Case Report

Carcinoma of the Tongue

FUNG Tai Hang Thomas

Department of Ear, Nose and Throat, Pamela Youde Nethersole Eastern Hospital

CASE REPORT

A 71 year-old gentleman presented with a painless right tongue mass for one month.
He was an ex- smoker and enjoyed good past health. Physical examination showed an
exophytic growth over the right lateral border of the tongue measuring 3cm x 2cm.
The tongue base was not involved and there was no ankyloglossia. There was no
palpable cervical lymph node. Biopsy of the tongue mass showed that it was
squamous cell carcinoma. Magnetic resonance imaging revealed a 3.6cm x1.7cm
x2.6cm right tongue tumor. No enlarged cervical lymph node was detected. VDRL
was negative. Chest X- Ray was clear.

Right hemiglossectomy and supraomohyoid neck dissection was performed.

Operation began with a half- apron incision on the right side of the neck. Skin flaps
were elevated incorporating platysma. Marginal mandibular branch of facial nerve
was preserved. Submandibular gland was dissected and separated from the lingual
nerve. Dissection extended to level II and level III. The spinal accessory nerve was
also preserved. Hemostasis was secured and one suction drain was inserted before the
wound was closed in layers. Operation was followed by excision of the right tongue
tumor, leaving a 1-2cm circuferential margin, using monopolar diathermy. The right
lingual artery was identified and ligated. Right tonsillectomy was performed as the
posterior margin was close the anterior pillar. Resection margins were sent for frozen
section which were all negative. The hemiglossectomy wound was closed with vicryl
sutures.
The post- operative course was uneventful. Wound healed well after stitches were
taken off in around post- op day 10. Tongue wound also healed with minimal
disturbance in swallowing and speech. Formal pathological section revealed well
differentiated squamous cell carcinoma with a clear margin ranging from 2mm to
8mm. There was no lymphovascular invasion. No malignant lymph node was detected
from the neck dissection specimen. The pathological staging was pT2N0. The patient
was referred to oncology where radical radiotherapy to the tumor bed and regional
lymphatics would be given.

DISCUSSION
Carcinoma of tongue accounts for 35% of squamous cell carcinoma of the oral cavity.
shares common risks factors with other oral cavity cancer namely tobacco, excess
alcohol consumption, male sex, syphilis, oral sepsis, spicy food as a well as sharp
teeth. In an study by Gonzalez- Moles et al, 81 patients underwent surgery for cancer
of the tongue were retrospectively studied to evaluate the influence on survival of
some clinical and pathologic parameters. The 5-year survival rate was 68.5%. The
study revealed that parameters influencing survival were: T (P<0.01), pathologic T
(P<0.01), N (P<0.05), pathologic N (P<0.05), extracapsular nodal spread (P<0.05),
locoregional recurrence (P<0.01), and tumour thickness (P<0.05). Tumor thickness
has been shown to be the most useful feature in predicting subclinical nodal
metastasis as hence 5- year survival rate. (Thickness of <=3mm 85.7% 5- year
survival, 4-7mm 58.3% 5- year survival, >7mm 57% 5-year survival). Tumors that
are greater than 1cm thick have a 50% chance of nodal metastasis. Surgical
management of tumor <=3mm is partial glossectomy alone. Larger tumor would
require partial/ subtotal glossectomy and selective neck dissection (level I-III) for N0
disease. For node positive disease, modified radical neck dissection should be
performed. Post- operative radiotherapy for T1-2 tumor is required for cases with
positive resection margin, extracapsular spread of nodal metastasis and multiple nodal
metastasis. Both primary site and neck require post-operative radiotherapy for T3-4
disease.

REFERENCES
1. Gonzalez-Moles MA et al. Importance of tumour thickness measurement in
prognosis of tongue cancer. Oral Oncol. 2002 Jun 38(4): 394-7.

2. Scott- Brown’s Otorhinolaryngology, Head and Neck Surgery. Seventh Edition,

Volume 2, p2550-3.