Squamous Cell Carcinoma Tongue: Risk Factors, Symptoms & Treatment

Introduction

Squamous cell carcinoma (SCC) of the tongue is a type of oral cancer that begins in the thin, flat cells lining the surface of the tongue. It is one of the most common forms of oral cancer and can be aggressive if not detected early. Historically, SCC of the tongue has been associated with lifestyle factors such as tobacco and alcohol use, but other causes, including human papillomavirus (HPV), have also been identified. This article provides a comprehensive overview of SCC of the tongue, covering its risk factors, symptoms, diagnostic tests, treatment options, and tips for managing symptoms at home. Understanding these aspects can help patients engage in more informed discussions with their healthcare providers and make well-informed decisions about their care.

Definition

Squamous cell carcinoma of the tongue is a type of cancer that affects the cells on the tongue’s surface. This article will explore its risk factors, symptoms, diagnostic tests, treatments (including medications and procedures), and strategies for managing symptoms at home.

Description of Squamous Cell Carcinoma of the Tongue

Squamous cell carcinoma of the tongue is a malignant tumor that originates in the squamous cells, which are thin, flat cells on the surface of the tongue. These cells can become cancerous when exposed to certain risk factors, leading to uncontrolled growth and tumor formation. SCC of the tongue can occur on the front (anterior) or base (posterior) of the tongue, with the latter often being more difficult to detect in its early stages.

SCC of the tongue typically begins as a small lesion or sore that does not heal. Over time, the cancer can invade deeper tissues and spread to nearby lymph nodes or other parts of the body, such as the lungs. Early detection is crucial for improving outcomes, as advanced stages are more challenging to treat.

According to the American Cancer Society, oral cancers, including SCC of the tongue, account for about 3% of all cancers in the United States. It is more common in men than women and tends to occur in individuals over 50. However, younger individuals, particularly those with HPV-related cancers, are also at risk.

Risk Factors for Developing Squamous Cell Carcinoma of the Tongue

Lifestyle Risk Factors

Several lifestyle factors increase the risk of developing SCC of the tongue. One of the most significant is tobacco use, including smoking cigarettes, cigars, or pipes, as well as using smokeless tobacco products like chewing tobacco. The chemicals in tobacco can damage the cells in the mouth and tongue, leading to cancerous changes over time.

Alcohol consumption is another major risk factor. People who drink alcohol excessively, especially in combination with tobacco use, have a much higher risk of developing oral cancers, including SCC of the tongue. The combination of alcohol and tobacco has a synergistic effect, meaning the two together are more harmful than either alone.

Poor oral hygiene and a diet low in fruits and vegetables may also contribute to the risk of developing SCC of the tongue. A healthy diet rich in vitamins and antioxidants can help protect the body’s cells from damage.

Medical Risk Factors

In addition to lifestyle factors, certain medical conditions can increase the risk of SCC of the tongue. One of the most notable is infection with the human papillomavirus (HPV), particularly HPV-16, which has been linked to a growing number of oral cancers. HPV-related cancers tend to occur in younger individuals and may have a different prognosis than those caused by tobacco and alcohol use.

A weakened immune system is another important medical risk factor. People with compromised immune systems, whether due to conditions like HIV/AIDS or medications that suppress the immune system (such as those used in organ transplants), are at higher risk for developing SCC of the tongue.

Chronic irritation of the tongue, such as from poorly fitting dentures or sharp teeth, may also contribute to SCC development. Constant irritation can cause changes in the cells of the tongue, increasing the likelihood of cancer.

Genetic and Age-Related Risk Factors

Age is a significant risk factor for SCC of the tongue, with most cases occurring in individuals over 50. As people age, their cells undergo more wear and tear, increasing the likelihood of genetic mutations that can lead to cancer.

There may also be a genetic component to SCC of the tongue, although this is less well understood. Some individuals may inherit genetic mutations that make them more susceptible to developing cancers, including those of the tongue. However, lifestyle and environmental factors typically play a larger role.

It is important to note that while certain risk factors increase the likelihood of developing SCC of the tongue, not everyone with these risk factors will develop the disease. Conversely, some people with no known risk factors may still develop SCC. Regular check-ups and being aware of any changes in your mouth or tongue are essential for early detection.

