Tongue cancer is a rare type of head and neck cancer.
The tongue has two parts, and cancer can develop in either of them. These parts include the following:
- The front part is the area you can see. This is called the oral tongue. Cancer that develops in this part of the tongue is called mouth cancer.
- The back part is the base of the tongue, which is very close to the throat (pharynx). This is the area you cannot see. Cancer that develops in this part of the tongue is called oropharyngeal cancer.
Symptoms of tongue cancer vary depending on whether the front or back part of the tongue is affected.
With certain symptoms, your dentist or GP should refer you to see a specialist within 2 weeks. This is called an urgent referral. You can read more about urgent referral symptoms in our information about the signs and symptoms of head and neck cancer.
Symptoms may include:
- a spot or ulcer on the tongue that does not heal (lasting for more than 3 weeks)
- a red or white patch on the tongue that does not go away
- unexplained bleeding from the tongue
- pain or difficulty when moving the jaw or tongue
- pain or difficulty when swallowing
- feeling a lump towards the back of the throat
- pain towards the back of the mouth or throat
- a lump in the neck that has been there for more than 3 weeks.
All of these symptoms can be caused by conditions other than cancer. But it is important to have them checked by your doctor or dentist.
Tongue cancer can be treated more successfully when it is diagnosed early.
We have more information about the signs and symptoms of head and neck cancer.
The exact causes of tongue cancer are not known, but there are risk factors that can increase your chance of developing it.
The main risk factors for tongue cancer are:
- smoking or chewing tobacco
- drinking large amounts of alcohol – the more years someone drinks for, the higher the risk.
Your risk of developing tongue cancer is higher if you do both.
Some cancers in the base of tongue may be linked to an infection called human papilloma virus (HPV). HPVs are a group of common infections that can affect areas such as the inside the mouth, the throat, genital area or anus. Some types of high-risk HPV can increase the risk of cancer. Most people have HPV at some time during their life. But most people with HPV in the mouth do not develop tongue cancer.
As with other cancers, tongue cancer is not infectious and cannot be passed on to other people.
We have more information about the causes and risk factors of head and neck cancers.
You usually start by seeing your GP or your dentist. If they think your symptoms could be linked to cancer, they will refer you to a specialist head and neck doctor. You will usually see a specialist within 2 weeks. You may see an ear, nose and throat (ENT) specialist. Or you may see an oral and maxillofacial surgeon (OMFS).
The specialist doctor will ask about your symptoms and general health. They will examine your tongue and feel for any lumps in your neck. Neck lumps may be caused by swollen lymph nodes but can be caused by other medical conditions.
Some people have no symptoms and find out that they may have tongue cancer during a routine examination with their dentist or doctor.
You may have some of the following tests:
To make a diagnosis, your doctor needs to remove a small piece of tissue or some cells (biopsy) from the area that looks abnormal. Your doctor may take a biopsy while they are examining you with the nasendoscope. Or they might arrange for you to have a general anaesthetic to take the biopsy.
A doctor called a pathologist looks at the sample under a microscope to check for cancer cells.
We have more information about tests for head and neck cancer
Further tests for tongue cancer
If tongue cancer is diagnosed, your doctor may want to do some further tests to find out more about the cancer. These tests may include:
Ultrasound scan of the neck
Waiting for test results can be a difficult time. We have more information that can help.
Doctors use the results of your tests to find out more about the size and position of the cancer, and whether it has spread. This is called staging. In tongue cancer, staging also looks at how deep the cancer is.
The grade of the cancer describes how the cancer cells look under the microscope. This gives an idea of how quickly it might develop.
Knowing the stage and grade of the cancer helps your doctors plan the best treatment for you. The staging systems most often used for tongue cancer are the TNM and number staging systems. The number staging system is less commonly used.
We have more information about staging and grading of tongue cancer.
Treatments for tongue cancer include surgery, radiotherapy and chemotherapy. Sometimes targeted therapies and immunotherapies may be used.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your cancer doctor or specialist nurse will explain the different treatments, any possible side effects and the support you have. They will also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment.
You will also usually be given advice about preparing for your treatment (sometimes called prehabilitation). This helps to improve your fitness and diet and help to get you ready mentally before treatment. If you smoke, it can also help you with stopping smoking.
Your treatment depends on the stage of the cancer and whether the front or back area of the tongue is affected. Treatment also depends on your general health.
You may have one treatment or a combination of treatments:
Early-stage tongue cancers are usually treated with surgery. Sometimes laser surgery might be used on small cancers. This type of surgery uses a laser light to destroy the cancer.
If the cancer is large and started on the front part of the tongue, you may need a bigger operation to remove part or all of the tongue. This is called a partial glossectomy or total glossectomy.
The surgeon may also remove some lymph nodes from the neck. This is called a neck dissection. This can tell them if you need further treatment, such as radiotherapy or chemotherapy.
You may also need reconstructive surgery. This is when the surgeon rebuilds the part removed using tissue, skin (called a flap), blood vessels or bone from somewhere else in the body, such as the forearm.
