From the Guidelines
The diagnostic approach for tongue cancer begins with a thorough clinical examination by a healthcare provider, who will inspect and palpate the tongue and oral cavity for suspicious lesions, ulcers, or masses. Any lesion that persists for more than two weeks warrants further investigation. The definitive diagnosis requires a biopsy, typically an incisional or excisional biopsy, where tissue is removed and examined microscopically by a pathologist to confirm malignancy and determine the cancer type. Following a positive diagnosis, staging investigations are essential and may include imaging studies such as CT scans, MRI, PET scans, or ultrasound to assess the extent of the primary tumor and check for regional lymph node involvement or distant metastases. Additional evaluations often include endoscopy to examine the upper aerodigestive tract for synchronous tumors and nutritional assessment since tongue cancer can affect eating and swallowing. Early detection is crucial for tongue cancer as it significantly improves treatment outcomes and survival rates. Risk factors like tobacco use, alcohol consumption, and HPV infection should be considered during assessment, and patients with these risk factors may require more vigilant screening, as supported by studies such as 1 and 1.
Some key points to consider in the diagnostic approach include:
- A systematic clinical examination of the oral cavity, including visual inspection and palpation of the tongue, oral cavity, and regional lymph nodes, as recommended by the World Health Organization and the National Institute of Dental and Craniofacial Research 1.
- The use of mouth mirrors to visualize all surfaces of the oral cavity and the examination of the oropharynx, which may require referral to a dental provider or specialist 1.
- The importance of considering risk factors such as tobacco use, alcohol consumption, and HPV infection in the assessment and management of tongue cancer, as highlighted in studies such as 1 and 1.
- The need for staging investigations, including imaging studies and endoscopy, to assess the extent of the primary tumor and check for regional lymph node involvement or distant metastases, as discussed in 1 and 1.
- The potential benefits and harms of screening for oral cancer, including the potential for early detection and improved treatment outcomes, as well as the potential for overdiagnosis and overtreatment, as noted in 1.
Overall, the diagnostic approach for tongue cancer should prioritize a thorough clinical examination, consideration of risk factors, and staging investigations to ensure early detection and effective management of the disease.
From the Research
Diagnostic Approach for Tongue Cancer
The diagnostic approach for tongue cancer involves a comprehensive oral and neck examination.
- The examination should include an assessment of the oral cavity, including the tongue, lips, mouth, and neck.
- According to the study 2, an oral and neck examination must be part of every dental examination, as it allows for early detection of oral cancer.
- The examination protocol should be similar to, but more detailed than, the standardised oral examination method recommended by the World Health Organisation.
- Dentists and dental hygienists play a crucial role in the examination of the oral cavity for mouth cancer, including tongue cancer.
- The study 2 highlights the importance of early detection, as the overall five-year survival rates for oral cancer average at between 50 and 80%, depending on the stage of the disease.
- A thorough examination can help identify signs of tongue cancer, such as unusual lesions or changes in the tongue's appearance.
- The oral epithelium is readily accessible for examination and even self-examination, making it easier to detect potential signs of cancer.