Symptoms and signs of tongue cancer

Tongue cancer can manifest in three early stages: ulcerative, exophytic, and infiltrative. In some cases, the first symptom is only tongue pain, which can sometimes be reflected to the temporal region or ear. Exophytic type may come from the malignant transformation of papilloma. Infiltrative type may have no protrusions or ulcers on the surface. Ulcerated and infiltrative cancers are often accompanied by spontaneous pain and varying degrees of limited tongue movement; exophytic type generally has no obvious tongue movement disorder and less spontaneous pain.

In the late stage, tongue cancer may directly exceed the midline or invade the floor of the mouth, or infiltrate the lingual periosteum, bone plate or bone of the mandible. It may extend backward to the root of the tongue or the anterior pharyngeal pillar and lateral wall of the pharynx. At this time, tongue movement may be severely restricted, fixed, and saliva may increase and overflow. Eating, swallowing, and speaking are all difficult. The pain is severe and may be reflected to half of the head.

The front 2/3 of the tongue is mostly squamous cell carcinoma, adenocarcinoma is less common, and is mostly located at the root of the tongue. Lymphoepithelial carcinoma or undifferentiated carcinoma may also occur at the root of the tongue. More than 85% of tongue cancers occur in the tongue body, and the side edge of the middle 1/3 of the tongue is the most common, accounting for more than 70%; the other common areas are the tongue belly, the tongue back, and the tongue tip is the least common.

Tongue cancer often metastasizes to lymph nodes, with literature reports showing that the rate can be as high as 60% to 80%, and a domestic study found that the rate is about 40%. The deep upper cervical lymph node group is the most common site of metastasis, followed by the submandibular lymph nodes, the deep middle cervical lymph node group, the submental lymph nodes, and the deep lower cervical lymph node group. The metastasis rate and number gradually increase with T classification. T4 and late recurrence cases can metastasize to the posterior cervical triangle lymph node group (i.e., the lymph nodes of the horizontal chain and the secondary chain). Tongue cancer that invades the midline, crosses the midline, or originates on the dorsum of the tongue can metastasize to bilateral lymph nodes.