Tongue cancer

There are two parts to the tongue. The front part is the part you can see. The back part is close to the throat. Symptoms of tongue cancer depend on where the cancer is. They include:

  • a spot or ulcer on the tongue
  • a red or white patch on the tongue
  • bleeding from the tongue.

If you have symptoms, it is important to have them checked by your GP or dentist. They may refer you to a specialist for tests. These may include a test to examine the back of your tongue closely. The doctor may also take a small sample of tissue (biopsy) to make a diagnosis.

The main treatments for tongue cancer are:

  • surgery to remove the cancer
  • radiotherapy, which treats the cancer with high energy x-rays.

Your doctor will discuss with you the best treatment for you. Side effects of treatment depend on your situation and the treatment you have. Treatment may affect your speech or how you swallow. Your hospital team will tell you more about what to expect. There are lots of things that can help you manage side effects during and after treatment.

What is tongue cancer?

Tongue cancer is a rare type of head and neck cancer.


The tongue

The tongue has two parts, and cancer can develop in either of them:

  • The front part is the part of the tongue you can see. It makes up two-thirds of the tongue and helps with eating and speaking. It is called the oral tongue. Cancers that develop in this part of the tongue are mouth cancers (oral cancers).
  • The back part is the base of the tongue, which is very close to the throat. You cannot see this part. It is in the part of the throat called the oropharynx and it helps with speaking and swallowing. Cancers that develop in this part of the tongue are called oropharyngeal cancers. ‘Oro’ means mouth and the ‘pharynx’ is the throat.
The tongue and the pharynx
The tongue and the pharynx

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Causes and risk factors of tongue cancer

The exact causes of tongue cancer are not known. But certain risk factors can affect the chances of developing it.

The main risk factors for head and neck cancers are:

  • smoking or chewing tobacco
  • drinking large amounts of alcohol.

Your risk of developing tongue cancer is even higher if you do both.

Chewing betel quid (paan) can also increase the risk of developing mouth cancers.


Symptoms of tongue cancer

Symptoms of tongue cancer vary depending on whether the front or back part of the tongue is affected. They may include:

  • a spot or ulcer on the tongue that does not heal
  • 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
  • a feeling of a foreign body or pain towards the back of the mouth or throat
  • a lump in the neck which has been there for more than three weeks.

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.


How tongue cancer is diagnosed

You usually start by seeing your GP or your dentist. They will examine your tongue and mouth closely.

They will refer you to a specialist doctor if:

  • they think that your symptoms could be caused by cancer
  • they are not sure what the problem is.

The specialist doctor will ask about your symptoms and general health. They will examine your tongue and feel for any lumps in your neck. These may be caused by swollen lymph nodes, but can be caused by other medical conditions.

You may have some of the following tests:

Nasendoscopy

You may have this test in the outpatient clinic. The doctor passes a thin, flexible tube called a nasendoscope into your nose, over the back of your tongue and down into the upper part of your throat. The tube has a camera and a light at the end to help the doctor get a better view of the back of your mouth and throat. You might find this a bit uncomfortable, but it only takes a few minutes.

Before the test, your doctor may numb your nose and throat with an anaesthetic spray. Some people prefer to have this done without the anaesthetic spray. If you have this spray, do not eat or drink for about an hour afterwards, or until the numbness wears off. This is because there is a risk that food and drink may go down the wrong way and into your lungs when you swallow. You could also burn your mouth or throat with hot food or drinks.

Biopsy

A biopsy is when your doctor takes a small piece of tissue or some cells from the area that looks abnormal.

Before the test, you may have an injection of local anaesthetic to numb the area. If the base of the tongue is affected, you are more likely to have a general anaesthetic (so you are asleep). Your doctor may also plan to remove as much of the affected area as possible at the same time. They may do this with the help of a special machine. This is called robotic surgery.

Another type of biopsy is when your doctor takes a sample of cells using a fine needle aspiration (FNA). The doctor passes a thin needle into the area and withdraws (aspirates) some cells into a syringe. This may also be used to find out if there are any cancer cells in the lymph nodes. You can have this in an outpatient clinic.

After the biopsy, a doctor who specialises in analysing cells (called a pathologist) will look at the sample under a microscope to check for cancer cells.

It’s hard to imagine how you will cope with the diagnosis of cancer. It has become a familiar word to all of us, but its meaning is highly personal.

