CARCINOMA OF TONGUE

Presentator : Sri Wulan Dhari

Moderator : Dr. dr. Bambang HW, Sp.T.H.T.K.L (K) FICS

Department of Otorhinolaryngology – Head and Neck Surgery

Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada
Dr. Sardjito General Hospital Yogyakarta
2020
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Visi Program Studi Kesehatan T.H.T.K.L

Menjadi program studi berstandar global yang inovatif dan

unggul, serta mengabdi kepada kepentingan bangsa dan
kemanusiaan dengan dukungan sumber daya manusia yang
profesional dan dijiwai nilai-nilai Pancasila pada tahun 2020
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Misi Program Studi Kesehatan T.H.T.K.L 3

1. Meningkatkan kegiatan pendidikan, penelitian dan

pengabdian masyarakat berlandaskan kearifan
lokal.
2. Mengembangkan sistem tata kelola Program Studi
IK THT-KL yang mandiri dan berkualitas (Good
Governance).
3. Membangun kemitraan dan kerjasama dengan
rumah sakit dan seluruh pihak yang berkepentingan
dalam rangka mendukung kegiatan pendidikan,
penelitian dan pengabdian masyarakat.
INTRODUCTION
• The oral cavity → the entrance to the upper aerodigestive tract
• It is lined by squamous epithelium with interspersed minor salivary
glands.
• The oral cavity also contains the dentoalveolar structures with the upper
and lower dentition.
• The oral cavity → inhaled and ingested carcinogens → common site for
the origin of malignant epithelial neoplasms in the head and neck region.
• Carcinogens for oral cavity carcinoma → tobacco, alcohol, and betel
nuts.
• HPV → oropharyngeal cancers?
Jatin Shah’s, 2020
ANATOMY OF TONGUE 5 4

Al-Ghamdi, 2013
VASCULARIZATION
OF TONGUE
INNERVATION
OF TONGUE
Epidemiology
• Older Males →
history smoking
and/or drinking
alcohol
• Men > women
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ETIOLOGY
• Heavy smoking
• Alcohol use

• Betel use,
• Radiation exposure,
• Immunocompromised states,
• Poor oral hygiene, and
• Genetic factors.
• Human papillomavirus (HPV) infection
(Leoncini et al, 2014).
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ANAMNESIS 15

• Older Age
• A history of smoking and/or alcohol use with a non-resolving oral cavity/tongue
lesion.
• A history of accidental trauma to the region
• Localized pain.
• Dysphagia, weight loss, dysarthria, and odynophagia.
• The patient’s ability to tolerate his usual diet
• Any history of recently noticed neck masses or nodules is also fundamental, →
locoregional metastatic disease.
• Unilateral nasal obstruction, unilateral hearing loss, or unilateral otalgia
Physical Examination
• Head and neck region
• Palpable lymphadenopathy, especially the submental,
submandibular, and jugulodigastric regions.
• Description of the lesion or mass (location, general appearance,
color, shape, margins, and the presence or absence of ulceration)
• Palpation
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CLINICAL FEATURES

• Variable.
• Ulcerative, exophytic, or endophytic.
• The gross characteristics of the lesion → raise the index of
suspicion regarding the need for a biopsy → established
diagnosis.
• Ipsilateral tongue deviation.
• Sensation in the tongue
• Numbness in the chin, lower lip, and/or mandibular teeth
Ulcerative lesions Exophytic lesions
 Ca In Situ SCC

Exophytic Papillary
Papillary Projection Polypoid SCC
Leukoplakia
Eritroplakia
T-category
AJCC 8th
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Supporting Examination 25

• Incisional biopsy or punch biopsy

• Flexible laryngoscopy or under direct visualization with general
anesthesia → base of tongue lesion
• FNAB
• CT Scan
• Immunohistochemical staining for p16 protein
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TREATMENT
• Primarily surgical
• Radiation
• Chemotherapy

Advanced disease : surgery and postoperative chemoradiation →

optimal treatment
 Surgical Approaches
• Peroral Laser Excision of Leukoplakia
• Partial Glossectomy
• Near Total Peroral Glossectomy
-Excision of a Tumor of the Floor of the Mouth and Reconstruction With a Full-Thickness Skin Graft
- Paramedian Mandibulotomy for Resection of Cancer of the Tongue

• Median Labiomandibular Glossotomy (Trotter’s Operation)

• Mandible Resection in the Management of Oral Cancer
• Peroral Marginal Mandibulectomy and Primary Closure
• Marginal Mandibulectomy and Skin Graft Reconstruction
• Marginal Mandibulectomy and Primary Vestibuloplasty With a Skin Graft
• Marginal Mandibulectomy in an Edentulous Patient
• Marginal Mandibulectomy of the Retromolar Area in a Dentate Patient
• Segmental Mandibulectomy
- Segmental Mandibulectomy With Neck Dissection (Commando Operation)
• Segmental Mandibulectomy and Reconstruction With a Fibula Free Flap
 DIFFERENTIAL DIAGNOSIS
• Squamous cell carcinoma Leukoplakia
• Carcinoma in situ Sarcoma
• Lymphoma Rhabdomyoma
• Neurofibroma Pyogenic granuloma
• Papilloma Vascular or lymphatic malformation
• Lingual thyroid Dermoid cyst
• Epidermoid cyst
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CASE REPORT
• Name : Mr. MS
• Age : 60 years old
• Gender : Male
• No. RM : 01.94.53.86
 ANAMNESIS
29

