Tongue cancer: symptoms, causes, tests, treatment and survival

The NHS says symptoms of mouth cancer can affect any part of the mouth, including the tongue. It notes that early stage mouth cancer can look like a mouth ulcer, and that white patches on the tongue or inside the mouth may be early symptoms.

Cancer Research UK adds that an ulcer that does not heal is a common symptom, that pain or discomfort or swelling in the mouth that does not go away may be present, and that a cancer lump usually forms and slowly gets bigger. A hot, red, painful lump usually means an infection rather than cancer, and lumps that come and go are not usually due to cancer.

• A mouth ulcer that lasts more than 3 weeks.

• A red or white patch inside your mouth.

• A lump inside your mouth or on your lip.

• Pain inside your mouth that does not go away.

• Difficulty swallowing, or pain or a burning sensation when chewing and swallowing.

• Difficulty speaking, or a hoarse (croaky) voice that does not go away.

• A lump in your neck or throat.

• Losing weight without trying.

• Cancer Research UK also lists a persistent sore throat, bad breath, unusual bleeding or numbness in the mouth, loose teeth for no clear reason, difficulty moving the jaw, and ear pain that does not get better in a few days.

The NHS says to see a GP if you have a mouth ulcer that has lasted more than 3 weeks, a lump in your mouth, on your lip, on your neck or in your throat, a red or white patch in your mouth, pain in your mouth that is not going away, difficulty swallowing or speaking, or a hoarse voice that does not go away. A dentist can also help with ulcers, lumps, patches or pain in the mouth.

These symptoms are very common and can be caused by other conditions, and having them does not definitely mean you have mouth cancer. If they are caused by cancer, finding it early may mean it is easier to treat. NICE guidance on suspected cancer advises considering a suspected cancer pathway referral for unexplained ulceration in the mouth lasting more than 3 weeks or a persistent unexplained lump in the neck, and an urgent dental assessment for a lump or a red or red and white patch.

Tongue cancer begins when abnormal cells in the tongue divide and grow in an uncontrolled way. Cancer Research UK says most mouth and oropharyngeal cancers develop in squamous cells, which line the mouth and throat.

The tongue sits across two regions. The front two thirds is part of the mouth (oral cavity), and the back one third (the base of the tongue) is part of the oropharynx, the part of the throat just behind the mouth. The areas behave and are treated somewhat differently. Cancer Research UK says oral cancer is more common in men than women and that most cases occur in middle-aged or elderly people.

Cancer Research UK says that the cause is unknown for most mouth and oropharyngeal cancers, but risk factors include smoking, alcohol and HPV infection. It estimates that around 17 in 100 mouth cancers in the UK are caused by smoking and around 35 in 100 by alcohol, with the risk higher for people who smoke and drink together. Chewing tobacco and betel quid, with or without tobacco, are also linked to mouth cancer.

The NHS lists a further set of things that may make you more likely to get mouth cancer. Red or white patches in the mouth (leukoplakia and erythroplakia) are not cancer, but Cancer Research UK says they can become cancerous if left untreated.

• Smoking or chewing tobacco, betel nut or paan.

• Drinking a lot of alcohol.

• Having leukoplakia.

• Exposure to a lot of sunlight or sunbeds, which can cause skin cancer affecting the lips.

• Having had cancer before.

• A weakened immune system, for example HIV or AIDS or taking immunosuppressant medicine.

• Changes in your genes, and some types of human papillomavirus (HPV) infection in the mouth.

You may start with a GP or a dentist. The NHS says they will usually ask about your symptoms, lifestyle and other medical conditions, and look and feel inside your mouth, and may feel your neck and jaw. If they think you could have cancer you may get an urgent referral to a specialist, which does not definitely mean you have cancer.

The NHS says the main tests are taking a small sample of cells from the affected area (a biopsy) and an X-ray, ultrasound scan, CT scan or MRI scan. You will usually get the results within 2 weeks. Cancer Research UK describes a nasoendoscopy, a thin flexible camera passed through the nose to look at the throat, and says there is no blood test that diagnoses mouth or oropharyngeal cancer. If cancer is found you may need further tests such as a lymph gland biopsy, a PET scan or blood tests to show how far it has spread and what genetic changes are present.

The NHS says treatment depends on the size of the cancer, where it is, whether it has spread, whether it has certain genetic changes, and your age and general health. A team of specialists will explain the options and plan treatment with you, and a clinical nurse specialist is your main point of contact.

Surgery is usually needed to remove mouth cancer, and sometimes some of the lymph glands in the neck are removed too. An area around the cancer may be removed to stop it coming back, which may include part of the tongue or jaw. If a large part is removed, reconstructive surgery using skin or bone from another part of the body may be used. Radiotherapy is often used and may be the only treatment you need if the cancer is found early.

Cancer Research UK says smoking during radiotherapy affects the ability of the treatment to cure the cancer, so it is important to stop smoking before treatment.

Cancer Research UK does not publish separate figures for tongue cancer, only for mouth and oropharyngeal cancer. For people diagnosed in England between 2014 and 2016, around 80 in 100 with mouth cancer survive 1 year or more and around 60 in 100 survive 5 years or more. For oropharyngeal cancer, almost 85 in 100 survive 1 year or more and 65 in 100 survive 5 years or more.

Outlook depends strongly on stage. For mouth cancers, more than 85 in 100 people with stage 1 survive 5 years or more, falling to around 70 in 100 at stage 2, more than 55 in 100 at stage 3 and 35 in 100 at stage 4. These are averages for large groups and cannot predict any one person's outcome. Cancer Research UK also says oropharyngeal cancers that contain HPV tend to have a better outlook, and that general health and fitness affect survival.

The tongue is used for speaking, chewing and swallowing, so treatment may affect these functions, and your team can involve professionals such as speech and language therapists and dietitians. You will have regular check-ups at the hospital after treatment. If the cancer cannot be cured, the NHS says the aim of treatment is to slow its growth and spread, help with symptoms and help you live longer, supported by a symptom control or palliative care team.

The NHS lists lowering your risk as eating a healthy diet with 5 portions of fruit and vegetables a day, exercising regularly, cutting down on alcohol (no more than 14 units a week), and trying to quit smoking and chewing tobacco, betel nut or paan. It stresses you cannot always prevent mouth cancer.

On the NHS, suspected cancer is handled through an urgent referral from a GP or dentist to a head and neck team, with tests, a multidisciplinary plan and treatment. Private head and neck or oral and maxillofacial surgeons can also assess a worrying ulcer or lump, take a biopsy and arrange scans. Do not delay seeing a GP or dentist while weighing up options.