Oral tongue and floor of mouth cancer
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.
Overview
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.
Treatment 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.
Postoperative 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.
State of the art
- 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.
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowHypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
- Check before combiningFood and drink: Pembrolizumab
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
- Check before combiningKidneys: Cisplatin
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
- Check before combiningKidneys: Methotrexate
High-dose methotrexate requires normal renal function, hydration, urine alkalinisation and leucovorin rescue with level monitoring.
- Good to knowImmune-related endocrinopathies (thyroiditis, hypophysitis)
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
See all on the product pages:CisplatinMethotrexatePembrolizumab·Printable cards in the navigator
Anatomy and lymph node drainage
- Oral cavity and tongue
- Oropharynx: tonsil, base of tongue (HPV)
- Nasopharynx (EBV)
- Larynx and hypopharynx
- Parotid and other salivary glands
- Thyroid
- Nodes: level I (submandibular)
- Nodes: level II (upper jugular)
- Nodes: level III-IV (jugular)
- Nodes: level V (posterior)
- Nodes: level VI (central, thyroid)
- Nodes: retropharyngeal (nasopharynx)
Site decides cause and behaviour: HPV drives oropharyngeal cancer, EBV drives nasopharyngeal cancer, tobacco drives oral and laryngeal cancer; all drain into the neck node levels that surgeons and radiotherapists map.
- Oral cavity and tongueOral tongue (anterior two-thirds) squamous cell carcinoma · Tongue cancer in young non-smokers · Verrucous carcinoma of the tongue and floor of mouth
- Oropharynx: tonsil, base of tongue (HPV)
- Nasopharynx (EBV)
- Larynx and hypopharynx
- Parotid and other salivary glands
- Thyroid
- level I (submandibular)
- level II (upper jugular)
- level III-IV (jugular)
- level V (posterior)
- level VI (central, thyroid)
- retropharyngeal (nasopharynx)
Same organ: Oropharyngeal cancer (tonsil and base of tongue), Laryngeal and hypopharyngeal cancer, Oral cavity cancer (mouth and tongue), Head and neck squamous cell carcinoma, Nasopharyngeal carcinoma, Salivary gland cancers, Papillary thyroid cancer, Follicular thyroid cancer, Medullary thyroid cancer, Anaplastic thyroid cancer, Thyroid cancer, Nasal cavity and paranasal sinus cancers (including esthesioneuroblastoma), NUT carcinoma (midline carcinoma with NUTM1 rearrangement), Parathyroid carcinoma, Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4), HPV-positive oropharyngeal cancer, HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer), Recurrent or metastatic head and neck squamous cell carcinoma, Hypopharyngeal cancer, Adenoid cystic carcinoma, Salivary duct carcinoma, Mucoepidermoid carcinoma, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Lip cancer
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.
- Oral cancer visual screeningEstablished
Nothing recorded yet.
Nothing recorded yet.
Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
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.
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.
Resection with neck dissection and free-flap reconstruction, then postoperative radiotherapy, or cisplatin chemoradiation for extranodal extension or positive margins.
Pembrolizumab alone or with platinum-fluorouracil (KEYNOTE-048); oral metronomic methotrexate-celecoxib where resources are limited.
Tobacco, alcohol and betel quid cessation; treatment of leukoplakia and erythroplakia; oral examination in high-risk people.
Subtypes & biomarkers
top- 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
- 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)
How often this target appears
- 1906Crile describes radical neck dissection
- 2015Tata Memorial: elective neck dissection improves survival in early oral cancer
- 2017Depth of invasion enters staging (AJCC 8th edition)
- 2019KEYNOTE-048: pembrolizumab first line in recurrent disease
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
All 10 changes by month →- 2026-09-17This recordOral tongue and floor of mouth cancerFacts on this page last checked
When this page itself was last checked or edited.
- 2025Trial resultKEYNOTE-689KEYNOTE-689 reported
Median EFS 59.
- 2025Trial resultNIVOPOSTOP (GORTEC 2018-01)NIVOPOSTOP (GORTEC 2018-01) reported
Three-year disease-free survival 63.
- 2020Trial resultOral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial) reported
Median OS 7.
- 2019Trial resultKEYNOTE-048KEYNOTE-048 reported
OS 14.
- 2019MilestoneKEYNOTE-048KEYNOTE-048: pembrolizumab first line in recurrent disease
A milestone in how this cancer is treated.
