{"entity":{"id":"oral-tongue-cancer","kind":"cancer","name":"Oral tongue and floor of mouth cancer","aka":["Tongue cancer","Anterior two-thirds of tongue cancer","Floor of mouth cancer","Oral tongue squamous cell carcinoma"],"tldr":"Cancer of the front of the tongue or the floor of the mouth is treated first with surgery, and a Tata Memorial trial settled that the neck lymph nodes should be removed at the same operation even when scans look clear. How deep the tumour has grown is now the number that decides staging and the need to treat the neck.","summary":"Squamous cell carcinoma of the oral tongue (the mobile anterior two-thirds) and floor of mouth usually presents as a persistent ulcer or lump, often painful, sometimes with ear pain or a neck node. Tobacco, alcohol and betel quid are the causes in most patients, but tongue cancer in young adults without these exposures is increasing in several countries and is not HPV-related. The tongue's rich lymphatic drainage means that a substantial minority of patients with a clinically clear neck already harbour nodal metastases, and depth of invasion, which entered the staging system in 2017, is the best predictor of that risk.\n\nTreatment is surgical: partial glossectomy or floor-of-mouth resection with margins of at least 5 mm, and treatment of the neck. The Tata Memorial trial of elective versus therapeutic neck dissection in 596 patients with early node-negative oral cancer, reported by D'Cruz in 2015, showed three-year overall survival of 80.0 percent with elective neck dissection against 67.5 percent with watchful waiting, ending a fifty-year debate; sentinel node biopsy, validated in the European SENT study, is an alternative for small tumours. Larger defects are reconstructed with free radial forearm or anterolateral thigh flaps to preserve speech and swallowing, and brachytherapy, once common for small tongue cancers, has largely given way to surgery.\n\nPostoperative radiotherapy is given for stage III to IV disease, perineural invasion, close margins or multiple nodes, and cisplatin chemoradiation for extranodal extension or positive margins. Recurrent or metastatic disease is treated as for other head and neck squamous cell carcinoma with pembrolizumab-based therapy, or with oral metronomic methotrexate-celecoxib where resources are limited. Second primaries in the mouth, pharynx, oesophagus and lung are common in smokers, so cessation and surveillance matter.","asOf":"2026-09-17","wikipedia":"https://en.wikipedia.org/wiki/Oral_cancer","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Oral_cancer"}],"tags":["subtype-page","head-and-neck"],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":["celecoxib"],"companies":[],"institutions":[],"pathways":[],"terms":["extranodal-extension","depth-of-invasion","cdkn2a-homozygous-deletion"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-dcruz-elective-neck-dissection-nejm-2015","paper-keynote-048-lancet-2019","paper-bernier-eortc-22931-nejm-2004"],"journals":[],"dependsOn":[],"notes":[],"group":"head and neck","burden":"The tongue is the commonest oral cavity site in Western countries, and tongue cancer is rising in young adults who neither smoke nor drink for reasons still unknown; the floor of mouth is the classic tobacco and alcohol site.","subtypes":["Oral tongue (anterior two-thirds) squamous cell carcinoma","Floor of mouth squamous cell carcinoma","Tongue cancer in young non-smokers","Thin (depth of invasion 5 mm or less) versus thick tumours","Verrucous carcinoma of the tongue and floor of mouth"],"biomarkers":["Depth of invasion (staging and elective neck dissection)","Worst pattern of invasion and perineural invasion","Margin status","Extranodal extension","TP53 mutation","PD-L1 combined positive score (recurrent disease)"],"standardOfCare":[{"setting":"Diagnosis and staging","approach":"Biopsy, MRI or CT of the tongue and neck to measure depth of invasion and nodes, chest imaging or PET-CT for advanced stage, and dental assessment before radiotherapy.","refs":["pet-ct"],"guideline":{"version":"NCCN Guidelines: Head and Neck Cancers","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437"}},{"setting":"Primary treatment (T1 to T2, clinically node-negative)","approach":"Partial glossectomy or floor-of-mouth resection with at least 5 mm margins and elective neck dissection (Tata Memorial trial); sentinel node biopsy as an alternative in small tumours.","refs":["elective-neck-dissection-tmh","sentinel-node"],"guideline":{"nccn":"Category 1 (elective neck dissection)","version":"NCCN Guidelines: Head and Neck Cancers","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437"}},{"setting":"Locally advanced (T3 to T4 or node-positive)","approach":"Resection with neck dissection and free-flap reconstruction, then postoperative radiotherapy, or cisplatin chemoradiation for extranodal extension or positive margins.","refs":["imrt-igrt","cisplatin","chemoradiation"],"guideline":{"nccn":"Category 1 (chemoradiation for extranodal extension or positive margins)","version":"NCCN Guidelines: Head and Neck