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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
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.
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.
| Setting | Approach | Guideline |
|---|---|---|
| Diagnosis and staging | 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. | not mapped |
| Primary treatment (T1 to T2, clinically node-negative) | 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. | NCCN Category 1 (elective neck dissection) |
| Locally advanced (T3 to T4 or node-positive) | Resection with neck dissection and free-flap reconstruction, then postoperative radiotherapy, or cisplatin chemoradiation for extranodal extension or positive margins. | NCCN Category 1 (chemoradiation for extranodal extension or positive margins) |
| Recurrent or metastatic | Pembrolizumab alone or with platinum-fluorouracil (KEYNOTE-048); oral metronomic methotrexate-celecoxib where resources are limited. | NCCN Category 1 |
| Prevention | Tobacco, alcohol and betel quid cessation; treatment of leukoplakia and erythroplakia; oral examination in high-risk people. | not mapped |