Treatment of cancer of the tongue

A 50 year old woman came to the OPD at Richardsons Dental and Craniofacial Hospital with the complaint of an enlarging ulcer at the right side of her tongue. She first noticed it a month back when reportedly it was much smaller in size and it has gradually grown since. It was a painful ulcer and she tried some local ayurvedic measures which failed to resolve the ulcer. She couldn’t recall any sharpness of the teeth due to which it started, nor was there any history of tobacco consumption. Dr.Sunil Richardson examined her and found a 3cm x 2cm indurated ulcer at the right lateral border of her tongue also involving the floor of the mouth. Lymph nodes of the neck on the right side were obviously enlarged on touch. A CT scan was ordered which didn’t show any involvement of the lower jaw but showed multiple enlarged lymph nodes of the right side of the neck. An incisional biopsy was done to confirm the clinical diagnosis. It came as moderately differentiated carcinoma of the tongue and floor of the mouth.

Surgery was planned for her as the first treatment modality. In the surgery, local excision of the tumor would be done followed by removal of all nodes of the neck along with the main vein of the neck which is the internal jugular vein. This would provide local clearance of tumor deposits. Extraction of all teeth of the related quadrant would be done as well. Post the surgery, radiotherapy would be considered.

Work up for surgery was done which included chest X-ray, ECG and blood tests. The patient was cleared for surgery. The surgery took four hours. The resected tongue was closed primarily and the floor of the mouth was reconstructed with a skin-muscle flap taken from the cheek called as the nasolabial flap. The patient was kept on tube feeding for the first five days after which she slowly switched to oral diet. She is expected to have near normal swallowing and only mildly disturbed speech. Timely and thorough treatment of oral cancer gives the patient a fair chance at survival while maintaining a decent quality of life.