Cancers","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437"}},{"setting":"Recurrent or metastatic","approach":"Pembrolizumab alone or with platinum-fluorouracil (KEYNOTE-048); oral metronomic methotrexate-celecoxib where resources are limited.","refs":["pembrolizumab","keynote-048","methotrexate","metronomic-vs-cisplatin-tmh","recurrent-metastatic-hnscc"],"guideline":{"nccn":"Category 1","version":"NCCN Guidelines: Head and Neck Cancers","url":"https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1437"}},{"setting":"Prevention","approach":"Tobacco, alcohol and betel quid cessation; treatment of leukoplakia and erythroplakia; oral examination in high-risk people.","refs":["smoking-cessation-after-diagnosis","alcohol-reduction-labelling","oral-visual-screening"]}],"stateOfArt":["Elective neck dissection for early tongue cancer is a category 1 recommendation on the strength of one Indian randomised trial.","Depth of invasion has replaced tumour thickness and diameter as the driver of staging.","Free-flap reconstruction preserves intelligible speech and oral swallowing after large resections."],"history":[{"year":1906,"title":"Crile describes radical neck dissection","refs":[]},{"year":2015,"title":"Tata Memorial: elective neck dissection improves survival in early oral cancer","refs":["elective-neck-dissection-tmh"]},{"year":2017,"title":"Depth of invasion enters staging (AJCC 8th edition)","refs":[]},{"year":2019,"title":"KEYNOTE-048: pembrolizumab first line in recurrent disease","refs":["keynote-048"]}],"pipeline":["pembrolizumab","keynote-689","sentinel-node","nivopostop"],"openProblems":["Why tongue cancer is rising in young non-smokers.","Whether sentinel node biopsy can replace elective neck dissection safely.","Speech and swallowing after resection of more than half the tongue.","Second primaries in the treated field."],"parent":"oral-cavity-cancer"},"route":"/cancers/oral-tongue-cancer/","neighbours":{"drug":[{"id":"celecoxib","kind":"drug","name":"Celecoxib","route":"/drugs/celecoxib/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"methotrexate","kind":"drug","name":"Methotrexate","route":"/drugs/methotrexate/"},{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"}],"term":[{"id":"cdkn2a-homozygous-deletion","kind":"term","name":"CDKN2A/B homozygous deletion","route":"/terms/cdkn2a-homozygous-deletion/"},{"id":"chemoradiation","kind":"term","name":"Chemoradiation (chemoradiotherapy, CRT)","route":"/terms/chemoradiation/"},{"id":"depth-of-invasion","kind":"term","name":"Depth of invasion (DOI)","route":"/terms/depth-of-invasion/"},{"id":"extranodal-extension","kind":"term","name":"Extranodal extension (ENE)","route":"/terms/extranodal-extension/"}],"paper":[{"id":"paper-dcruz-elective-neck-dissection-nejm-2015","kind":"paper","name":"Elective versus therapeutic neck dissection in node-negative oral cancer","route":"/key-papers/paper-dcruz-elective-neck-dissection-nejm-2015/"},{"id":"paper-bernier-eortc-22931-nejm-2004","kind":"paper","name":"EORTC 22931: postoperative irradiation with or without concomitant cisplatin for locally advanced head and neck cancer","route":"/key-papers/paper-bernier-eortc-22931-nejm-2004/"},{"id":"paper-keynote-048-lancet-2019","kind":"paper","name":"KEYNOTE-048: pembrolizumab, alone or with chemotherapy, as first treatment for recurrent or metastatic head and neck cancer","route":"/key-papers/paper-keynote-048-lancet-2019/"}],"trial":[{"id":"elective-neck-dissection-tmh","kind":"trial","name":"Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial)","route":"/trials/elective-neck-dissection-tmh/"},{"id":"keynote-048","kind":"trial","name":"KEYNOTE-048","route":"/trials/keynote-048/"},{"id":"keynote-689","kind":"trial","name":"KEYNOTE-689","route":"/trials/keynote-689/"},{"id":"nivopostop","kind":"trial","name":"NIVOPOSTOP (GORTEC 2018-01)","route":"/trials/nivopostop/"},{"id":"metronomic-vs-cisplatin-tmh","kind":"trial","name":"Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)","route":"/trials/metronomic-vs-cisplatin-tmh/"}],"technology":[{"id":"alcohol-reduction-labelling","kind":"technology","name":"Alcohol reduction, pricing and cancer warning labels","route":"/technologies/alcohol-reduction-labelling/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"oral-visual-screening","kind":"technology","name":"Oral cancer visual screening","route":"/technologies/oral-visual-screening/"},{"id":"pet-ct","kind":"technology","name":"PET/CT","route":"/technologies/pet-ct/"},{"id":"sentinel-node","kind":"technology","name":"Sentinel lymph node biopsy","route":"/technologies/sentinel-node/"},{"id":"smoking-cessation-after-diagnosis","kind":"technology","name":"Smoking cessation in cancer patients","route":"/technologies/smoking-cessation-after-diagnosis/"}],"cancer":[{"id":"oral-cavity-cancer","kind":"cancer","name":"Oral cavity cancer (mouth and tongue)","route":"/cancers/oral-cavity-cancer/"},{"id":"recurrent-metastatic-hnscc","kind":"cancer","name":"Recurrent or metastatic head and neck squamous cell carcinoma","route":"/cancers/recurrent-metastatic-hnscc/"}]}}