What are the causes of tongue cancer? Pictures of early symptoms of tongue cancer

Tongue cancer is the most common oral cancer, and it occurs more often in men than in women. Most tongue cancers are squamous cell carcinomas, especially in the front 2/3 of the tongue. Adenocarcinomas are less common and are mostly located at the root of the tongue. Lymphoepithelial carcinoma and undifferentiated carcinoma may also occur at the root of the tongue. Tongue cancer mostly occurs at the edge of the tongue, followed by the tip, back and root of the tongue, and is often ulcerative or infiltrative. It is generally highly malignant, grows fast, and is highly invasive. It often affects the tongue muscles, resulting in limited tongue movement, making it difficult to speak, eat and swallow. Tongue cancer can invade the palatoglossal arch and tonsils posteriorly. In the late stage, tongue cancer can spread to the floor of the mouth and jawbone, fixing the entire tongue.

Tongue cancer can manifest in three early stages: ulceration, exophytic, and infiltrative. In some cases, the first symptom is only tongue pain, which can sometimes be reflected in the temporal region or ear. The exophytic type may come from the malignant transformation of papilloma. The infiltrative type may have no protrusions or ulcers on the surface, which is the most likely to delay the disease, and patients often cannot detect it early. Tongue cancer often manifests as ulceration and infiltration at the same time, accompanied by spontaneous pain and varying degrees of tongue movement disorders.

In the late stage of tongue cancer, it can directly go beyond the midline or invade the floor of the mouth, as well as infiltrate the lingual periosteum, bone plate or bone of the mandible. It can extend backward to the root of the tongue or the anterior pharyngeal pillar and the lateral wall of the pharynx. At this time, the movement of the tongue can be severely restricted and fixed, and the saliva increases and overflows, and it cannot be controlled. Eating, swallowing, and speaking are all difficult. The pain is severe and can be reflected to half of the head. The lymph node metastasis rate of tongue cancer is relatively high, usually around 40%. The most common metastatic site is the deep cervical lymph node group. In the late stage of tongue cancer, lung metastasis or distant metastasis to other parts may occur.

1. Symptoms

1. Mostly seen on the edge of the tongue, followed by the tip, back and belly of the tongue. There may be a history of local leukoplakia or chronic irritation factors.

2. It is often ulcerative or infiltrative, grows fast, causes obvious pain, and is highly infiltrative.

3. There may be limited tongue movement, difficulty eating and swallowing. 4. Cervical lymph node metastasis often occurs early.

2. Diagnosis

1. Ulcers on the edge, tip, back or belly of the tongue that do not heal for a long time.

2. Rapid growth, pain, hard texture, unclear borders, tenderness

3. Limited tongue movement, difficulty eating and swallowing. 4. Confirmed by pathological histological examination.

There are many causes of tongue cancer, and the causes of tongue cancer are closely related to the following reasons:

1. Caused by the patient's bad living habits: Patients with long-term smoking and drinking habits have a higher incidence of tongue cancer than ordinary patients. Smoking and drinking are high-risk factors for tongue cancer.

2. Chronic oral damage: Because patients eat hard food for a long time, or are injured by sharp and hard objects, chronic damage occurs and tongue cancer is induced.

3. Influence of radioactive substances: long-term exposure to ultraviolet rays, X-rays and other radiation rays.

4. Genetic reasons: Heredity is also an important cause of tongue cancer. Patients with a family history of genetics have a high incidence of tongue cancer.

1. Pay attention to oral hygiene, brush your teeth every morning and evening, and rinse your mouth after meals.

2. If there are cavities, they should be filled early. The residual crowns and roots that can be repaired should be treated in time to restore the normal anatomical shape of the teeth as soon as possible.

3. Grind the sharp non-functional cusps and marginal ridges to make the cusps and marginal ridges on the occlusal surface of the crown rounded and blunt to prevent damage to the lingual marginal tissue.

4. If benign lesions or precancerous lesions are found, such as papilloma of the tongue or erosive lichen planus, they should be removed and biopsied in time, or actively treated and observed regularly.

5. Quit bad habits such as smoking and drinking, strengthen physical exercise, improve nutrition, eat more fresh fruits rich in vitamins and those that have anti-cancer and anti-cancer effects, and eat less irritating food.

Management of primary tumor

Early-stage, well-differentiated tongue cancer can be treated with radiotherapy, simple surgical resection, or cryosurgery. Advanced tongue cancer should be treated with comprehensive treatment, using radiotherapy plus surgery or triple (chemotherapy, surgery, radiotherapy) or quadruple (triple plus traditional Chinese medicine or immunotherapy) therapy according to different conditions.

1. Radiation therapy

It can be used as an adjuvant treatment before and after surgery for advanced tongue cancer cases.