Christine


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:

CT (computerised tomography) scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10 to 30 minutes and is painless. It uses a small amount of radiation. This is very unlikely to harm you and will not harm anyone you come into contact with. You may be asked not to eat or drink for at least four hours before the scan.

CT scan
CT scan

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You may be given an injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It is important to let your doctor know if you are allergic to iodine or have asthma. You could have a more serious reaction to the injection.

You will probably be able to go home as soon as the scan is over.

MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas of your body. The scanner is a powerful magnet so you may be asked to complete and sign a checklist to make sure it is safe for you. The checklist asks about any metal implants you may have, such as a pacemaker, surgical clips or bone pins, etc.

You should also tell your doctor if you have ever worked with metal or in the metal industry as very tiny fragments of metal can sometimes lodge in the body. If you do have any metal in your body, it is likely that you will not be able to have an MRI scan. In this situation, another type of scan can be used. Before the scan, you will be asked to remove any metal belongings including jewellery.

Some people are given an injection of dye into a vein in the arm, which does not usually cause discomfort. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones. You can hear, and speak to, the person operating the scanner.

Ultrasound scan of the neck

This test uses soundwaves to produce a picture of your neck and lymph nodes on a computer screen. Lymph nodes are part of the lymphatic system, which helps to protect us from infection and disease.

The scan is painless and only takes a few minutes. The doctor puts some gel onto your neck and moves a small device which produces soundwaves over the area. The doctor will look for any changes in the size or appearance of the lymph nodes in your neck.

An ultrasound can also be used to guide a needle biopsy.

PET scan

A PET scan uses low-dose radioactive glucose (a type of sugar) to measure the activity of cells in different parts of the body. A very small amount of a mildly radioactive substance is injected into a vein, usually in your arm. You then have a scan a couple of hours later. Cancer cells are usually more active than surrounding tissue, and show up on the scan. Not all hospitals have PET scanners. So if you need one, you may have to travel to another hospital.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos


Staging for tongue cancer

The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage helps doctors decide on the best treatment for you.

The most commonly used staging systems for tongue cancer are the TNM and number staging systems.

TNM staging system

  • T describes the size of the tumour and whether it has grown into areas around the tongue. It is numbered between 0 and 4 depending on the size and extent of the tumour. T0 means that there are no signs of a tumour, but there may be abnormal cells that are pre-cancerous. A T1 tumour is small and only in the tongue. A T4 tumour has spread into nearby areas, such as muscles or bones.
  • N describes whether the cancer has spread to the lymph nodes. N0 means that no lymph nodes are affected. N1, N2 or N3 means that there are cancer cells in the lymph nodes. The number depends on how many lymph nodes contain cancer cells, the size and where they are.
  • M describes whether the cancer has spread to another part of the body. This is called metastatic cancer. M0 means the cancer has not spread. M1 means the cancer has spread to distant organs, such as the lungs or liver.

Number staging system

There are usually 3 or 4 number stages for each cancer type. Stage 1 describes a cancer at an early stage when it is usually small in size and has not spread. Stage 4 describes a cancer at a more advanced stage when it has usually spread to other parts of the body.

Your doctor can tell you more about the stage of your cancer.

Other terms used

Your doctor may use other terms to describe the stage of the cancer:

  • Early or local – a small cancer that has not spread.
  • Locally advanced – cancer that has started to spread into surrounding tissues or nearby lymph nodes, or both.
  • Local recurrence – cancer that has come back in the same area after treatment.
  • Secondary, advanced, widespread or metastatic – cancer that has spread to other parts of the body.


Grading

The grade of a cancer gives the doctors an idea of how quickly it may develop. Doctors will look at a sample of the cancer cells under a microscope to find the grade of the cancer.

  • Grade 1 or low grade – the cancer cells look like normal cells and usually grow slowly.
  • Grade 2 and 3 – the cancer cells look different to normal cells and are slightly faster growing.
  • Grade 4 or high grade – the cancer cells look very different to normal cells and may grow more quickly.


How tongue cancer is treated

Your treatment depends on the stage of the cancer and whether the front or back of the tongue is affected. Treatment also depends on your general health. Your specialist doctor plans your treatment carefully with a team of doctors, nurses and other health professionals. This is called a multidisciplinary team (MDT).

