Treatment Plan

After determining a diagnosis and completing a full pre-treatment evaluation, doctors will recommend a course of treatment for their patients. This treatment plan will depend on whether or not the cancer has spread to other regions. In general, there are three different options for the treatment of tongue cancers that can be used alone or in combination.

Surgery 

For tongue cancer, complete surgical removal of the tumour is almost always the first treatment, unless a doctor decides that it is not possible or safe to proceed with surgery. Tongue cancers are commonly treated with a type of surgery called a glossectomy.

The surgery that a doctor recommends will depend on the location of the cancer, as well as the stage. The extent and location of a tongue resection will determine the type of reconstruction required and will also allow the doctor to predict the impact that it will have on speech and swallowing.  Patients and their care teams should discuss the types of surgeries that may be required for the treatment of their cancer.

Radiation 

The most common use of radiation for the treatment of tongue cancer is called adjuvant radiation, which is radiation given after surgery in order to decrease the chances that the tumour will come back.

Reasons for Post-Surgical Radiation

A doctor may recommend post-surgical radiation in a few scenarios.

  • If the tumour was not completely removed or if the surgical margins were positive for cancer.
  • If the type of cancer was determined to be aggressive or of a high grade or T-stage.
  • If the cancer had spread to lymph nodes or other structures, such as nerves or vessels.

In some cases, complete surgical removal of a tongue cancer may be impossible or unsafe, and a doctor may recommend radiation therapy as the primary treatment. In this type of treatment, an external beam of radiation is directed at the tumour in order to destroy the rapidly dividing cancer cells.

Chemotherapy 

Chemotherapy is not commonly used to treat tongue cancer.  In some cases, it is used in combination with radiation as additional treatment following surgery. Chemotherapy is usually only added to adjuvant radiation therapy if there is extranodal extension from cancerous lymph nodes in the neck, or if there is cancer left behind during surgery.

General Treatment Options for Tongue Cancer

These options depend on T and N stages.

T1-2, N0

  • The preferred treatment is surgical removal of the cancer, with or without a neck dissection, depending on the location of the tumour and on how thick the tumour is.
    • A sentinel lymph node biopsy (a procedure to remove and examine the sentinel lymph nodes, which are the first lymph nodes to which cancer cells are likely to spread) may also be performed, and may be followed by a neck dissection, depending on the results of the biopsy.
  • Surgery will sometimes be followed by radiation, additional surgeries, and/or chemotherapy with radiation, depending on the outcome of the primary surgery.
  • Radiation alone is also a primary treatment option.
    • Radiation could be followed by surgery, depending on whether any disease remained after the initial radiation.

T3, N0; T1-3, N1-3; or T4a, any N

  • The initial treatment is surgical removal of the cancer with neck dissection(s).
  • Surgery will sometimes be followed by radiation, additional surgeries, and/or chemotherapy with radiation, depending on the outcome of the primary surgery.
  • Factors that will guide additional treatment include:
    • Positive margins (the presence of cancer cells at the edge of the tissue that was resected).
    • Spread of cancer beyond the lymph nodes in the neck (extranodal extension).
    • T3 or T4 tumours based on pathological evaluation.
    • N2 or N3 disease in the neck lymph nodes.
    • Cancerous lymph nodes in unusual parts of the neck.
    • Tumour invasion into or around nerves (perineural invasion).
    • Tumour invasion into blood vessels (lympho-vascular invasion).

T4b, any N; unresectable neck disease; or patients unfit for surgery

In cases that are very advanced, or in patients who are extremely sick, patients should have an extensive discussion with their doctor in order to consider the possibility of palliative therapy or hospice care.