Indications

Radiation therapy for tongue cancer is used for:

1. Radical radiotherapy for T1 and T2 lesions in the anterior part of the tongue without invasion of the floor of the mouth. 2. Preoperative or postoperative radiotherapy for patients with late T2, T3 and some T4 lesions. 3. Palliative radiotherapy for patients with advanced lesions, no surgical indications, contraindications to surgery or refusal of surgery may consider palliative radiotherapy or combined chemotherapy. Contraindications 1. Poor general condition or with dysfunction of other organs.

2. Patients with severe local necrosis, infection and bleeding.

3. Patients with extensive local tumor invasion and airway obstruction.

Prepare

1. Explain the purpose and effect of treatment to the patient before the operation, and explain the precautions to obtain the patient's active cooperation.

2. Clean the mouth with normal saline three times a day before surgery. If the oral infection is severe, treatment should be postponed.

3. Check blood count regularly and provide nutritious and easily digestible diet.

4. The patient should fast on the morning of the operation, remove any dentures, and insert a nasogastric feeding tube.

5. Prepare emergency medicines and equipment.

6. Before interstitial brachytherapy, 50-100 mg of pethidine should be injected intramuscularly. Patients with excessive mental tension can be given appropriate sedatives.

method

1. Radioactive source selection

For radiotherapy of primary tongue lesions, 60Coγ rays, high-energy X-rays or electron beams of corresponding energy are used.

2. Irradiation range

Positioning is performed under CT simulation or X-ray simulation, and the irradiation field includes lesions on the tongue, submental, submandibular and upper cervical lymph nodes; preventive irradiation of the middle and lower cervical and supraclavicular lymph nodes can be considered.

3. Dosage

(1) Preoperatively: Tumor dose (DT) is 45-55 Gy, and surgery is performed after 2-4 weeks of rest.

(2) Postoperative radiotherapy: The tumor dose is 50-60 Gy, which is performed 2-4 weeks after surgery. If the tumor remains, the dose can be increased as appropriate.

(3) External radiotherapy alone: ​​After the planned target area large-field irradiation tumor dose (DT) is about 50 Gy, an additional dose of 15 to 30 Gy is added depending on the tumor shrinkage.

(4) Early stage cancer of the mobile tongue: External beam radiotherapy or external beam radiotherapy plus interstitial brachytherapy can be used. Interstitial brachytherapy is usually treated with external beam radiotherapy DT 40-50 Gy for 4-5 weeks and interstitial dose 20-35 Gy in fractionated irradiation.

(5) For those with positive cervical lymph nodes: neck dissection, or radiotherapy plus surgical treatment may be considered.

Precautions

1. Pay attention to whether the implant needle is displaced, fallen off, or bleeding.

2. During the treatment, fluid replacement, anti-inflammatory and analgesic treatment are required.

3. Measure body temperature regularly. If the fever is severe, the implant should be removed and radiotherapy should be stopped.

4. When the irradiation dose is over, remove the source tube, apply pressure to stop bleeding locally and bandage it, count the implant needles and buttons, and recycle and store them after cleaning and disinfection.

5. After treatment, the patient still needs to continue to be observed and the oral cavity needs to be cleaned until the wound is completely healed. Eating more is encouraged.

6. Provide discharge instructions, including self-examination knowledge and the importance of regular examinations.

2. Surgical treatment

It is the main method for treating tongue cancer. For T1 cases, wedge-shaped resection more than 1 cm away from the lesion can be performed and sutured directly; for T2-T4 cases, hemiglossectomy or even total glossectomy should be performed. As an important organ for chewing and speech, reconstruction should be performed when more than 1/2 of the tongue is missing.

3. Chemotherapy

Cryosurgery can be considered for T1 and T2 tongue cancer. Treatment of metastatic lesions: Due to the high metastasis rate of tongue cancer, all cases except T1 should be considered for selective neck dissection at the same time; for patients with clinically positive lymph nodes, therapeutic neck dissection should be performed at the same time.

1. The diet should be mainly fresh, easy to digest, and rich in high-quality protein, vitamins, and minerals. Fresh vegetables and fruits are a must for every meal.

2. Eat more foods that have certain anti-cancer effects, such as cauliflower, cabbage, broccoli, asparagus, beans, mushrooms, sea cucumber, shark, etc.

3. Choose foods that have the effect of softening and dispersing lumps: jellyfish, seaweed, mussels, sea cucumber, abalone, cuttlefish, kelp, turtle, red bean, radish, shepherd's purse, water chestnut, shiitake mushroom, etc. However, these foods are greasy and easy to hurt the spleen and stomach. Eat less when you have poor appetite or fever.

4. Choose different foods for different body types. People with weak spleen and stomach and insufficient qi can eat pigeon, quail, eggs, jujube, longan, ginger, garlic, etc.

1. Eat high-protein foods

2. Eat high-vitamin foods

3. It is advisable to eat selenium-rich foods.