Squamous carcinoma of the tongue: review

doi:10.1054/bjom.1999.0031

British Journal of Oral and Maxillofacial Surgery

Volume 37, Issue 3, June 1999, Pages 164-174

https://doi.org/10.1054/bjom.1999.0031 Get rights and content

Abstract

Carcinoma of the tongue is a common condition treated by oral and maxillofacial surgeons. The tongue is a complex anatomical site at the entrance of the oropharynx, bounded by the floor of mouth and lingual mandibular cortex; its form and mobility are crucial for efficient swallowing; speech, and the appreciation of taste. Single and multiple treatments have been used, but the tongue remains a difficult area to assess and treat. In this paper, we have attempted to review some of the papers published over the last 20 years with particular reference to prognosis and functional outcome. We have dealt exclusively with squamous cell carcinoma of the tongue and its management by surgery, radiotherapy, brachytherapy, photodynamic therapy, and chemotherapy.

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The effects of Emblica officinalis and Tinospora cordifolia herbal treatment on the prognosis of squamous cell carcinoma of the buccal mucosa and tongue
2018, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
The fruit of Emblica officinalis (Eo) and Tinospora cordifolia (Tc) has been widely consumed as a folk medicine in Southeast Asia due to its nutritional and pharmacological effects. Number of laboratory research showed these herbs have an inhibitory effect on cancer cells. A randomized double blind prospective clinical trial was conducted during 2005–2009 to determine whether a herbal preparation made from Eo and Tc has a prognostic effect in the treatment of oral cancer.
The study group comprised of 114 patients with oral squamous cell carcinoma (OSCC) of buccal mucosa (70) and tongue (44). Following conventional treatment they were randomly assigned to a trial (51) and a control group (63). The trial group was administered a herbal regimen consisting of Eo and Tc in powdered form and the control group a placebo for three months. The efficacy of the herbal regimen in the prognosis of OSCC patients was analysed by the recurrence free survival and incidence of recurrences in relation to patient’s age and stage of the lesions.
The results, showed statistically significant improvements in the prognosis of the trial group consisted of OSCC buccal mucosa with greatly reduced local (p = 0.02) and overall recurrences (p = 0.05). The trial group of OSCC of the tongue, showed a highly statistically significant reduction in nodal (p = 0.01) and overall recurrences (p = 0.01).The reduction of nodal recurrence was greater in the OSCC tongue group. Five-year combined recurrence-free survival of the trial groups together (62.7%) was significantly better, in comparison to (42.3%) the control group (p = 0.031).
Elective neck dissection in unilateral carcinomas of the tongue: Unilateral versus bilateral approach
2017, Journal of Cranio-Maxillofacial Surgery
Elective neck dissection (END) is a common primary treatment strategy for oral tongue squamous cell carcinoma (OTSCC), although uncertainty remains regarding the necessary extent of END for strictly unilateral early stage OTSCC. The authors evaluated two END variations, unilateral and bilateral, to determine the optimal extent.
A retrospective cohort study was performed on patient data from two departments of oral and maxillofacial surgery. All previously untreated patients from both clinics who were diagnosed with early-stage (pT1-2) unilateral OTSCC were included. The following variables were collected: age, gender, END type/extent, tumor localization, later nodal metastasis, and TNM status. Statistical analyses were performed (p < 0.05).
A total of 150 patients were identified, 105 receiving unilateral END and 45 bilateral END. The rates of postoperative positive lymph nodes were 21.9% for ipsilateral END and 26.7% for bilateral END (bilateral END: all positive nodes ipsilateral). In all, 14 patients in the ipsilateral group developed nodal metastasis during tumor aftercare (11 patients ipsilateral, 3 patients contralateral neck). In the bilateral group, nodal metastasis was later observed in 4 cases (8.9%; 3 cases ipsilateral, 1 case contralateral neck). Statistical analysis could not detect significant differences between the END procedures.
As both procedures lead to similar results in preventing or omitting possible later nodal metastasis, the two methods seem to be valuable alternatives. In conclusion, we recommend bilateral END because of advantages with regard to oncologic safety and esthetic outcome, but the decision for END should always be according to the patient's general health status, comorbidities, and individual tumor risk profile.
Relationship between proliferative activity of tumor cells and the enlargement pattern of metastatic lymph nodes in oral squamous cell carcinomas
2017, Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology
This study was conducted to investigate the time-course changes in the size of metastatic lymph nodes and determine their relationship with the histological features of oral squamous cell carcinomas (OSCC).
Thirteen metastatic lymph nodes from 13 OSCC patients were examined in this study. The cervical lymph nodes were periodically followed up with ultrasonographic examination and diagnosed as metastatic when the minimum axis of the nodes (size) reached ≥8 mm in three-dimensional measurements. Enlargement patterns of the metastatic nodes were compared with the histological features and proliferative activity of tumor cells by Ki-67 immunostaining of the primary tumors and nodes.
The enlargement patterns of the metastatic lymph nodes were classified into two types: rapid enlargement (RE), which involved rapid increase in node size, and slow enlargement (SE), which involved slow increase and fluctuation in size. No significant differences in histological findings between the RE and SE types were observed in the primary tumors or metastatic nodes. On the other hand, Ki-67 scores in primary tumors and metastatic foci were associated with the enlargement pattern of the metastatic nodes, wherein metastatic nodes of the RE type showed significantly higher Ki-67 scores than those of the SE type.
The proliferative activity of primary tumors can be a valuable marker for predicting the speed of enlargement of metastatic lymph nodes. In addition, it may aid in reaching a decision regarding follow-up duration in N0 neck cancer patients.
A new surgical strategy for treatment of tongue squamous cell carcinoma based on anatomic study with preliminary clinical evaluation
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This study characterized the infiltration of primary tumors along the intrinsic and extrinsic muscles of the tongue in oral tongue squamous cell carcinoma (OTSCC), to create a new surgical strategy that is suitable for most stages. A preliminary evaluation of this novel surgical approach was also conducted.
An anatomic study of macroscopic specimens from 10 human cadavers and 100 OTSCC patients was conducted. The anatomic characteristics of the primary tumors and the origin and distribution of fibers of the intrinsic and extrinsic tongue muscles were observed and measured. After initial treatment with curative intent, the 100 patients were regularly followed-up with clinical examination and imaging.
Based on the anatomic characteristics of the primary tumors and tongue muscles, a new surgical approach was developed, and was described as muscle anatomy tongue surgery (MATS). MATS proved suitable for almost all stages of OTSCC. According to the morphology of the invasive tumor front, the 100 cases were divided into four types. The rate of 2-year local disease control was 98%, locoregional control 86%, disease-free survival 85%, and overall survival 89%. Tongue functions were perfectly recovered in more than 60% of the patients.
Application of the principles of MATS to the treatment of OTSCC proved suitable for almost all stages of the disease. MATS is a novel surgical technique that may improve outcomes in tongue cancer surgery.
Relationship between appearance of tongue carcinoma on intraoral ultrasonography and histopathologic findings
2014, Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Citation Excerpt :
This study was not able to confirm tumor infiltration patterns and histopathologic malignancy as factors associated with cervical lymph node metastasis, but a significant relationship was noted between invasive depth and cervical lymph node metastasis. The representative method for measuring the histologic grade of oral squamous cell carcinoma includes the Jacobsson classification15 and Willen classification16 as well as the Anneroth classification.17 According to these classifications, 6 to 8 factors in the tumor host borderline are made into scores, and the malignancy grades are evaluated by the total score, thereby providing high usability; however, it is not applicable for actual use because it is difficult to perform.
To clarify whether intraoral ultrasonography (I-US) is effective for predicting metastasis of tongue cancer to the cervical lymph nodes.
Participants comprised 29 patients with tongue carcinoma classified as T1-T4 using the TNM staging system. All patients underwent I-US preoperatively. Postoperatively, resected specimens were evaluated histopathologically.
I-US found that cases with invasive depth ≥3 mm had higher potential for cervical lymph node metastasis than those with invasive depth <3 mm (P < .05). No other significant relationships were identified between observations on I-US and cervical lymph node metastasis. Cases with histopathologic blood vessel infiltration or lymph duct infiltration had a significant difference in risk of cervical lymph node metastasis.
I-US is useful for preoperatively assessing the invasive depth of tongue carcinoma. Furthermore, observations from I-US and invasive depth of the tumor allowed presumptive diagnosis with regard to cervical lymph node metastasis.
Assessment of speech in patients undergoing hemiglossectomy with primary closure and radiotherapy - A prospective study
2022, Annals of Maxillofacial Surgery

