From the Guidelines
Evaluation of squamous cell carcinoma (SCC) of the tongue requires a comprehensive approach including physical examination, head and neck endoscopy, and imaging studies such as head and neck CT-scan, as recommended by the European Union's guidelines for diagnosis, treatment, and follow-up of squamous cell carcinoma of the head and neck 1. The evaluation process should begin with a thorough physical examination, palpating the tongue and lymph nodes to assess the primary tumor and potential metastasis.
- Head and neck endoscopy should be performed to visualize the lesion and surrounding structures.
- Imaging studies are essential, with contrast-enhanced CT or MRI of the head and neck being the standard to determine tumor extent, depth of invasion, and lymph node involvement, as stated in the guidelines for staging and risk assessment 1.
- A thoracic CT-scan may be included to rule out metastatic disease, but routine esophagoscopy and bronchoscopy are not recommended 1.
- The cancer should be staged according to the TNM classification system, which guides treatment planning, and tumors should be subdivided into categories, including T4-tumors into T4a resectable and T4b unresectable 1.
- A multidisciplinary treatment schedule should be established in all cases, including surgical oncology, radiation oncology, and medical oncology, with consideration of the patient's nutritional status, dental rehabilitation, and psychological support 1. The treatment plan may involve chemoradiotherapy, concomitant or alternated treatment, which is recommended for unresectable tumors, with platinum-based regimens remaining the standard chemotherapy for concurrent chemoradiotherapy 1.
- Additional evaluations, such as nutritional assessment, speech and swallowing assessment, and laboratory tests, including complete blood count, liver function tests, and renal function tests, should be performed to support the development of an appropriate treatment plan.
From the Research
Evaluation of Squamous Cell Carcinoma (SCC) of the Tongue
- The evaluation of SCC of the tongue involves various treatment options, including surgery, radiation therapy, and chemotherapy 2, 3, 4, 5, 6.
- Surgical treatment of SCC of the tongue base is highly effective in achieving local disease control and disease-free survival for early lesions 2.
- However, for advanced lesions, surgical treatment has poor functional outcome and survival, and alternative treatments such as brachytherapy with radiation therapy or combined chemoradiation protocol may be considered 2.
- Induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil has shown an excellent response rate in patients with tongue cancer 3.
- Clinicopathological evaluation of patients with SCC of the tongue has shown that early detection and treatment with surgery alone are associated with improved survival 4.
- A new surgical strategy based on anatomic study, known as muscle anatomy tongue surgery (MATS), has been developed and has shown promising results in terms of local disease control, locoregional control, disease-free survival, and overall survival 5.
Treatment Options
- Surgery: effective for early lesions, but has poor functional outcome and survival for advanced lesions 2, 5.
- Radiation therapy: used in combination with surgery or as an alternative treatment for advanced lesions 2, 6.
- Chemotherapy: induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil has shown an excellent response rate in patients with tongue cancer 3.
- Combined chemoradiation protocol: may be considered as an alternative treatment for advanced lesions 2.