Clinical Presentation and Work-Up of SCC of the Oral Tongue

Clinical presentation of oral tongue cancer:
- Patients with oral cancer may present with several symptoms notably:
- Pain
- Ulceration
- A lump on the tongue
Lesions of the oral tongue:
- Are more likely to be symptomatic than lesions of the base of the tongue:
  - Although despite this many patients still present with a four- to six-month history of symptoms prior to seeking medical advice
- The majority of patients with cancer of the oral tongue present with stage I / II disease:
  - Which contrasts significantly with cancers of the base of the tongue that are usually stage III / IV at presentation
- Clinically positive cervical lymphadenopathy at presentation:
  - Is in the region of 21% to 34%:
    - Occult cervical metastasis has been demonstrated in up to 53% of patients with tongue cancer:
      - Being related to tumor thickness
    - Tumors arising on the lateral aspect of the tongue tend to be thicker than those of the ventral aspect of the tongue:
      - Up to 4.5% may have occult cervical disease in the contralateral neck
    - Clinical examination, CT and MRI:
      - Have relatively poor sensitivity at determining cervical lymph-adenopathy
The majority of tongue tumors:
- Are well to moderately differentiated on histological examination
Work up:
- As with many sites, management of the neck is frequently determined by tumor thickness:
  - Tumor thickness can be assessed accurately with intraoral sonography, or immediate sonography of the resected tumor:
    - Prior to proceeding to a neck dissection if access to the neck is not required for reconstructive purposes
- Biopsies should endeavour to include the deep margin of the tumor in addition to mucosa at the periphery of the tumor:
  - Deep biopsies may give an indication of tumor depth:
    - But also multifactorial histological malignancy grading of the most dysplastic areas of the invasive front may help in assessing the risk of cervical metastasis