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Regular ArticleSquamous carcinoma of the tongue: review

Abstract

J Oral Maxillofac Surg

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Br J Maxillofac Surg

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Int J Radiat Oncol Biol Phys

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Int J Radiat Oncol Biol Phys

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Br J Oral Maxillofac Surg

J CranioMaxilloFac Surg

J CranioMaxilloFac Surg

Am J Surg

Am J Surg

Am J Surg

Br J Oral Maxillofac Surg

Cancer incidence in five continents. Vol. V IARC Scientific Publications No. 88

Oral cancer: a comparative study between 1962–67 and 1980–84 in England and Wales

Br Dent J

Epidermoid carcinoma of the mouth and pharynx 1960–1964

J Laryngol Otol

Oral cancer in young adults less than 40 years of age: Rationale for aggressive therapy

Head Neck

Incompleteness of oral cancer registration in south-east England

Br J Cancer

Risk factors for cancer of the tongue and the mouth

Cancer

Smoking, gender and age as risk factors for site-specific intraoral squamous cell carcinoma

Cancer

Carcinogenic effect of tobacco smoking and alcohol drinking on anatomic sites of the oral cavity and oropharynx

Int J Cancer

Smoking and drinking in relation to oral and pharyngeal cancer

Cancer Res

Quantification of the role of smoking and chewing tobacco in oral, pharyngeal and oesophageal cancers

Br J Cancer

Dietar indicators of oral and pharyngeal cancer

Int J Epidemiol

Dietary factors in oral and pharyngeal cancers

J Nat Cancer Inst

Vitamin supplement use and reduced risk of oral and pharyngeal cancer

Am J Epidemiol

Regular Article
Squamous carcinoma of the tongue: review