Close

Tongue Cancer

Signs and Symptoms of Tongue Cancer

For cancers in the mouth, you, your dentist or your general doctor can actually see or feel something abnormal in most cases. This is different from cancers in other parts of the head and neck, which can remain hidden for some time.

Symptoms to watch for include:

  • Painful sores in the mouth: Most commonly, an oral cancer will start as a painful sore in the mouth. In some cases, a dentist or dental hygienist will see a sore in the mouth that you didn’t even realize was there. In general, a patch or sore in the mouth that doesn’t heal after a few weeks should be evaluated in more detail by a specialist.
  • A patch on the tongue: A red patch (erythroplakia) on the tongue that lasts for more than a few weeks is more likely to be cancer than a white patch.5Neville BW, Day TA. Oral cancer and precancerous lesions. CA: a cancer journal for clinicians. Jul-Aug 2002;52(4):195-215. However, any lesion that doesn’t go away needs to be biopsied to determine whether it is cancer. The topic of white patches in the mouth (leukoplakia) and dysplasia (abnormal cells that are not cancer) can get complicated, and you should discuss this with a specialist.
  • Difficulty speaking: This is called dysarthria, and it can occur when a tumor changes the way your tongue moves.
  • Recurrent bleeding from the mouth: This can happen when the cancer makes a hole in some part of the tongue (this is called an ulcer) or if cancer cells are accidently rubbed off while brushing your teeth or eating certain foods.
  • Bad breath: In rare circumstances, when cancer cells start to become necrotic, the dead cells can lead to a bad smell from the mouth. This is called halitosis.

In some cases, a dentist or oral surgeon will see something in the mouth, remove it and a week later get the report that it is a cancer.

  • If a lesion was removed and later found to be cancer: In this case, you should still see a specialist in head and neck cancers because it is important to review the pathology in detail to see if any more treatment is needed. Some questions to review are:
    • What type of cancer was it?
    • How big was it?
    • How deeply did it invade?
    • Was it completely removed with a rim of normal tissue around it? (This is known as having “clear margins.”)

In rare cases, the first sign of an oral cancer could be a lump in the neck.

  • A lump in the neck: This means that the tumor has spread to the lymph nodes in the neck. This is less common for oral cancers than other types of cancers in the head and neck because the primary cancer is usually the main problem.

If the tongue cancer grows to involve other parts of the oral cavity (such as the floor of mouth, alveolus, gums, jawbone and/or deeper muscles), the following symptoms might result:

  • Loose teeth or dentures that don’t fit correctly: This happens if the tumor gets into the tooth sockets or the bones in which the teeth are rooted.
  • Difficulty opening the mouth: This can happen if the cancer gets into any of the muscles that help to open and close the mouth. This is called trismus.
  • Numbness (for example in the lower teeth or lower lip/chin area): This means that the cancer cells have gotten into nerves that allow you to feel. The main nerve responsible for this when dealing with oral cancer runs just inside the lower jawbone, and a branch even runs in the middle of the jawbone and comes out under the skin of your chin.
  • Pain or difficulty with swallowing: This can happen when tumors get large and either get in the way of eating or involve the muscles and nerves of swallowing.

But don’t jump to any conclusions. You could have one or more of these symptoms but NOT have an oral cancer. There are several non-cancerous causes of the same symptoms. That’s why you need to see a specialist.

References

1 National Cancer Institute. SEER Database. SEER Stat Fact Sheets. http://seer.cancer.gov/statfacts/html/tongue.html . Accessed January 25, 2012.

2 Petersen PE. Oral cancer prevention and control – The approach of the World Health Organization, Oral Oncol. 2008.

3 Ko YC, Huang YL, Lee CH, Chen MJ, Lin LM, Tsai CC. Betel quid chewing, cigarette smoking and alcohol consumption related to oral cancer in Taiwan. Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. Nov 1995;24(10):450-453.

4 Shugars DC, Patton LL. Detecting, diagnosing, and preventing oral cancer. The Nurse Practitioner. Jun 1997;22(6):105,109-110,113-105 passim.

5 Neville BW, Day TA. Oral cancer and precancerous lesions. CA: a cancer journal for clinicians. Jul-Aug 2002;52(4):195-215.

6 Spiro RH, Thaler HT, Hicks WF, Kher UA, Huvos AH, Strong EW. The importance of clinical staging of minor salivary gland carcinoma. Am J Surg. 1991 Oct;162(4):330-6.

7 Morton DL, Wen DR, Foshag LJ, Essner R, Cochran A. Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanomas of the head and neck. J Clin Oncol.1993;11:1751-6.

8 Civantos FJ, Zitsch RP, Schuller DE, Agrawal A, Smith RB, Nason R, Petruzelli G, Gourin CG, Wong RJ, Ferris RL, El Naggar A, Ridge JA, Paniello RC, Owzar K, McCall L, Chepeha DB, Yarbrough WG, Myers JN. Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial. J Clin Oncol. 2010 Mar 10;28(8):1395-400.

9 Koch WM, Choti MA, Civelek AC, Eisele DW, Saunders JR. Gamma probe-directed biopsy of the sentinel node in oral squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 1998. 124:455-9.

10 Shoaib T, Soutar DS, MacDonald DG, Camilleri IG, Dunaway DJ, Gray HW, McCurrach GM, Bessent RG, MacLeod TIF, Robertson AG. The accuracy of head and neck carcinoma sentinel lymph node biopsy in the clinically N0 neck. Cancer. 2001;91:2077-2083.

11 Kademani D. Oral cancer. Mayo Clinic proceedings. Mayo Clinic. Jul 2007;82(7):878-887.

12 Funk GF, Karnell LH, Robinson RA, Zhen WK, Trask DK, Hoffman HT. Presentation, treatment, and outcome of oral cavity cancer: a National Cancer Data Base report. Head Neck. 2002 Feb;24(2):165-80.

13 Kraus FT, Perezmesa C. Verrucous carcinoma. Clinical and pathologic study of 105 cases involving oral cavity, larynx and genitalia. Cancer. Jan 1966;19(1):26-38.

14 Listl S, Jansen L, Stenzinger A, Freier K, Emrich K, et al. Survival of patients with oral cavity Cancer in Germany. PLoS ONE. 2013;8(1):e53415.

15 Anneroth G, Batsakis J, Luna M. Review of the literature and a recommended system of malignancy grading in oral squamous cell carcinomas. Scand J Dent Res. 1987;95;229-249.

16 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010.

17 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 9, 2016. To view the most recent and complete version of the guideline, go online to www.NCCN.org.

18 Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, Jan JS, Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011 Feb;69(2):396-404.

19 Pradhan SA, Rajpal RM. Marginal mandibulectomy in the management of squamous cancer of the oral cavity. Indian J Cancer. 1987;24;167-171.

20 Pentenero M, Gandolfo S, Carrozzo M. Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: a review of the literature. Head Neck. 2005 Dec;27(12):1080-91.

21 Maddox WA, Urist MM. Histopathological prognostic factors of certain primary oral cavity cancers. 1990 Dec;4(12):39-42; discussion 42,45-6.

22 Urist MM, O'Brien CJ, Soong SJ, Visscher DW, Maddox WA. Squamous cell carcinoma of the buccal mucosa: analysis of prognostic factors. Am J Surg. 1987 Oct;154(4):411-4.

23 Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the head and neck.Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.