Tongue cancer refers to cancers that involve the structures of the oral tongue. The type of cancer (e.g., sarcoma, squamous cell cancer, adenoid cystic cancer) depends on the type of cell in the tongue from which the cancer originates. 

The tongue is a muscle covered with a skin lining (referred to as mucosa) and minor salivary glands. The tongue also has nerves.

The oral tongue is the front two-thirds of the tongue. This includes the tip, lateral tongue, the dorsal surface and the ventral surface. Cancers of the areas near the tongue, such as teeth, gums and underneath the tongue (floor of the mouth), can also impact the oral tongue. 

The tongue is vital for speech, chewing and swallowing. 

What are the symptoms of tongue cancer? 

Common symptoms of tongue cancer include: 

• A sore that does not heal on the tongue 
• A white or red patch on the tongue 
• A painful lump on the tongue 
• Unusual bleeding, pain or numbness of the tongue
• Pain in the ear that does not go away 
• Pain while swallowing or chewing or difficulty swallowing or chewing 
• Change in articulation

Symptoms vary among people with tongue cancer, and some symptoms resemble those of other medical problems. Always consult your practitioner for a diagnosis. Some people with tongue cancer do not have symptoms other than a lesion on the tongue. 

What are the causes of tongue cancer? 

Many people are diagnosed with tongue cancer without a known cause. Established causal agents include:

• Tobacco use (including cigarettes, cigars, pipes and smokeless forms) 
• Alcohol use 
• Human papillomavirus (HPV) infection 

The frequency of tongue cancer in people without recognized risk factors is growing.

How is tongue cancer evaluated and diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for tongue cancer may include one or more of the following:

• Biopsy: A procedure during which tissue samples are removed from the body. Typically, when tongue cancer is suspected, a biopsy is performed in the office with local anesthesia, and the sample is sent to pathology for evaluation under a microscope to determine if cancer or other abnormal cells are present. Samples are sometimes collected from the lymph nodes in the neck by using a needle.  
• Endoscopy: A small fiber-optic scope can be used to examine the throat to determine the extent of tongue cancer. 
• Computerized tomography (CT) scan or magnetic resonance imaging (MRI): These noninvasive procedures take images in the body to detect abnormalities that may not show up on an ordinary X-ray. 
• Ultrasonography: This noninvasive procedure uses high-frequency sound waves to create an image of internal organs. For tongue cancer, ultrasonography may be used to examine or collect biopsies from the lymph nodes in the neck. 
• Positron emission tomography (PET)/CT scan: This noninvasive procedure uses special radioactive dyes that may help detect cancer in the body.

Once a diagnosis is made, the cancer is staged to identify the extent of the cancer before a treatment plan is established. The patient’s health-care practitioner determines which tests are needed.

What is the treatment for tongue cancer? 

Treatment options for tongue cancer include surgery, radiation therapy and chemotherapy. Only one type of treatment or a combination of treatments may be needed. Recommendations are usually made after consultation among oncologists on a multidisciplinary team (head and neck surgeons, radiation oncologists and medical oncologists) and a speech-language pathologist. 

• Surgery: Surgery for tongue cancer includes different surgical techniques that depend on the location, size and extent of the cancer. Surgery may be needed to remove the cancer from the mouth as well as to repair (reconstruct) the tongue after the cancer is removed. Surgery may also be necessary to remove the lymph nodes from the neck if there is concern that the cancer may have spread there. 
• Radiation therapy: Radiation therapy uses high-energy rays that damage cancer cells and halt spread of the disease. Radiation therapy is very localized and is aimed at only the area where the cancer is present. This therapy is usually given externally with a machine, but it can be delivered internally with radioactive materials. For tongue cancer, radiation therapy is typically reserved for after surgery. 
• Chemotherapy: Chemotherapy uses medications that go throughout the entire body to kill cancer cells. Chemotherapy may be given alone, or it can be used in combination with surgery or radiation therapy. For tongue cancer, chemotherapy is typically given with radiation therapy and is usually reserved for patients with adverse features on a pathology report after surgery. 
• Immunotherapy: Immunotherapy uses medications that help the body’s immune system fight the cancer. It may be given to people with advanced tongue cancers before surgery in a clinical trial. 

Treatment is determined based on: 

• The patient’s age, overall health and medical history 
• The location, size and extent of the cancer 
• The patient’s tolerance for specific medications and procedures
• Expectations for the course of the disease

Tongue Cancer Prevention

Although tongue cancer can’t be completely prevented, there are ways to reduce risk:

• Do not smoke or use tobacco products.
• Do not vape.
• Limit alcohol intake or abstain completely.
• Have regular dental exams.
• Get an HPV vaccine.

Tongue Cancer Survival Rates

Keep in mind that survival rates are based on averages and don’t necessarily reflect an individual patient’s outcome — they compare people with cancer to those in the general population. Every patient is different, and what works for one person might not work for another. 

For tongue cancer, the five-year survival rate depends on whether the cancer has spread. In general, the earlier the cancer is caught, the more likely it is to be successfully treated. 

• If the cancer is localized, meaning it has not spread beyond the tongue, the five-year survival rate is about 85%.
• If the cancer is regionalized, meaning it has spread to nearby lymph nodes or structures, the five-year survival rate is about 70%.
• If the cancer is distant, meaning it has spread to other areas of the body, the five-year survival rate is about 40%.