Treatment of Feline Squamous Cell Carcinoma of the Tongue
The treatment of feline squamous cell carcinoma (SCC) of the tongue requires a multimodal approach, with surgery and radiation therapy offering the best chance for survival, though prognosis remains poor regardless of treatment modality. 1
Diagnosis and Staging
- Complete physical examination with special attention to the oral cavity
- Contrast-enhanced CT scan and/or MRI to assess the primary tumor and regional lymph nodes 2
- Chest imaging (CT preferred) to rule out metastatic disease 2
- Biopsy for pathological confirmation 2
- Assessment of nutritional status and weight 2
Treatment Options
Surgical Management
- Surgery with wide margins (4-6 mm) is the primary treatment option when the tumor is resectable 2
- Complete surgical resection offers the best chance for cure in cats with early, accessible disease 1
- For tongue SCC specifically:
- Partial glossectomy may be considered for small, anterior lesions
- More extensive lesions often require aggressive surgery that may significantly impact quality of life
Radiation Therapy
- Accelerated radiation therapy protocol with 14 fractions of 3.5 Gy given within a 9-day period has shown better outcomes than traditional protocols 3
- Addition of concurrent carboplatin (90-100 mg/m² on day 1 and day 4.5) to radiation therapy has shown improved outcomes 3
- Median survival with this protocol is approximately 163 days, with lingual SCC having a median survival of approximately 147-197 days 4
Chemotherapy
- Platinum-based regimens (cisplatin or carboplatin) are the most commonly used 3
- Single-agent chemotherapy has limited efficacy when used alone
- Most beneficial when combined with surgery or radiation therapy
Palliative Care
- Palliative radiation therapy alone has shown poor results, with median survival of only 60 days and significant side effects 5
- Pain management is essential:
- NSAIDs for inflammation and pain
- Opioid analgesics for moderate to severe pain
- Nutritional support (feeding tubes may be necessary)
Treatment Algorithm Based on Disease Stage
Early, accessible disease:
- Complete surgical resection with wide margins
- Consider adjuvant radiation therapy if margins are incomplete
Locally advanced disease:
- Combined modality treatment with accelerated radiation therapy and concurrent carboplatin 3
- Consider surgical debulking if feasible before radiation
Advanced, unresectable disease:
- Accelerated radiation therapy with concurrent carboplatin 3
- Palliative care focused on pain management and maintaining nutrition
Prognosis
- Overall prognosis for feline oral SCC is poor
- Lingual SCC has a median survival of 147-197 days with aggressive treatment 4
- Complete response at 30 days post-treatment is a significant predictor of longer survival 3
- Most cats are eventually euthanized due to local disease progression, difficulty eating, and poor quality of life 1
Monitoring and Follow-up
- Regular oral examinations to assess for local recurrence
- Nutritional assessment and support
- Pain management evaluation
- Quality of life assessment
Important Considerations
- Treatment decisions should prioritize quality of life given the poor overall prognosis
- Aggressive surgical approaches may significantly impact eating, drinking, and grooming abilities
- Early intervention offers the best chance for prolonged survival
- Owner counseling regarding realistic expectations is essential