Tongue cancer

A nasendoscopy is a thin, flexible tube with a light and camera on the end. It allows your doctor to look inside your nose, the back of your tongue and your throat.

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.

A CT scan takes a series of x-rays, which build up a three-dimensional (3D) picture of the head and neck.

An MRI scan uses magnetism to build up a detailed picture of the head and neck.

If you have a lump or a swelling in your neck you usually have an ultrasound scan of the neck. This uses soundwaves to produce a picture of your neck and lymph nodes (lymph glands) nearby.

A PET-CT scan uses low-dose radiation to check the activity of cells in different parts of the body.

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.

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.

Immunotherapies are treatments that use the immune system to find and attack cancer cells. They may be used to treat some tongue cancers that have spread.

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 cancerinformationteam@macmillan.org.uk

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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