Information on the following diseases can be found in the Related Disorders section of this report:

• Cancer of the floor of the mouth
• Cancer of the cheek (mouth, buccal mucosa, carcinoma)

Generally, the first sign of squamous cell cancer of the oral tongue is a pinkish-red sore at the side of the tongue that persists and seems not to heal over time. Quite often, the sore bleeds easily if bitten or touched. If this occurs, it is recommended that the person see a physician, especially if the person is older than fifty.

In its earliest developmental period, squamous cell cancer of the base of the tongue is asymptomatic. This means that the cancer does not make itself known until later in its growth. However, symptoms may begin with pain in the tongue and surrounding tissue, changes in voice tones and sounds, and difficulty in swallowing that may lead to feelings of bloat or fullness. Because the early symptoms are dormant, most squamous cell cancers of the base of the tongue are further advanced by the time a patient sees a physician. Many patients will have already had squamous cancer cells in the lymph nodes of the neck (metastases).

The cause of tongue cancer is unknown. Inadequate oral hygiene and thickened white patches on the mucous membranes of the oral cavity (leukoplakia) may be a cause. The disorder is statistically linked with alcoholism, cirrhosis of the liver, excessive smoking, and syphilis.

Irritation by jagged teeth, projecting fillings and ill-fitting dentures may also be factors contributing to development of tongue cancer. As in some other types of cancer, the possibility of a genetic predisposition to malignancy may also be a factor.

Tongue cancer is most common in men over age 60. It is rare in people, particularly women, under age 40.

There are many types of mouth cancer. All types are relatively rare.

Carcinoma of the floor of the mouth is characterized by a hard growth that can be felt by the tip of the tongue. Pain in the ear, increased salivation, difficulty speaking and later bleeding, are signs of this disorder. This type of cancer may be caused by poor oral hygiene or irritation of the tissues by sharp teeth, ill-fitting dentures, smoking, etc. Frequently, the lymph nodes in the neck are also affected.

Carcinoma of the cheek (mouth, buccal mucosa, carcinoma) is characterized by a malignant lesion in the cheek, pain, difficulty chewing, spasms in the cheek muscles (trismus) and mucosal bleeding. The carcinoma may spread to the lymph glands under the jaw.

Diagnosis
Examination of a sample of tissue from the site of the suspected cancer by a qualified pathologist is the key to diagnosis. MRI and/or CAT scans may be ordered to determine the location and size of the growth. This examination will also determine the stage of the disorder (how advanced it may be), which in turn, will help determine the method and pace of treatment.

Treatment
Not all specialists agree on the form of treatment of an oral tumor at any particular stage. Most do, however, agree that any dental work that the patient may need should be taken care of before treatment of the cancer begins and that smoking must stop. Treatment usually consists of surgery followed by radiation therapy. Chemotherapy is less commonly administered.

Controversy exists among cancer specialists (oncologists) and among head & neck surgeons regarding which of several surgical procedures yields better outcomes. Controversy also exists regarding the used of implanted radioactive seeds (brachytherapy) as an alternative to external beam therapy. Regardless, early diagnosis and treatment is imperative, especially in individuals under 20 years of age.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

TEXTBOOKS
Sidransky D. Cancer of the Head and Neck. In: De Vita Jr Vt, Hellman S, Rosenburg SA. eds. Cancer: Principles and Practice on Oncology. 5th ed. J.B. Lippincott Company. Philadelphia, PA; 1997:779-81 (Oral Tongue), :783-86 (Base of Tongue).

REVIEW ARTICLES
Palme CE, Gullane PJ, Gilbert RW. Current treatment options in squamous cell carcinoma of the oral cavity. Surg Oncol Clin N Amer. 2004;13:47-70.

Lin DT, Subbaramaiah K, Shah JP, et al. Cyclooxygenase-2: a novel molecular target for the prevention of treatment of head and neck cancer. Heasd Neck. 2002;24:792-99.

Sciubba JJ. Oral cancer. The importance of early diagnosis and treatment. Am J Clin Dermatol. 2001;2:239-51.

Llewellyn CD, Johnson NW, Warnakulasuriya KA. Risk factors for squamous cell carcinoma of the oral cavity in young people—a comprehensive literature review. Oral Oncol. 2001;37:401-18.

Lingen M, Sturgis EM, Kies MS. Squamous cell carcinoma of the head and neck in nonsmokers: clinical and biologic characteristics and implications for management. Curr Opin Oncol. 2001;13:176-82.

McCann MF, Macpherson LM, Gibson J. The role of the dental practitioner in detection and prevention of oral cancer: review of the literature. Dent Update. 2000;27:404-08.

Yoleri L, Mavioglu H. Total tongue reconstruction with free functional gracilis muscle transplantation: a technical note and review of the literature. Ann Plast Surg. 2000;45:181-86.

Harrison LB. Applications of brachytherapy in head and neck cancer. Semin Surg Oncol. 1997;13:177-84

FROM THE INTERNET
Oral Cancer. What You Need To Know About. National Cancer Institute. nd. 27pp.
www.cancer.gv/cancertopics/wyntk/oral/allpages/print

Oral Cancer. CancerNet. National Cancer Institute. Last modified: 12/12/2000. 17pp.
www.medhelp.org/NIHlib/GF-458.html