Clinical Manifestations

Sore Throat

A sore throat is a common symptom of squamous cell carcinoma of the tongue, occurring in about 60% of patients. It may be more prevalent in the early stages, especially when the tumor is located at the base of the tongue. The persistent sore throat is caused by the tumor irritating surrounding tissues, leading to inflammation and discomfort. Unlike a typical sore throat from a cold or infection, this pain does not resolve with time or over-the-counter treatments. Patients may notice that the pain worsens when swallowing or speaking, and it may radiate to the ears.

Difficulty Swallowing (Dysphagia)

Difficulty swallowing, or dysphagia, affects approximately 50-70% of patients with squamous cell carcinoma of the tongue. This symptom often occurs as the tumor grows, obstructing the normal passage of food and liquids through the throat. Dysphagia can range from mild discomfort to severe pain, making it difficult to swallow even soft foods or liquids. In advanced stages, patients may experience choking or coughing when trying to swallow. This symptom is particularly concerning because it can lead to malnutrition and dehydration if not addressed.

Mouth Ulcers

Mouth ulcers are present in about 40-50% of patients with squamous cell carcinoma of the tongue. These ulcers are typically persistent, painful, and do not heal over time, unlike common canker sores. The ulcers may appear as open sores on the tongue’s surface and can bleed or become infected. The presence of non-healing ulcers is a key indicator of potential malignancy, and patients should seek medical attention if they notice any persistent sores in their mouth that do not resolve within two weeks.

Persistent Pain

Persistent pain in the tongue or mouth is reported by approximately 60-80% of patients with squamous cell carcinoma of the tongue. This pain is often described as a dull ache or burning sensation that does not go away. It can be exacerbated by eating, drinking, or speaking. The pain is caused by the tumor invading nearby tissues and nerves, leading to inflammation and irritation. In some cases, the pain may radiate to the jaw or ears, making it difficult for patients to pinpoint the exact source of discomfort.

White Patches (Leukoplakia)

White patches, also known as leukoplakia, are seen in about 30-40% of patients with squamous cell carcinoma of the tongue. These patches are areas of thickened, white tissue that cannot be scraped off. Leukoplakia is considered a precancerous condition, meaning it can develop into cancer over time. In patients with squamous cell carcinoma of the tongue, the presence of leukoplakia may indicate early-stage disease. It is important for patients to monitor any white patches in their mouth and seek medical evaluation if they persist or change in appearance.

Red Patches (Erythroplakia)

Red patches, or erythroplakia, are less common than white patches but are more concerning. They occur in about 10-20% of patients with squamous cell carcinoma of the tongue. Erythroplakia appears as red, velvety areas on the tongue’s surface and may be associated with a higher risk of malignancy. These patches are often painless but can become sore or bleed as the disease progresses. Erythroplakia is considered a more serious finding than leukoplakia, as it is more likely to be associated with cancerous changes.

Swelling

Swelling of the tongue or surrounding tissues is a symptom experienced by approximately 40-60% of patients with squamous cell carcinoma of the tongue. The swelling is caused by the tumor growing and pressing against nearby structures, leading to inflammation and fluid accumulation. In some cases, the swelling may be visible as a lump or thickened area on the tongue. This can make it difficult for patients to speak, chew, or swallow, and may cause discomfort or pain.

Changes in Taste

Changes in taste, or dysgeusia, occur in about 30-40% of patients with squamous cell carcinoma of the tongue. Patients may notice that foods taste different or that they have a persistent metallic or bitter taste in their mouth. This symptom is caused by the tumor affecting the taste buds or nerves responsible for transmitting taste signals to the brain. In some cases, patients may lose their sense of taste altogether, which can lead to a decreased appetite and weight loss.

Bleeding

Bleeding from the tongue or mouth is reported in approximately 20-30% of patients with squamous cell carcinoma of the tongue. The bleeding is usually caused by the tumor eroding blood vessels in the tongue or surrounding tissues. Patients may notice blood in their saliva or when brushing their teeth. In some cases, the bleeding may be spontaneous, while in others, it may be triggered by eating or speaking. Persistent or unexplained bleeding from the mouth should always be evaluated by a healthcare provider.

