Tongue Cancer

Diagnosis

Diagnosis of tongue cancer can be made through the following techniques:

• Medical history and physical examination: Physical examination plays an important role in the diagnosis of tongue cancer and in ruling out the presence of other diseases. Further, it allows cancer specialists to recommend other diagnostic tests to confirm the presence of tongue cancer. Patients are enquired about the development, duration, and progression of the symptoms. A persistent white or red patch with pain and a burning sensation on the tongue warrants further investigation.
• The physical examination includes detailed evaluation of patient history and neck examination for palpable lymphadenopathy, particularly in the submandibular region. The lifestyle factors are also considered during the preliminary examination, as people who smoke or drink excessively are at increased risk for developing tongue cancer.
• Blood tests: No blood tests are available to independently diagnose tongue cancer. However, the patients are advised to undergo blood tests to determine the overall health of the body and nutritional status. Blood count tests are particularly important if the patient has recurrent, heavy bleeding from the sore. Further, blood tests are usually recommended before the treatment in patients with tongue cancer. Certain biomarkers, such as VEGF, PTEN, cytokines, and TGF-β1, are also used in diagnosis of cancer.
• Saliva tests: As saliva is in close contact with the tongue lesions, evaluating saliva may help obtain important information about the lesion. It has been found that lactic acid and valine in the saliva strongly indicate oral cancer. Further, the presence of other substances, such as proline, lysine, ornithine, and citrulline, in the saliva is linked to early-stage squamous cell carcinoma of the oral cavity.
• Fluorescent light test: This test detects tongue cancer at an early stage. The test also provides information about the precancerous tissues in the oral cavity. During this technique, the oncologist makes use of a special light. The light reflects in a different pattern if there is any abnormal surface in the oral cavity.
• Toluidine blue dye test: It is another test to screen the oral cavity for cancer and diagnose oral cancer at its early stages. The tissues of the oral cavity are coated with the dye. The color of the dye changes to darker blue in the presence of abnormal cells.
• X-rays: Preliminary radiographic examination is performed to determine if the tongue cancer has spread to the jaw.
• MRI: Magnetic resonance imaging is a preferred imaging modality in evaluating the oral cavity and adjacent structures for diagnosing cancer. MRI has excellent discrimination of the soft tissues, allowing better revealing of the tumor invasion and its spread to nearby structures. It also provides detailed information about the spread of the tumor to the local and regional sites, the extent of lymphadenopathy, and the depth of tumor invasion. It detects the tumor invasion in marrow earlier than a CT scan without exposing patients to harmful radiation. It also helps in accurate tongue cancer staging, which helps develop the optimal treatment strategy.
• CT scan: CT scan provides detailed images of the cancer site in patients suspected to have tongue squamous cell carcinoma. Bony algorithm thin section CT assists in detecting early bone erosion due to tumors.
• PET scan: If the patient is diagnosed with tongue cancer and is strongly suspected of its spread to other body organs, they are advised to undergo a PET scan. A PET scan involves using radioactive sugar derivatives accumulated around the abnormal cells. A special camera is used to detect the site of radioactive sugar accumulation.
• Nasoendoscopy: It is performed to evaluate the oral cavity, back of the tongue, throat, and larynx for the spread of tongue cancer. The procedure is performed by inserting the nasoendoscopy in the mouth and guiding it to the larynx. Nasoendscope is a thin tube with a light and video camera at the end.
• Biopsy: Biopsy is the confirmatory test for tongue cancer. A tissue sample from the abnormal site is obtained and sent to the laboratory for examination. The techniques used for biopsy are fine needle aspiration biopsy, punch biopsy, and incisional biopsy.