What is in development for Oral tongue and floor of mouth cancer, drawn from the whole corpus: 3 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Trials reported · 3
- KEYNOTE-689 · phase 3 · 2025 · positive
- NIVOPOSTOP (GORTEC 2018-01) · phase 3 · 2025 · positive
- Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial) · phase 3 · 2015 · positive
Open problems and what is being done
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.
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Baltimore · cancer center | United States | 0 | 2,955 | 41,449 | #10 | ||
Milan · cancer center | Italy | none recorded | 0 | 1,246 | 21,746 | #11 | |
Mumbai · cancer center | India | none recorded | 2 | 665 | 4,926 | none recorded | #80 |
Bethesda, MD · government | United States | none recorded | 0 | 2,905 | 47,715 | - | |
Utrecht · cancer center | Netherlands | none recorded | 0 | 1,422 | 20,323 | - | |
Tianjin · cancer center | China | none recorded | 0 | 1,219 | 11,455 | - | |
Hangzhou · cancer center | China | none recorded | 0 | 1,219 | 17,635 | - | |
Beijing · hospital | China | none recorded | 0 | 1,154 | 11,808 | - | |
Rozzano (Milan) · hospital | Italy | none recorded | 0 | 1,031 | 10,720 | - | |
Changsha · cancer center | China | none recorded | 0 | 930 | 14,477 | - | |
Jinan · cancer center | China | none recorded | 0 | 920 | 7,804 | - | |
Rotterdam · cancer center | Netherlands | none recorded | 0 | 852 | 12,180 | - | |
Dresden · cancer center | Germany | none recorded | 0 | 728 | 7,984 | - | |
| United Kingdom | none recorded | 0 | 693 | 7,168 | - | ||
Aarhus · hospital | Denmark | none recorded | 0 | 624 | 4,497 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Oral tongue and floor of mouth cancer but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Oral tongue and floor of mouth cancer
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Depth of invasion, Worst pattern of invasion and perineural invasion, Margin status, Extranodal extension, TP53 mutation), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Oral tonguesquamous cell carcinoma, Floor of mouth squamous cell carcinoma, Tongue cancer in young non-smokers.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Diagnosis and staging
- For my situation (diagnosis and staging), which of the standard options do you recommend and why?Why: Guideline options include: 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.
Primary treatment (T1 to T2, clinically node-negative)
- For my situation (primary treatment (t1 to t2, clinically node-negative)), which of the standard options do you recommend and why?Why: Guideline options include: 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.
- How do the results of Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Locally advanced (T3 to T4 or node-positive)
- For my situation (locally advanced (t3 to t4 or node-positive)), which of the standard options do you recommend and why?Why: Guideline options include: Resection with neck dissection and free-flap reconstruction, then postoperative radiotherapy, or cisplatin chemoradiation for extranodal extension or positive margins.
- Am I a candidate for Cisplatin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Recurrent or metastatic
- For my situation (recurrent or metastatic), which of the standard options do you recommend and why?Why: Guideline options include: Pembrolizumab alone or with platinum-fluorouracil (KEYNOTE-048); oral metronomic methotrexate-celecoxib where resources are limited.
- Am I a candidate for Pembrolizumab, Methotrexate, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-048 and Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial) apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Prevention
- For my situation (prevention), which of the standard options do you recommend and why?Why: Guideline options include: Tobacco, alcohol and betel quid cessation; treatment of leukoplakia and erythroplakia; oral examination in high-risk people.
Any stage
- Are there clinical trials I could join, for example of Pembrolizumab, KEYNOTE-689, Sentinel lymph node biopsy, NIVOPOSTOP (GORTEC 2018-01)?Why: Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Why tongue cancer is rising in young non-smokers”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Whether sentinel node biopsy can replace elective neck dissection safely”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Newly diagnosed? Read the first 60 days with Oral tongue and floor of mouth cancer, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
9targets
1drugs
3companies
1terms
4trials
5Latest papers
topQuery for this cancer: (TITLE:"Oral tongue and floor of mouth cancer" OR ABSTRACT:"Oral tongue and floor of mouth cancer" OR TITLE:"Tongue cancer" OR ABSTRACT:"Tongue cancer" OR TITLE:"Anterior two-thirds of tongue cancer" OR ABSTRACT:"Anterior two-thirds of tongue cancer" OR TITLE:"Floor of mouth cancer" OR ABSTRACT:"Floor of mouth cancer" OR TITLE:"Oral tongue squamous cell carcinoma" OR ABSTRACT:"Oral tongue squamous cell carcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Oral tongue and floor of mouth cancer, not a curated reading list.
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