Cancer of the tongue: A review of the literature and a summary of two cases, with clinical histories and necropsy findings

Abstract

Cancer of the tongue is most commonly of epithelial origin and may result from chronic irritation. Lack of vitamin B should not be overlooked as a related causal factor. Frequently, if not always, certain premalignant states precede the cancerous lesion. These include leucoplakia, ulceration, and induration. The fact that pain is often not an early symptom may delay detection of the tumor. The importance of early diagnosis is emphasized because the prognosis is very grave after metastasis has occurred. Metastatic spread is by way of the lymphatic system and primarily involves the deep cervical chain of lymph nodes. The submaxillary and submental lymph nodes are frequently involved. The most successful method of treatment has been by radium implantation in the primary lesion and complete surgical removal of the lymph nodes draining the affected side. Adjunctive roentgentherapy is frequently advocated. The two cases of squamous-cell carcinoma of the tongue which are reported illustrate several factors described in the review. The first patient was treated by x-ray and radium, and the primary lesion regressed satisfactorily. Subsequent lymphatic involvement occurred, which was given roentgen-therapy. The patient died with acute monocytic leucemia about three years after the first oral symptoms. The second patient had a history of previous radiation therapy. The primary lesion was treated by surgical removal of about two-thirds of the tongue. Metastasis to the cervical lymph nodes followed about two and one-half months later. These were treated surgically. The patient succumbed shortly thereafter with a flare-up of an old tuberculosis, possibly precipitated by the surgical treatment.