stage III or IV.
 Occult cervical metastasis have been demonstrated in upto 53%
cases.
 The majority of tongue tumours are well to moderately differentiated
squamous cell carcinoma on histological examination. [4]

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 Work up-biopsy: it should include the deep margins of tumour in
addition to the mucosa at the periphery of the lesion.
 The imaging modality depends on the clinical extent of the disease.
If suspecting bone involvement, CT will be the imaging modality of
choice. If not, MRI is the imaging modality of choice for carcinoma
tongue [5]
 Screening for distant metastases is indicated in patients with multiple
cervical nodes, recurrence, second primary or advanced disease.
 The modality of choice for screening is a CT chest, although FDG-
PET may have an increasing role.

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 CT scan gives assesment
for tumour location, spread
and is the imaging of
choice if suspecting bone
involvement eg.mandibular
involvement

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 MRI is the
investigation of
choice for carcinoma
tongue, as it gives
accurate soft tissue
involvement and
extent.

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 MRI done in a case of
carcinoma tongue with
extension into right
hemimandible.

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 If carcinoma tongue is detected when it is confined to the oral
mucosa, 5year survival rates exceed 80%, decreasing to 40% for
those with regional disease at presentation and 20% if distant
metastasis has occurred.
 Due to the lower morbidity of primary surgical resection of oral
tongue tumors compared to primary radiation therapy most
international guidelines recommend surgery as the primary
modality[6]
 There has been changes in the approach of treatment towards the
carcinoma tongue, with previous cases being operated with wide
local excision of primary tumour, but neck dissection is
considered now and being done for primary tumour even in the
absence of palpable LN metastasis.[7] 8
 Methodology
 From 2020 december till 2021 november, over 1 year period,
16 carcinoma tongue patients were admitted under Dr D Y
PATIL HOSPITAL, and evaluated, by sending biopsy for
histopathological examination. The combined assessment of
biopsy reports, CT and MRI scans were used to know the
extent of the disease. Also TNM staging was done based on
clinical examination, and staging was given for these cases.

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 The cases which involved base of tongue or with distant metastasis
was sent for palliative chemoradiotherapy, and 9 of the above
mentioned cases were either stage I, II, III or IVa and was operated
for the same.
 The remaining 7 cases were either stage IVb,IVc or involved the
base of tongue and was sent for palliative chemoradiotherapy.

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OBSERVATIONS:
Risk Factors
CASES ALCOHOL TOBACCO MISHRI SMOKING
CHEWING

8 YES YES NO YES

4 YES YES NO NO

2 YES NO NO YES

1 YES YES YES YES

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CASES CLINICAL EXTENT TNM STAGING
3 Right lateral border of Stage II
tongue
2 Left lateral border of Stage II
tongue
1 Right lateral border+floor Stage IVa
of mouth+right
mandible+right level Ib
LN
1 Right lateral border + floor Stage IVa
of mouth+right level Ib
LN
1 Left lateral border+left Stage III
level Ib
1 Right lateral border+tip of Stage IVa
tongue+right level 1a LN

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Cases Clinical extent TNM staging

4 Involvement of base of Stage IVa

tongue

3 Distant metastasis Stage IVc

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 Ulceroproliferative growth
involving the left lateral border
of tongue. On palpation
induration was extending till
the floor of mouth.

• Ulceroproliferative growth on
the left lateral border of tongue
without palpable neck LN

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 Initially the growth was on the
left lateral border of tongue, with
later extended beyond the midline
along with ipsilateral level Ib
palpable

 Ulceroproliferative growth on
the right lateral border of
tongue

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 CASE LN INVOLVEMENT SURGICAL
MANAGEMENT
LATERAL BORDER NO WIDE LOCAL EXCISION
WITH SUPRAOMOHYOID
NECK DISSECTION

LATERAL YES(LEVEL Ib) WIDE LOCAL EXCISION

BORDER+FLOOR OF WITH MRND TYPE III
MOUTH
LATERAL YES(LEVEL Ib) WIDE LOCAL EXCISION
BORDER+FLOOR OF WITH MRND TYPE III
MOUTH+MANDIBLE WITH
INVOLVEMENT HEMIMANDIBULECTOMY

LATERAL BORDER+TIP OF YES(IPSILATERAL LEVEL WIDE LOCAL EXCISION

TOUNGUE Ib) WITH B/L MRND
TYPE III

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 Out of the 16 cases, 7 cases were inoperable, either due to extension
to the posterior 1/3rd of tongue, or due to distant metastasis. Palliative
chemoradiotherapy was given to these patients.
 Of the above 9 operated cases, 2 cases were diagnosed as poorly
differentiated on HPE examination, and 3 cases were having positive
tumour margins, and these cases were sent for post operative
radiotherapy.

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 CONCLUSION
 Irrespective of palpable neck lymph nodes, neck dissection is
preferred as there is high chances of lymphatic metastasis.
 Surgical procedure has to be selected based on the stage of the
disease and the extent of the disease.
 Post operative radiotherapy is preferred for LN metastasis.
 Palliative chemoradiotherapy is considered for inoperable cases i.e,
involving the posterior 1/3rd or cases with distant metastasis.

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 References:
1)McQuarrie DG (1986) Cancer of the tongue: Selecting appropriate
therapy. CurrProblSurg23:561-653
2) Hashibe M, Brennan P, Chuang SC, Boccia S, et al. (2009) Interaction
between tobacco and alcohol use and the risk of head and neck
cancer: pooled analysis in the International Head and Neck Cancer
Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev 18:
541-550.
3) Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer statistics,
2014. Cancer J Clin 64: 9-29.
4) Thompson LDR (2003) Squamous Cell Carcinoma Variants of the
Head and Neck. Current Diagnostic Pathology 9: 384-396.
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5) Steinkamp HJ, Mäurer J, Heim T, Knöbber D, Felix R (1993)
Magnetic resonance tomography and computerized tomography in
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525.
6) Gamaletsou MN, Rammaert B, Bueno MA, Moriyama B, Sipsas NV,
et al. (2014) Aspergillus osteomyelitis: epidemiology, clinical
manifestations, management, and outcome. J Infect 68: 478-493.
7) McGuirt WF Jr, Johnson JT, Myers EN, Rothfield R, Wagner R
(1995) Floor of mouth carcinoma. The management of the clinically
negative neck. Arch Otolaryngol Head Neck Surg 121: 278-282.

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