The aim is to treat the cancer, while doing as little damage as possible to the tongue and throat. Your doctors also try not to change your appearance if possible. Your specialist doctor will talk to you about your treatment options and any possible side effects.

Treatments used for tongue cancer include:

  • surgery
  • radiotherapy
  • chemotherapy
  • targeted therapies.

You may have one or a combination of treatments. If you have a small, early-stage cancer, you may be treated with surgery or radiotherapy alone. If the cancer is bigger or has spread to the lymph nodes, you may have a combination of surgery and radiotherapy. You may also have chemotherapy.

Chemotherapy is sometimes given together with radiotherapy. This is called chemoradiation. Some people have surgery followed by radiotherapy or chemoradiation.


Surgery for tongue cancer

The type of surgery used depends on the size of the cancer and where it is. Your surgeon will explain the operation to you beforehand. You will be able to ask any questions you have about it.

Surgery may be used to remove early-stage tongue cancer. Sometimes laser surgery might be used on small cancers. This type of surgery uses a laser light to destroy the cancer. Depending on where the cancer is on the tongue, surgery may also be used to treat more advanced cancers.

If the cancer is large and started on the front part of the tongue, you may need an operation to remove part or all of the tongue. This is called a partial glossectomy or total glossectomy.

You may also need reconstructive surgery. This is when the surgeon uses tissue, skin or bone from somewhere else in the body to rebuild parts they have removed. This can be very difficult to cope with, but you will have support before and after your operation.

The surgeon may also remove some lymph nodes from the neck. They do this through a cut in the neck. This is called a neck dissection. There are different types of neck dissection. If you need to have this, your doctor will explain what they will do in your situation.

Radiotherapy or chemotherapy may also be used in combination with surgery.

How long you stay in hospital depends on the operation you need. You may be looked after in a high-dependency unit or intensive care for a while after the operation. 

We have more information about what to expect before and after surgery.

Effects of surgery

Depending on the type of operation you have, it might:

  • affect your speech
  • affect your sense of taste or smell
  • affect how you swallow
  • leave scars or change your appearance.

If you have some or all of the tongue removed, it will change the way you speak and swallow.

Your surgeon will explain what to expect and what support is available. A speech and language therapist (SLT) will help you prepare for your operation and cope with any changes to your speech or how you swallow. SLTs specialise in speech, voice and swallowing problems. You can ask them about how an operation on the tongue will affect your speech and your eating and drinking. They will support you before and after the operation and will be in contact with you when you go home, for as long as you need.

A dietitian can advise you about problems you may have with eating, drinking and weight loss. They will explain what to expect and how they will support you. It is important that you have enough nutrition to help you recover from your treatment. You may need to have a feeding tube put into your stomach to help with this. This may be put in by:

  • passing it through the nose and down into the stomach (nasogastric tube)
  • passing it directly into the stomach (gastrostomy tube).

It may be put in before or at the time of your surgery. The tube can come out when you can eat and drink more easily.

Your doctor and specialist nurse are also there to help support you, before your operation and during your recovery.

You can read more in our general information about head and neck cancers. You may also find some of these organisations helpful:

  • Changing Faces supports people who have conditions or injuries that affect their appearance. It offers a skin camouflage service for people living with scarring or a skin condition that affects their confidence. Call 0300 012 0275 or email info@changingfaces.org.uk
  • Let’s Face It is a support network for people with facial disfigurements. Call 01843 833724 or email chrisletsfaceit@aol.com
  • Saving Faces has an expert patient helpline that puts people in touch with someone who has had the same condition or similar surgery. Call 07792357972 or email helpline@savingfaces.co.uk

A man is pressing his finger on his throat in a doctor's office.

Speech therapy and voice restoration after cancer

A speech and language therapist and someone who has had a laryngectomy discuss different ways to communicate.

About our cancer information videos

Speech therapy and voice restoration after cancer

A speech and language therapist and someone who has had a laryngectomy discuss different ways to communicate.

About our cancer information videos


Radiotherapy for tongue cancer

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells.

Radiotherapy may be the only treatment used for some tongue cancers. It may also be used to reduce the chance of the cancer coming back after surgery. Radiotherapy is sometimes given with chemotherapy. This is called chemoradiation.

You may have radiotherapy or chemoradiation if the cancer started on the back or base of the tongue (oropharynx).