Depending on your operation, some people may have a feeding tube put in before or during surgery. It can usually be removed once you are able to swallow. If you are likely to need this, your team will discuss it with you before your operation.
We have more information about recovering from your operation.
Radiotherapy uses high-energy rays to destroy the cancer cells. It may also be used after surgery to reduce the chance of the cancer coming back. This is called adjuvant treatment.
You may have radiotherapy on its own, or radiotherapy with chemotherapy (chemoradiation). It might be used if the cancer started on the back or base of the tongue (oropharynx).
Rarely, radiotherapy may be the only treatment used for some tongue cancers. This would be if surgery is not possible.
You may have side effects during and for a few weeks after radiotherapy. These usually get better slowly after treatment finishes.
ChemotherapyChemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You may have chemotherapy with radiotherapy. This is called chemoradiation.
Or you may have chemotherapy if the cancer has spread to other parts of the body or has come back in the head or neck. If this happens, you may have a single chemotherapy drug or a combination of different ones. Chemotherapy may also be given with a targeted therapy treatment called cetuximab.
Chemoradiation is when you have chemotherapy and radiotherapy together. Chemotherapy can make the cancer cells more sensitive to radiotherapy treatment. Cisplatin is the most common chemotherapy drug that is used with radiotherapy.
Chemoradiation may be used:
- to reduce the chance of tongue cancer coming back after surgery (adjuvant treatment)
- if the cancer started on the back or base of the tongue (oropharynx)
- instead of surgery.
Targeted therapy drugs work by targeting something in or around the cancer cell that is helping it grow and survive. A targeted therapy called cetuximab may be used to treat some tongue cancers. It may be used for tongue cancers that have spread or cannot be removed with surgery, or have come back after treatment. You might have cetuximab with chemotherapy.
You may have some treatments as part of a clinical trial.
After treatment, you will have regular follow-up appointments with your specialist doctor. These may continue for several years. These may be monthly to begin with and then become less frequent. Follow-up appointments will continue for 5 years.
You may also have regular follow-up appointments with your multidisciplinary team (MDT), including,a speech and language therapist (SLT), dietitian, restorative dentist and dental hygienist and sometimes a physiotherapist.
If you have any problems or notice new symptoms between appointments, let your doctor or nurse know as soon as possible.
Long-term or late effects
Some treatment side effects may take a long time to improve after treatment finishes, or they may become permanent. These are called long-term effects. Other side effects can develop months or even years after treatment has finished. These are known as late effects. We have more information about long-term and long-term and late effects of head and neck cancer treatment.
Head and neck cancer and its treatment can sometimes have an effect on your sex life.
If you are worried about this, talk to your doctor or nurse. You can read about things that may help in our information on cancer and sex.
Some cancer treatments can also affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.
We have more information about:
Well-being and recovery
Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes during and after treatment. For example, if you smoke or drink alcohol, it is best to avoid smoking or reduce the amount of alcohol.
Eating well and keeping active can improve your health and well-being. It can also help your body recover. Your dietitian can help with any difficulties you might have with eating after treatment.
It may take several months to recover from treatment. It can be hard if treatment has changed your appearance, how you eat or drink, or your voice. This may also affect your body image but there are ways to help you to manage any changes.
There are also national support groups that you may find helpful:
- The Mouth Cancer Foundation
The Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
- Changing Faces
Changing Faces offers advice and information to anyone who is affected by a change in their appearance.
- The Swallows Head and Neck Cancer Support Group
The Swallows offers a 24-hour support line to anyone affected by head and neck cancer.
- Salivary Gland Cancer UK
Salivary Gland Cancer UK supports people with rare salivary gland cancers, such as adenoid cystic carcinoma, ACC, and unknown carcinoma.
Macmillan is also here to support you. If you would like to talk, you can:
Below is a sample of the sources used in our tongue cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
British Association of Head and Neck Oncologists. Head and Neck Cancer: United Kingdom National Multidisciplinary Guidelines. 2016. Available from: https://www.bahno.org.uk/_userfiles/pages/files/ukheadandcancerguidelines2016.pdf (accessed August 2022).
Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS–ESMO–ESTRO Clinical practice guidelines for diagnosis, treatment and follow-up. November 2020. Available from: www.annalsofoncology.org/article/S0923-7534(20)39949-X/fulltext (accessed August 2022).
British Association of Head and Neck Oncologists. BAHNO Standards2020. Available from: bahno.org.uk/_userfiles/pages/files/final_bahno_standards_2020.pdf (accessed August 2022).
National Institute for Health and Care Excellence (NICE). Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over NICE guideline NG36 Published: 10 February 2016. Last updated: 06 June 2018 Available from: www.nice.org.uk/guidance/ng36/chapter/recommendations (accessed August 2022).
National Institute of Health and Care Excellence. NICE. www.nice.org.uk/guidance/conditions-and-diseases/cancer/head-and-neck-cancers/products?ProductType=Guidance&Recent=NewInLast6Months (accessed August 2022).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.
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