Surgical Treatment Strategy for Tongue Cancer

Abstract

Anatomically, the tongue consists of the oral tongue (OT: the anterior 2/3 of the tongue) and the base of the tongue (BOT: the posterior 1/3 of the tongue). Most of tongue cancers are squamous cell carcinomas. Patients with tongue cancers experience symptoms such as pain, speech difficulties, dysphagia and weight loss. Tongue cancers have a rapid onset and BOT cancers have a tendency to be infiltrative and aggressive. Tongue cancers have high propensity for metastasis to the cervical lymph nodes and the risk of nodal metastases increases as T stage increases. Especially, BOT cancers have great tendency for bilateral cervical lymph node invasion. BOT cancers can spread into the pre-epiglottic space, the OT, the tonsillar area or the pharyngeal wall without any clinical sign.The surgical treatment strategy for tongue cancers is to apply various approaches to completely excise both the primary lesion and the proper cervical neck lymph nodes. In addition, proper reconstruction methods are used for rehabilitating such functions as speech and swallowing. Although surgical extirpation has been the mainstay of the treatment, additional adjuvant radiation therapy is often used for more aggressive tongue cancers. In fact, cancers of the OT and BOT show different survival rates and prognoses.A retrospective review of the squamous cell carcinomas of the OT and BOT was done in the Department of Oral & Maxillofacial Surgery and Otolaryngology, Yonsei University, Seoul, Korea. Among the 239 patients diagnosed with primary tongue cancers, 171 patients who were treated by surgery and/or adjuvant radiation therapy and they were closely followed up were selected for this study and evaluated. Anatomically, the tongue consists of the oral tongue (OT: the anterior 2/3 of the tongue) and the base of the tongue (BOT: the posterior 1/3 of the tongue). Most of tongue cancers are squamous cell carcinomas. Patients with tongue cancers experience symptoms such as pain, speech difficulties, dysphagia and weight loss. Tongue cancers have a rapid onset and BOT cancers have a tendency to be infiltrative and aggressive. Tongue cancers have high propensity for metastasis to the cervical lymph nodes and the risk of nodal metastases increases as T stage increases. Especially, BOT cancers have great tendency for bilateral cervical lymph node invasion. BOT cancers can spread into the pre-epiglottic space, the OT, the tonsillar area or the pharyngeal wall without any clinical sign. The surgical treatment strategy for tongue cancers is to apply various approaches to completely excise both the primary lesion and the proper cervical neck lymph nodes. In addition, proper reconstruction methods are used for rehabilitating such functions as speech and swallowing. Although surgical extirpation has been the mainstay of the treatment, additional adjuvant radiation therapy is often used for more aggressive tongue cancers. In fact, cancers of the OT and BOT show different survival rates and prognoses. A retrospective review of the squamous cell carcinomas of the OT and BOT was done in the Department of Oral & Maxillofacial Surgery and Otolaryngology, Yonsei University, Seoul, Korea. Among the 239 patients diagnosed with primary tongue cancers, 171 patients who were treated by surgery and/or adjuvant radiation therapy and they were closely followed up were selected for this study and evaluated.