Planning your radiotherapy treatment

To make sure that your radiotherapy is as effective as possible, it has to be carefully planned. Planning your treatment makes sure the radiotherapy is aimed precisely at the cancer, so it causes the least possible damage to the surrounding healthy tissue. The treatment is planned by a specialist doctor called a clinical oncologist.

You usually need to have a clear plastic mould or mask made before your treatment is planned. This helps keep your head in the same position for each session of radiotherapy. The mask should not be uncomfortable and does not affect your breathing. We have a video that shows how radiotherapy masks are made. If you are worried about the mask, let your radiotherapy team know so they can help.

Having radiotherapy

Radiotherapy is normally given as a series of short, daily outpatient treatments with a rest at the weekend. Each treatment only takes a few minutes. It is given in the radiotherapy department using equipment similar to a large x-ray machine. Radiotherapy only treats the area of the body the rays are aimed at. It does not make you radioactive.

There are different types of radiotherapy. The type of radiotherapy usually used to treat head and neck cancers is called intensity-modulated radiotherapy (IMRT). IMRT uses high-energy rays that are shaped very precisely to target the area of cancer. This means a higher dose of radiation is given to the tumour, and healthy areas nearby get a lower dose. This can reduce side effects.

The number of treatments you have depends on the aim of your treatment. Your doctor or nurse will tell you how many treatments you are likely to have.

Side effects of radiotherapy

You may have side effects during radiotherapy. These usually get better slowly over a few weeks or months after treatment finishes, but many people continue to have a dry mouth.

Some side effects develop later on after treatment finishes and can last longer. These are less common, but can happen months or even years after your treatment. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help.

Sore and sensitive skin

The skin over your face and neck will slowly redden or darken, depending on your skin tone. It may also feel sore and itchy (a bit like sunburn). This starts after about 2 weeks of treatment and lasts for up to about 4 weeks after radiotherapy has finished.

When you wash your face and neck, it is important to use only the soaps, creams and lotions your radiotherapy team recommend. This is because chemicals in some products can make the skin more sensitive to radiation. Moisturisers need to be sodium lauryl sulphate (SLS) free. Your radiotherapy team can give you more information about how to care for your skin when you have radiotherapy and after you have finished treatment. They can also tell you when and how to use sun-protection cream after your treatment.

We have more information about skin care when you have radiotherapy to the head and neck area.

Sore mouth

It is important to look after your mouth during radiotherapy. Following a mouth care routine to keep your mouth clean helps prevent problems. Your mouth and throat may become sore after a couple of weeks of treatment. You may develop mouth ulcers. You might also find it difficult to speak, or notice changes to your sense of taste and smell. Eating food can become difficult and you may find it painful to swallow. Your doctor can prescribe medicines to help.

We have more information about coping with a sore mouth.

Dry mouth

Radiotherapy to the head and neck may reduce the amount of spit (saliva) you make. It can make the mouth and throat dry. This can affect eating, speaking and sleeping. It also makes you much more likely to have tooth decay. So it is really important to care for your teeth during and after treatment.

It also helps to carry a bottle of water with you so you can take frequent sips of water. Or you could use a water spray instead. Artificial saliva can also help moisten your mouth and throat. It comes in different forms, such as gels, sprays, mouthwashes, pastilles or tablets. Your doctor or dentist can prescribe artificial saliva, or you can buy it from a chemist.

We have more information aboutcoping with a sore mouth.

Thick, sticky saliva (mucus)

Radiotherapy to the head and neck affects the salivary glands. Your saliva may become thicker, stringy and sticky. Your mouth and throat may also feel dry. This can make eating and talking difficult.

Rinsing your mouth regularly can help with this. Your specialist head and neck team can give advice on the type of mouth rinse that might be best for you. Sometimes a build-up of mucus can cause coughing, especially at night. Your nurse or doctor may prescribe a nebuliser to help to loosen the mucus. A nebuliser is a machine that changes a liquid medicine into a mist or fine spray. Your nurse or doctor can also prescribe mouthwashes, lozenges, artificial saliva sprays or gels to help.

Changes in the saliva usually get better within about 8 weeks of radiotherapy ending, but sometimes it continues for several months or longer.

Difficulty eating

If you find it hard to eat and drink because of any side effects, let your doctor or nurse know. They can give you advice and medicines to help. They may refer you to a dietitian for more advice. You may need food supplements to add extra energy or protein to your diet. Some supplements can be used to replace meals, and others are used in addition to your normal diet. You can get some of these from your chemist or the supermarket. Your doctor, nurse or dietitian can also prescribe them for you.