Lumps in the Neck

Lumps in the neck, also known as cervical lymphadenopathy, are a common symptom of advanced squamous cell carcinoma of the tongue, occurring in about 50-70% of patients. These lumps are caused by the cancer spreading to the lymph nodes in the neck. The lumps are usually painless but may become tender or swollen as the disease progresses. The presence of enlarged lymph nodes is a concerning sign that the cancer has spread beyond the tongue and may require more aggressive treatment.

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Treatment Options for Squamous Cell Carcinoma of the Tongue

Medications for Tongue Cancer

Cisplatin

Cisplatin is a chemotherapy drug that damages the DNA of cancer cells, preventing them from dividing and growing. It is commonly used to treat squamous cell carcinoma of the tongue.

Administered through an IV, cisplatin is often combined with other chemotherapy drugs or radiation therapy. It is frequently a first-line treatment for advanced or metastatic squamous cell carcinoma of the tongue.

Patients may experience tumor shrinkage and symptom relief, though the full effects may take several weeks, and multiple treatment cycles are often necessary.

Carboplatin

Carboplatin is similar to cisplatin but tends to have fewer side effects. It also interferes with the DNA of cancer cells, stopping their growth.

Carboplatin is used when cisplatin is not well-tolerated. It is often combined with other chemotherapy agents and radiation therapy in advanced stages of squamous cell carcinoma of the tongue.

Like cisplatin, carboplatin can shrink tumors and improve symptoms, with outcomes depending on the cancer stage and the patient’s overall health.

Docetaxel

Docetaxel inhibits cancer cell growth by disrupting their ability to divide. It is used to treat various cancers, including squamous cell carcinoma of the tongue.

Typically combined with other chemotherapy agents like cisplatin or carboplatin, docetaxel is often used when the cancer has spread or when other treatments have failed.

Patients may experience tumor reduction, though side effects like fatigue and nausea are common. Full benefits usually appear after several treatment cycles.

Paclitaxel

Paclitaxel prevents cancer cells from dividing and is commonly used to treat head and neck cancers, including squamous cell carcinoma of the tongue.

Often combined with other chemotherapy drugs, paclitaxel is used in advanced or recurrent cancer cases and may be paired with radiation therapy.

Patients can expect symptom improvement and tumor reduction, though outcomes depend on the cancer stage and individual response to treatment.

Cetuximab

Cetuximab is a targeted therapy that blocks the epidermal growth factor receptor (EGFR), which is often overexpressed in squamous cell carcinoma of the tongue. By blocking this protein, cetuximab helps slow or stop cancer growth.

Typically used with radiation therapy or chemotherapy, cetuximab is reserved for advanced cases where other treatments have failed or when the cancer has spread.

Patients may experience slowed cancer growth and symptom relief, though cetuximab is not a cure, and its effectiveness varies by case.

Pembrolizumab

Pembrolizumab is an immunotherapy drug that helps the immune system recognize and attack cancer cells by targeting the PD-1 protein, which cancer cells use to evade detection.

Often used in advanced or metastatic squamous cell carcinoma of the tongue, especially when other treatments have failed, pembrolizumab may be used alone or with other therapies.

Patients may see symptom improvement and slowed cancer progression, though responses vary, and results may take several weeks.

Nivolumab

Nivolumab is another immunotherapy drug targeting the PD-1 protein, helping the immune system recognize and destroy cancer cells. Like pembrolizumab, it is used for advanced cancers.

Nivolumab is typically used when other treatments have failed. It may be used alone or with other therapies, depending on the patient’s health and cancer stage.

Patients may experience tumor reduction and symptom relief, though effectiveness varies from person to person.

Radiation Therapy for Squamous Cell Carcinoma of the Tongue

Radiation therapy uses high-energy beams to kill cancer cells or slow their growth. It is a common treatment for squamous cell carcinoma of the tongue, especially in early-stage cases.

Often combined with surgery or chemotherapy, radiation therapy may also be the primary treatment if surgery is not an option.

Patients can expect tumor reduction and symptom relief, though side effects like mouth sores and dry mouth are common.

