HEAD NECK 12 Tongue Cancer

5.3 TONGUE

 

Carcinoma originates at the tip or along the free borders:   Area

of hyperkeratosis develops first.

 

Later  this  develops  into an ulcerated  lesion  with  exophytic

undermined border.

 

Palpation  detects  hardness  and  indicates  that  invasion  has

occurred beyond the ulcer.

 

Spread   cancer  of  the  tip  of  the  tongue  metastasises   to

ipsilateral sub mandibular nodes and later the nodes at the  angle

of  the mandible are involved. 

 Forty percent have nodes  at  the time of presentation.

 

CLINICAL

 

The patient presents with :

-  Pain

-  Salivation

-  Fixation of Tongue

-  Dysphagias

-  Difficulty in speech

-  Foetor

 

Diagnosis

 

Multiple biopsies establish the diagnosis and the extent in large

tumours.

 

TREATMENT

 

T1NoMo lesions can be treated by radiotherapy or surgery as small

lesion  is  removed  with 1.5 cm margin  of  healthy  tissue  all

around.  Lesion of upto 1cm can be treated by interstitial radion

with Iridium192 wire. 

 

Combined  operation  including  wide resection of  a  small  oral

lesion  if  they  have nodes at the time  of  presentation,  they

require radial neck dissection.

 

Treat  all  larger lesions with preoperative  radiation  therapy,

following  this with a radical neck dissection and in  continuity

excision of any residual cancer.

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