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Tongue Cancer

Disease Details

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Description: Tongue cancer is a type of head and neck cancer where malignant cells form in the tissues of the tongue.
Type: Tongue cancer is typically classified as a type of oral cancer and can be categorized into two main types: squamous cell carcinoma, which is the most common, and less commonly, other types such as adenocarcinoma. The condition generally arises due to environmental factors like tobacco use, alcohol consumption, and HPV infection rather than genetic transmission. While there may be some genetic predispositions, tongue cancer is not commonly inherited in a Mendelian fashion.
Signs And Symptoms: The signs and symptoms of oral cancer depend on the location of the tumor but are generally thin, irregular, white patches in the mouth. They can also be a mix of red and white patches (mixed red and white patches are much more likely to be cancerous when biopsied). The classic warning sign is a persistent rough patch with ulceration, and a raised border that is minimally painful. On the lip, the ulcer is more commonly crusting and dry, and in the pharynx it is more commonly a mass. It can also be associated with a white patch, loose teeth, bleeding gums, persistent ear ache, a feeling of numbness in the lip and chin, or swelling.When the cancer extends to the throat, there can also be difficulty swallowing (usually a base of tongue HPV16+ cancer) or a visibly enlarged tonsil unilaterally, also from the same etiology, painful swallowing, and an altered voice. Typically, the lesions have very little pain until they become larger and then are associated with a burning sensation. As the lesion spreads to the lymph nodes of the neck, a painless, hard mass will develop. If it spreads elsewhere in the body, general aches can develop, most often due to bone metastasis.
Prognosis: Survival rates for oral cancer depend on the precise site and the stage of the cancer at diagnosis. Overall, 2011 data from the SEER database shows that survival is around 57% at five years when all stages of initial diagnosis, all genders, all ethnicities, all age groups, and all treatment modalities are considered. Survival rates for stage 1 cancers are approximately 90%, hence the emphasis on early detection to increase survival outcome for people. Similar survival rates are reported from other countries, such as Germany.
Onset: Onset of tongue cancer typically involves the development of symptoms such as a persistent sore or lump on the tongue that does not heal, pain in the tongue or difficulty swallowing. These symptoms can develop gradually over time.
Prevalence: For tongue cancer, the prevalence varies widely by region and population. It is generally more common in areas with high rates of tobacco use and alcohol consumption, such as parts of India and Southeast Asia. In Western countries, it accounts for about 2-4% of all cancers. More detailed prevalence data can be obtained from specific cancer registries and studies.
Epidemiology: Globally, it newly occurred in about 355,000 people and resulted in 177,000 deaths in 2018. Of these 355,000, about 246,000 are males and 108,000 are females.In 2013, oral cancer resulted in 135,000 deaths, up from 84,000 deaths in 1990. Oral cancer occurs more often in people from lower and middle income countries.
Intractability: The intractability of tongue cancer depends on several factors, including the stage at diagnosis, the specific characteristics of the tumor, the patient's overall health, and the response to treatment. Early-stage tongue cancer often has better treatment outcomes and may be treated successfully with surgery, radiation, and/or chemotherapy. However, advanced or late-stage tongue cancer can be more challenging to treat and may have a higher risk of recurrence, making it more intractable.
Disease Severity: Tongue cancer is generally considered a serious and potentially life-threatening condition. The severity of tongue cancer can vary based on factors such as the stage at diagnosis, the size and location of the tumor, and whether it has spread to lymph nodes or other parts of the body. Early detection and treatment are crucial for a better prognosis. Advanced stages may require more aggressive treatment and can significantly impact survival rates.
Healthcare Professionals: Disease Ontology ID - DOID:8649
Pathophysiology: Oral squamous cell carcinoma is the end product of an unregulated proliferation of mucous basal cells. A single precursor cell is transformed into a clone consisting of many daughter cells with an accumulation of altered genes called oncogenes. What characterizes a malignant tumor over a benign one is its ability to metastasize. This ability is independent of the size or grade of the tumor (often seemingly slow growing cancers like the adenoid cystic carcinoma can metastasis widely). It is not just rapid growth that characterizes a cancer, but their ability to secrete enzymes, angiogeneic factors, invasion factors, growth factors and many other factors that allow it to spread.
Carrier Status: Tongue cancer is not typically associated with being a carrier of a particular gene or genetic mutation, unlike some hereditary cancers. It is mainly linked to lifestyle risk factors such as tobacco use, alcohol consumption, and HPV infection. If you have specific concerns about genetic risks, consulting with a healthcare professional or genetic counselor is recommended.
Mechanism: Tongue cancer primarily involves the uncontrolled growth of malignant cells on the tongue. It is commonly categorized as a type of oral cancer and often manifests as squamous cell carcinoma.

### Mechanism
The development of tongue cancer typically follows a multi-step process:
1. **Initiation**: Genetic mutations or alterations induce changes in normal tongue cells, making them precancerous.
2. **Promotion**: Additional genetic and environmental factors promote the clonal expansion of these precancerous cells.
3. **Progression**: Precancerous cells acquire more mutations, allowing them to invade surrounding tissues and metastasize.

