CARCINOMA OF TONGUE

(CASE PRESENTATION)

AROOBA ALI
2019/170
 CASE
• Mr. Abdul Qayoum, a 52-year-old male, presented with a
painful ulceration on the left side of his tongue that had been
present for the last 6 weeks. He reported a history of heavy
smoking and alcohol consumption for over 30 years. On
examination, a 3 cm ulcerative lesion with irregular margins
was noted on the left lateral border of his tongue. The lesion
was firm, fixed to underlying tissues, and bled on palpation.
The submandibular lymph nodes were palpable and enlarged.
 HISTORY

• SMOKING HABITS
• ALCOHOL CONSUMPTION
• TOBACCO CHEWING
• ANY DIETARY DEFICIENCY LIKE RIBOFLAVIN AND IRON
• DENTAL INFECTION
• JAGGED SHARP TEETH
• ANY DENTURES
• History of loss or loosening of teeth (whether or not has invaded
mandible)
• History of recurrent oral ulcers (syphilitic ulcer)?
• History of mass in neck (any palpable lymph nodes)?
• History of radiation exposure to head and neck region?
• Association with any discharge/bleeding/ulceration?
• Association with difficulty in swallowing (lingual or
auriculotemporal nerve)?
• Speech or decrease in mouth opening (medial/lateral pterygoid
muscles) or ear pain?
 EXAMINATION
• SITE of tongue
• SIZE
• SURFACE
• MARGINS
• TENDERNESS
• Apperance of teeth
• LEUKOPLAKIC PATCH
• BLEEDING ON TOUCH
 INTRODUCTION

• Carcinoma involving anterior two-thirds of tongue is

commonly seen in men in the age group of 50–70 years.
• It may also occur in younger age group and in females.
• majority are squamous cell type.
Site
• Most common site is middle of the lateral border or the ventral
aspect of the tongue. Uncommonly, the tip or the dorsum may
be involved.
Spread
• Locally, it may infiltrate deeply into the lingual musculature
causing ankyloglossia or may spread to the floor of mouth,
alveolus and mandible. Lymph node metastases go to the
submandibular and upper jugular nodes (from the lateral border
of tongue) and to the submental and jugulo-omohyoid group
(from the tip). Bilateral or contralateral nodal involvement can
also occur
Clinically, cancer of the oral tongue presents as:
• (a) An exophytic lesion like a papilloma
• (b) A non healing ulcer with rolled edges, greyish white shaggy
base and induration
• (c) A sub mucous nodule with induration of the surrounding
tissue.
 SYMPTAMOLOGY

• Early lesions are painless and remain asymptomatic for a long

time.
• Pain in the tongue locally at the site of ulcer.
• Pain in the ipsilateral ear; it is due to common nerve supply of
the tongue (lingual nerve) and ear (auriculo temporal) from the
mandibular division of the trigeminal nerve.
• A lump in the mouth.
• Enlarged lymph node mass in the neck.
• Dysphagia, difficulty to protrude the tongue, slurred speech and
bleeding from the mouth are late features
• Trismus, involvement of pterygoid muscles
 INVESTIGATIONS
• BIOPSY (FNAC)
• Plain X-rays
• Orthopantomogram to see the involvement of mandible and
maxilla
• CT (helpful for assessing deeper extent of tumor, involvement
of pterygoid muscle, erosion of bone)
• MRI for soft tissue involvement
 TREATMENT
• Aim of treatment is to treat primary tumour in the tongue, control
neck disease (nodal metastasis) and preserve function of the tongue
as much as possible.
• Small tumours (T1N0) give equal results if treated with radiotherapy
or surgery.
• T2N0 tumours can also be treated by radiotherapy including the neck
nodes to eliminate micrometastases. They can also be treated by
surgical excision with prophylactic neck dissection.
• Stage III or IV tumours require combined treatment with surgery and
postoperative radiotherapy. It gives better results than either modality
alone. Block dissection neck is always done.
• Depending on the size and extent of the primary lesion of the
tongue, surgery may consist of hemiglossectomy including a
portion of the floor of mouth, segmental or
hemimandibulectomy and block dissection of neck nodes—the
so-called “commando operation.”
 REFERENCES
• Diseases of EAR, NOSE & THROAT Book by P. L.
Dhingra and Shruti Dhingra
• Udairpurwala
• https://www.cureus.com/articles/65563-tongue-cancer-in-
a-young-male#!/
• https://www.ncbi.nlm.nih.gov/books/NBK562324/