The most common site of oral cavity cancer is the mobile tongue, usually on the lateral border of the tongue. Behaviors that put patients at risk to develop cancer of the tongue include smoking, alcohol abuse, chewing tobacco, and immunosuppression. Approximately 85% of oral cancers can be seen and the remainder palpated. Detection of cancers early results in less morbidity from treatment, smaller scope of treatment and a better prognosis. For early stage lesions, surgery is usually indicated. The cure rates are quite good and only one modality is needed. Larger lesions require combinations of surgery and radiation with or without chemotherapy, and the prognosis is worse. The extent of surgery, logically, is broader.
Methods of diagnosing tumor early depend on early recognition of tumor and timely biopsy of the lesion. Biopsies can be obtained with a cup forcep, a punch biopsy, a scalpel excision or brush biopsies. These methods do not place the patient at much risk, are fast and the discomfort is short-lived.
What is also obvious and well-known is that earlier diagnosis leads to earlier treatment and better outcomes. Stage I tongue cancer carries a 5-year survival rate of 80%; one study claimed survival around 89%. Stage II has a 5-year survival rate of 75%. When lymph node involvement is present with small oral tongue cancers, survival falls to 53%. Stage IV disease generally has a prognosis that is poor with survivals running in the 20% range.
Tongue cancer medical expert witness specialties include head and neck surgery, otolaryngology, pathology, radiation oncology, oral and maxillofacial surgery, and radiology.