Some people need to be fed through a tube if they cannot eat and are losing lots of weight. This is known as nutritional support or tube feeding. It is usually only done for a short time until treatment is finished and their swallowing is back to normal.

Tiredness

This is a common side effect that may last for a couple of months after treatment. Try to get plenty of rest and pace yourself. Balance this with some physical activity, such as short walks. This will give you more energy.

Late effects of radiotherapy

Your doctor, specialist nurse or radiographer can tell you whether your treatment may cause any late effects. They will also tell you what you can do to help reduce your risk of problems. And they can tell you what support is available.

Our general information about head and neck cancers has more information about:

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos

Radiotherapy explained

Consultant Clinical Oncologist Vincent Khoo describes external beam radiotherapy, how it works, and what it involves.

Information about our videos


Chemotherapy for tongue cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.

You may have chemotherapy with radiotherapy instead of surgery. This is called chemoradiation. Chemotherapy is also sometimes given after surgery to reduce the risk of the cancer coming back. Or you may have chemotherapy if the cancer has spread to other parts of the body or the cancer has come back in the head or neck.

Chemotherapy is usually given as several sessions of treatment, called treatment cycles. Each treatment cycle is followed by a rest period, to give the body time to recover.

You may have a single chemotherapy drug or a combination of different ones. Cisplatin is the most common chemotherapy drug that is used with radiotherapy. It is given into a vein (intravenously).

Side effects of chemotherapy

The side effects depend on the drug or combination of drugs you are given. Your doctor or nurse will explain the treatment you are offered and what to expect.

Chemotherapy can reduce the number of white blood cells in the blood during treatment. This makes you more likely to get an infection. Your doctor or nurse will give you advice about what to do if this happens.

Chemotherapy can also cause other side effects, such as:

  • feeling tired
  • a sore mouth
  • feeling sick (nausea) or being sick (vomiting)
  • diarrhoea
  • hair loss.

Let your doctor or nurse know about any side effects during treatment. They can often give you advice and help to reduce these.

We have more information about coping with the side effects of chemotherapy and about different chemotherapy drugs.

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos

Chemotherapy

This video provides a brief overview of chemotherapy treatment, how it can be given, how it works and possible side effects.

About our cancer information videos


Targeted therapies for tongue cancer

Targeted therapies interfere with the way cells grow and divide.

They may only be available in some situations. Some people may be given them as part of a clinical trial. If a drug is not available on the NHS, there may be different ways you are still able to have it. Your cancer doctor can give you advice.


Clinical trials for tongue cancer

Cancer research trials are done to try to find new and better treatments for cancer. Trials that are done on patients are known as clinical trials. Research into treatments for tongue cancer is ongoing. But because tongue cancer is rare, there may not always be a relevant trial in progress. If there is, you may be asked to take part. Your doctor must discuss the treatment with you, so you have a full understanding of the trial and what it means to take part. You can decide not to take part, or withdraw from a trial at any stage. You will still receive the best standard treatment available.


Follow-up after treatment

After your treatment finishes, you will have regular check-ups and tests. These may continue for several years. You may also have regular follow-up appointments with a speech and language therapist (SLT), dietitian, restorative dentist and dental hygienist. If you have any problems or notice new symptoms between appointments, let your doctor know as soon as possible.


Your feelings

For some people, it takes several months to recover from treatment. It can be hard to cope if treatment has changed your appearance, voice or how you eat and drink.

It is common to feel overwhelmed by different feelings. For example, you may feel shocked, scared, upset or angry. Everyone has their own way of coping. But it is important to be able to express how you feel.

Some people find that it helps to share their feelings with family or friends. Others get help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope. But remember that help is available if you need it.

You might want to join a local cancer support group. Meeting other people in a similar situation and sharing your experience may help you feel less alone. You can ask your specialist nurse if there are any local support groups in your area.

If you are finding it difficult to talk, our Online Community (community.macmillan.org.uk) is also a good place to meet people who may be in a similar situation.

There are national support groups that you may find helpful:

  • Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
  • Changing Faces offers advice and information to anyone who is affected by a change in their appearance.

You may also want to talk to our cancer support specialists. Call us free on 0808 808 00 00 (Monday to Friday, 9am to 8pm).

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