Tongue Cancer in Ahmedabad

Tongue Cancer: What You Need to Know

Where tongue cancer starts

Most tongue cancers start on the side (lateral border) of the front, mobile part of the tongue. This part is in the mouth and is treated as oral cancer. Cancer of the back third of the tongue (base of tongue) behaves differently and is treated as throat cancer.

Symptoms of tongue cancer

• An ulcer on the side of the tongue that does not heal in two to three weeks
• A white or red patch on the tongue
• A hard lump or thickening in the tongue
• Pain on the tongue or pain spreading to the ear on the same side
• Bleeding from the tongue
• Difficulty moving the tongue, slurred speech or difficulty swallowing
• A lump in the neck

A sharp or broken tooth rubbing against the tongue can cause an ulcer, but if the ulcer does not heal within two weeks of fixing the tooth, a biopsy is essential.

Why tongue cancer needs early, expert treatment

The tongue is a muscle with a rich lymphatic supply, so tongue cancer can spread to the lymph nodes of the neck even when the tumor is small. Depth of invasion – how deep the tumor has grown – is one of the most important factors in planning treatment, which is why MRI is often used before surgery.

Treatment of tongue cancer

• Partial glossectomy: removal of the tumor with a margin of healthy tongue. Small defects heal well on their own or are closed directly.
• Hemiglossectomy or larger resections: removal of half or more of the tongue for larger tumors, usually followed by reconstruction.
• Neck dissection: removal of lymph nodes, advised for most tongue cancers except very thin, superficial tumors, because of the risk of hidden spread.
• Reconstruction: a thin, flexible free flap (often from the forearm or thigh) replaces the removed tongue tissue so that the remaining tongue can move for speech and swallowing.
• Radiation, with or without chemotherapy, after surgery when the pathology shows higher-risk features.

Life after tongue cancer surgery

Most patients with small tongue cancers speak and eat normally after healing. After larger resections, speech and swallowing therapy begins early and continues for several weeks. Patients are usually able to eat by mouth, though some need a soft diet for a longer period.

Maxillary Cancer in Ahmedabad (Upper Jaw Cancer)

What is maxillary cancer?

“Maxillary cancer” describes cancer involving the maxilla – the upper jaw bone that holds the upper teeth and forms the roof of the mouth and the floor of the nose and eye socket. It may start in the upper gum or hard palate (an oral cancer), or in the maxillary sinus above it (a sinus cancer).

Symptoms of maxillary cancer

• An ulcer or growth on the upper gum or palate
• Loose upper teeth or dentures that no longer fit
• Swelling of the cheek or palate
• A blocked nose or nosebleeds on one side
• Numbness of the cheek or upper lip
• Watering of the eye, double vision or bulging of the eye in advanced cases

Treatment of maxillary cancer

• Maxillectomy: removal of part or all of the upper jaw with the tumor. The extent depends on how far the cancer has spread.
• Reconstruction: an obturator (a custom dental prosthesis that fills the gap in the palate) or a free flap rebuilds the palate and cheek so the patient can speak and eat without food or liquid entering the nose.
• Radiation therapy after surgery for most sinus cancers and for advanced gum or palate cancers.
• Tumors extending upward toward the eye or brain may need combined surgery with the skull base cancer

Lower Jaw (Mandible) Cancer

Cancers of the lower gum, floor of the mouth and cheek can grow into the lower jaw. Treatment depends on how close the cancer is to the bone:

• Marginal mandibulectomy: removal of the upper rim of the jaw bone when the cancer is close to but not deep into the bone, keeping the jaw continuous.
• Segmental mandibulectomy: removal of a full segment of the jaw when cancer has invaded the bone.
• Fibula free flap reconstruction: the fibula (a non-weight-bearing bone of the lower leg) with its blood supply is shaped to replace the removed jaw. It can later hold dental implants in selected patients. See craniofacial surgery.

How Tongue and Jaw Cancers Are Diagnosed

• Examination of the mouth and neck
• Biopsy of the ulcer or growth
• MRI for tongue tumors (to measure depth) and CT for bone involvement of the jaw
• Ultrasound or fine-needle sampling of neck lymph nodes
• PET-CT for advanced cancers
• Dental assessment and treatment planning

Why Choose Dr. Vishal Choksi for Tongue and Jaw Cancer Surgery

• Fellowship-trained at Memorial Sloan Kettering Cancer Center, New York, in head and neck surgery
• Experience with glossectomy, maxillectomy, mandibulectomy and neck dissection
• Planning of reconstruction with free flaps and dental rehabilitation
• Multidisciplinary care with radiation oncology, medical oncology, speech therapy and prosthodontics at Apollo Ahmedabad
• More than 20 years of experience in head and neck surgery

Frequently Asked Questions About Tongue and Jaw Cancer

Is tongue cancer curable?

Yes. Early tongue cancer is often cured with surgery, frequently including removal of neck lymph nodes. Advanced tongue cancer can also be cured in many patients with surgery followed by radiation.

Will I be able to talk after tongue cancer surgery?

Most people can. After small resections speech usually returns to near normal. After larger resections, reconstruction and speech therapy help most patients speak understandably.

How much of the tongue is removed?

Only as much as needed to remove the cancer with a clear margin – usually about one centimetre of normal tissue around the tumor. The amount depends on the size and depth of the tumor.

Why does tongue cancer need a neck operation?

Tongue cancer can spread to neck lymph nodes early, sometimes without showing on scans. Removing the nodes lowers the risk of recurrence and tells the team whether radiation is needed.

What is maxillary cancer?

It is cancer involving the upper jaw bone (maxilla), starting either in the upper gum or palate, or in the maxillary sinus above the teeth.

What is an obturator?

An obturator is a custom-made dental prosthesis that closes the opening in the palate after part of the upper jaw is removed, allowing normal speech and eating.

Can a removed jaw be rebuilt?

Yes. The lower jaw is commonly rebuilt using a fibula free flap, and the upper jaw with a free flap or an obturator.

Will I need radiation after tongue or jaw cancer surgery?

Radiation is recommended when the cancer is advanced, lymph nodes are involved or margins are close. Your team will decide once the final pathology report is available.

How long is the hospital stay?

About two to four days for a small glossectomy, and usually one to two weeks after major surgery with free flap reconstruction.

Is base of tongue cancer treated the same way?

No. Base of tongue cancer is a throat (oropharyngeal) cancer, often linked to HPV, and may be treated with radiation and chemotherapy or with surgery depending on the case.

Sources

• NCI – Lip and Oral Cavity Cancer Treatment (PDQ)
• NCI – Paranasal Sinus and Nasal Cavity Cancer Treatment (PDQ)
• NCCN Guidelines for Patients – Mouth Cancer

Author & Medical Review

Dr. Vishal Choksi, MBBS, Diplomate American Board of Surgery, AHNS Fellow. Medically reviewed by Dr. Vishal Choksi.