• Chief complaint: Lump on the left tongue

• The left tongue lump has been felt since 6 months ago, gradually getting
bigger from small. Complaints are accompanied by a feeling of prop on
the right tongue. Complaints are accompanied by difficulty moving the
tongue (+). Difficulty swallowing (+) eating solid food but still able to eat
soft food. Choking history is refuted.
• Initially there was a small lump and sores on the right tongue, patients
often experience mouth ulcers due to friction on the tongue.
• 30 years of smoking history but had stopped for 5 years.
• History of recurrent infections (+), oral hygiene (-).
• History of HT, DM, allergies is denied
Physical Examination
Patient’s Pic
ENDOSCOPY OF
LARYNX
16/10/2020
MSCT SCAN
SPN
17/11/2020
POST KONTRAS
MSCT SCAN
17/11/2020
POST KONTRAS
PEMERIKSAAN HISTOPATOLOGI
19/09/2020
• NO PA : J-20-498
• Organ : Ulkus lidah
• Makroskopis :
Satu pot jaringan indentitas sesuai keterangan : tumor lidah. Jaringan pecah
belah +/- 0.5 cc warna putih kecoklatan sebagian hitam semua cetak
• Mikroskopis :
Sediaan menunjukkan fragmen-fragmen jaringan dilapisi spitel skuamosa
kompleks hiperplastik, sebagian ulserasi, sebagian menjadi tumor dengan sel sel
pleomorfi, sitoplasma sedikit sampai sedang, eosinofilik, inti bulat, oval, kromatin
besar, sebagian anak inti terikat, mitosis didapatkan. Stroma dengan nekrosis dan
perdarahan disebuk limfosit makrofag dan limfosit PMN
Kesimpulan : Biopsi tumor lidah. Squamous Cell Carcinoma
PEMERIKSAAN AJH
02/11/2020
• NO PA : TRS-20-709
• Organ : colli sinistra
• Makroskopis :
Dilakukan AJH dengan panduan USG pada regio colli sinistra
• Mikroskopis :
Sediaan sitologi AJH dan blok sel menunjukkan sedikit sel radang tersebar terdiri
atas cukup limfosit dan sedikit neutrofil dengan latar belakang eritrosit merata
dan massa amorf.
Tidak didapatkan sel ganas.
Kesimpulan : Sitologi AJH (FNAB) dengan panduan USG dan blok sel regio colli
sinistra: Tidak didapatkan sel ganas.
Pendapat: Radang kronis
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DIAGNOSIS

Tongue Cancer
(Pa: Squamous cell carcinoma )
T2N1M0 Stadium III
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PLANNING

Hemiglosektomi + Selective neck

dissection
Thursday 1 November 2020.
Problem
• The Recurrency
Discussion
• T stage and N stage were important factors affecting regional
recurrence in OSCC.
• Co-morbidities, degree of tumor differentiation, and tumor stage
were important prognostic factors for recurrence.
• Oral cancer can come back in these places:
- Where you first had it. Doctors call this a “local” recurrence.
- In the same general area as before, like nearby lymph nodes. This is a “regional” recurrence.
- In other parts of your body, like your bones or lungs. This is a “distant” recurrence.
Discussion
Signs of recurrence depend on where it happens. Common signs include:
• New lump or growth in your mouth or around your face or neck
• Voice changes
• Swallowing problems
• Mouth sore that doesn’t heal
• Ear or jaw pain
• Ongoing tiredness
• Unexplained weight loss
• Shortness of breath
• Bone pain or break
 DISCUSSION 40
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ANAMNESIS
Male 61 years old
The left tongue lump has been felt
since 6 months ago, gradually
getting bigger from small.
Complaints are accompanied by a
feeling of prop on the right tongue.
Complaints are accompanied by
difficulty moving the tongue (+).
Difficulty swallowing (+) eating
solid food but still able to eat soft
food.
THEORY
• Older Age
• A history of smoking and/or alcohol use
with a non-resolving oral cavity/tongue
lesion.
• A history of accidental trauma to the region
• Localized pain.
• Dysphagia, weight loss, dysarthria, and
odynophagia.
• The patient’s ability to tolerate his usual diet

Bousquet J,2008
 DISCUSSION 41
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Physical Examinations THEORY

Initially there was a small lump and sores on the • Description of the lesion or mass (location, general
right tongue, patients often experience mouth appearance, color, shape, margins, and the presence or
absence of ulceration)
ulcers due to friction on the tongue

Bousquet J,2008
 DISCUSSION 41
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Risk Factor THEORY

• 30 years of smoking history but had stopped • Heavy smoking
for 5 years. • Alcohol use
• History of recurrent infections (+) • HPV infection

Bousquet J,2008
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