Other Chemotherapy Options for Tongue Cancer

5-Fluorouracil (5-FU)

5-Fluorouracil (5-FU) interferes with the DNA and RNA of cancer cells, preventing them from growing and dividing.

Often combined with other chemotherapy drugs or radiation therapy, 5-FU is used to treat advanced squamous cell carcinoma of the tongue.

Patients may experience tumor shrinkage and symptom relief, though side effects like nausea and fatigue are common.

Doxorubicin

Doxorubicin damages the DNA of cancer cells, preventing them from dividing and growing.

Typically used with other chemotherapy drugs for advanced or recurrent squamous cell carcinoma of the tongue, doxorubicin can improve symptoms and reduce tumor size, though side effects like fatigue and nausea are common.

Procedures for Treating Tongue Cancer

Surgery

Surgery is often the first-line treatment for squamous cell carcinoma of the tongue, especially in early-stage cases. The goal is to remove the tumor and any affected tissue.

In advanced cases, surgery may involve removing part of the tongue (partial glossectomy) or nearby lymph nodes. Surgery is often followed by radiation therapy or chemotherapy to ensure all cancer cells are eliminated.

Patients can expect significant symptom reduction and, in some cases, a complete cure. However, recovery may take several weeks, and speech or swallowing difficulties may occur.

Neck Dissection

Neck dissection is a surgical procedure to remove lymph nodes in the neck that may contain cancer cells. It is often performed when squamous cell carcinoma of the tongue has spread to nearby lymph nodes.

This procedure is typically done alongside surgery to remove the primary tumor and may be followed by radiation therapy or chemotherapy.

Patients can expect a reduced risk of cancer recurrence, though recovery may take time, and there may be some loss of sensation or movement in the neck area.

Reconstructive Surgery

Reconstructive surgery is often needed after removing large tumors or parts of the tongue. The goal is to restore the appearance and function of the tongue and mouth.

This procedure may involve using tissue from other parts of the body to rebuild the tongue or mouth. It is typically done after cancer removal.

Patients can expect improved function and appearance, though full recovery may take several months.

Improving Squamous Cell Carcinoma of the Tongue and Seeking Medical Help

While medical treatments are essential for managing squamous cell carcinoma of the tongue, some home remedies and lifestyle changes can help improve your quality of life during treatment:

1. Maintain good oral hygiene: Keeping your mouth clean can help prevent infections and reduce discomfort.
2. Stay hydrated: Drinking plenty of water can alleviate dry mouth, a common side effect of radiation therapy.
3. Eat a balanced diet: Soft, nutritious foods can help you maintain strength and energy during treatment.
4. Avoid tobacco and alcohol: These substances can worsen symptoms and increase the risk of cancer recurrence.
5. Manage stress: Techniques like meditation, yoga, or counseling can help you cope with the emotional challenges of cancer treatment.

If you notice new or worsening symptoms, such as persistent mouth sores, difficulty swallowing, or unexplained weight loss, seek medical help. Telemedicine offers a convenient way to consult with healthcare providers from home, allowing you to discuss symptoms and receive guidance on treatment options without an in-person visit.

Living with Squamous Cell Carcinoma of the Tongue: Tips for Better Quality of Life

Living with squamous cell carcinoma of the tongue can be challenging, but there are steps you can take to improve your quality of life:

1. Follow your treatment plan: Adhering to prescribed treatments, including medications and therapies, is crucial for managing your condition.
2. Stay connected: Reach out to friends, family, or support groups to help cope with the emotional aspects of cancer.
3. Communicate with your healthcare team: Keep your doctors informed about any changes in symptoms or side effects so they can adjust your treatment as needed.
4. Focus on self-care: Rest, eat well, and engage in activities that bring you joy and relaxation.

Conclusion

Squamous cell carcinoma of the tongue is a serious condition that requires prompt diagnosis and treatment. With a range of treatment options, including surgery, chemotherapy, radiation therapy, and immunotherapy, many patients can achieve significant improvements in symptoms and quality of life.

Early diagnosis is key to successful treatment. If you notice any suspicious symptoms, seek medical care immediately. Our telemedicine practice offers a convenient way to consult with healthcare providers from home, ensuring timely and appropriate care.

James Kingsley

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