### Molecular Mechanisms
The key molecular mechanisms in tongue cancer include:
1. **Genetic Mutations**: Mutations in oncogenes (e.g., PIK3CA) and tumor suppressor genes (e.g., TP53, CDKN2A) are common. These mutations dysregulate cell growth and apoptosis pathways.
2. **Epigenetic Changes**: DNA methylation, histone modification, and non-coding RNA regulation can silence tumor suppressor genes and activate oncogenes.
3. **Signal Transduction Pathways**: Dysregulation of pathways such as the EGFR, Wnt, and PI3K/Akt/mTOR signaling pathways can promote cell proliferation and survival.
4. **Angiogenesis**: Enhanced formation of new blood vessels through mechanisms driven by VEGF (vascular endothelial growth factor) supports tumor growth and metastasis.
5. **Immune Evasion**: Tumor cells may evade immune surveillance through mechanisms like the overexpression of PD-L1, which inhibits T-cell function.

These mechanisms collectively contribute to the initiation, progression, and metastasis of tongue cancer.
Treatment: For tongue cancer, treatment options typically include:

- **Surgery:** To remove the cancerous tissue. This may involve partial removal of the tongue (partial glossectomy) or more extensive surgery based on the spread.
- **Radiation Therapy:** High-energy rays aimed at killing cancer cells or shrinking tumors, often used in conjunction with surgery.
- **Chemotherapy:** Drugs that kill or slow the growth of cancer cells, often used when cancer has spread beyond the tongue.
- **Targeted Therapy:** Medicines that specifically target cancer cells without affecting much of the normal cells.
- **Rehabilitation:** Post-treatment therapies, including speech and swallowing therapy, may be necessary for recovery of function.

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Compassionate Use Treatment: Compassionate use treatment for tongue cancer typically involves accessing experimental drugs or treatments that have not yet been approved by regulatory agencies but show promise in clinical trials. This is usually considered for patients who have exhausted standard treatment options and have no other alternatives.

Off-label or experimental treatments for tongue cancer can include:
1. **Immunotherapy**: While drugs like pembrolizumab and nivolumab are approved for other cancers, they might be used off-label for advanced tongue cancer.
2. **Targeted Therapy**: Agents targeting specific genetic mutations or pathways (e.g., EGFR inhibitors like cetuximab) can be considered.
3. **Gene Therapy**: Experimental approaches that involve altering the patient’s genes to treat or prevent disease.
4. **Photodynamic Therapy (PDT)**: A treatment that uses special drugs, called photosensitizing agents, along with light to kill cancer cells might be explored experimentally.
5. **Hyperthermia Treatment**: Using heat to damage and kill cancer cells.

These treatments are typically part of ongoing clinical trials and might be accessible through specific medical research programs.
Lifestyle Recommendations: For tongue cancer, here are lifestyle recommendations:

1. **Avoid Tobacco**: Both smoking and smokeless tobacco use can significantly increase the risk of tongue cancer.
2. **Limit Alcohol Consumption**: Heavy and regular alcohol consumption is a risk factor, and reducing intake can lower the risk.
3. **Maintain Good Oral Hygiene**: Regular brushing, flossing, and dental check-ups help maintain oral health and can aid in early detection of abnormalities.
4. **Healthy Diet**: A diet rich in fruits, vegetables, and whole grains supports overall health and can potentially reduce cancer risk.
5. **Protection from HPV**: Human Papillomavirus (HPV) can be a contributing factor, so vaccination and safe sexual practices are recommended.
6. **Regular Check-ups**: Routine medical and dental examinations can aid in early detection and timely intervention.
7. **Avoid Excessive Sun Exposure**: Protect your lips by using lip balm with SPF, as UV radiation can contribute to the risk of cancers in the oral region.

Adopting these lifestyle habits can help in the prevention and management of tongue cancer.
Medication: Medication for tongue cancer typically includes chemotherapy drugs. Commonly used medications are:

1. Cisplatin
2. 5-Fluorouracil (5-FU)
3. Paclitaxel
4. Docetaxel
5. Carboplatin

These drugs are often used in combination with other treatments like surgery and radiation therapy. The choice of medication depends on the stage and specific characteristics of the cancer.
Repurposable Drugs: Repurposable drugs for tongue cancer include metformin (originally for diabetes), which has shown potential anticancer effects. Additionally, celecoxib (an anti-inflammatory drug) may have potential due to its ability to inhibit cancer cell growth. Research is ongoing to explore these and other existing medications for their efficacy in treating tongue cancer.
Metabolites: Tongue cancer has been associated with several metabolites due to disruptions in metabolic pathways within cancer cells. Key metabolites that can be altered include lactate, pyruvate, glucose, and certain amino acids such as glutamine and glycine. These changes can affect energy production, cell growth, and the microenvironment of the tumor.
Nutraceuticals: There is currently no substantial evidence to support the effectiveness of nutraceuticals for the treatment or prevention of tongue cancer. Nutraceuticals, which include vitamins, minerals, herbs, and other dietary supplements, are sometimes explored for their potential health benefits, but they should not replace conventional cancer treatments. As for nanotechnology (abbreviated as nan.), it is an emerging field in cancer therapy. Research is ongoing to develop nanocarriers for targeted drug delivery, which may enhance the effectiveness of chemotherapy and reduce side effects. However, these approaches are primarily in experimental stages and not yet standard clinical practice. Always consult a healthcare provider for personalized medical advice.
Peptides: Peptides are short chains of amino acids that can be involved in various biological processes, including potentially acting as biomarkers or therapeutic agents in cancer. In the context of tongue cancer, certain peptides may be studied for their role in tumor growth, metastasis, or as targets for new treatments.

Nanotechnology (nan) involves the use of nanoscale materials and devices. In tongue cancer, nanotechnology can aid in early detection, targeted drug delivery, and improved imaging techniques. Nanoparticles can be designed to carry drugs directly to cancer cells, reducing side effects and increasing the efficacy of treatments.