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Tongue carcinoma

Oral cancer is the fifth most common malignancy globally, with rates as high as 40% in Asia. The tongue is the second most common site of oral cancer after the lips. Tobacco use is implicated in 90% of tongue cancer cases, while alcohol consumption increases risk 6-fold. Premalignant conditions like leukoplakia and erythroplakia are associated with higher malignant transformation risks over time. Squamous cell carcinoma comprises 95% of tongue cancers, usually presenting as an ulcerative mass on the lateral border of the tongue in men around age 60. Early detection and cessation of tobacco and alcohol use can help prevent this potentially preventable disease.

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Dr sumer yadavDr sumer yadav
INTRODUCTIONINTRODUCTION  ORAL CANCER IS FIFTH MOST COMMONORAL CANCER IS FIFTH MOST COMMON MALIGNANCY GLOBALLY.MALIGNANCY GLOBALLY.  WESTERN WORLD # 2 TO 4 % OFWESTERN WORLD # 2 TO 4 % OF MALIGNANT TUMORS.MALIGNANT TUMORS.  ASIA # NOT LESS THAN 40%ASIA # NOT LESS THAN 40%  RATIO OF MEN & WOMEN 3 : 1.RATIO OF MEN & WOMEN 3 : 1.  APPROX AGE > 60 YEARSAPPROX AGE > 60 YEARS
 SOLID CONICAL MUSCULAR ORGAN,SOLID CONICAL MUSCULAR ORGAN, COVERED BY MUCOUS MEMBRANE,COVERED BY MUCOUS MEMBRANE, PRESENT IN ORAL CAVITY &PRESENT IN ORAL CAVITY & OROPHARYNX.OROPHARYNX.  ANT 2/3 ORAL TONGUE – FREELY MOBILEANT 2/3 ORAL TONGUE – FREELY MOBILE & ANT. TO CIRCUMVALLATE PAPILLAE& ANT. TO CIRCUMVALLATE PAPILLAE  POST 1/3 – BASE TONGUE – POST TOPOST 1/3 – BASE TONGUE – POST TO CIRCUM VALLATE PAPILLAE &CIRCUM VALLATE PAPILLAE & PALATOGLOSSAL ARCHPALATOGLOSSAL ARCH  ANATOMIC REGION – TIP, LATERALANATOMIC REGION – TIP, LATERAL BORDER, DORSUM & UNDER SURFACEBORDER, DORSUM & UNDER SURFACE  EXTRINSIC & INTRINSIC MUSCLES AREEXTRINSIC & INTRINSIC MUSCLES ARE ANATOMYANATOMY
 IT HELP IN MASTICATION, DEGLUTITION &IT HELP IN MASTICATION, DEGLUTITION & SPEECHSPEECH  RELATIVELY AVASCULAR MIDLINE -RELATIVELY AVASCULAR MIDLINE - MARKED BY MEDIAN FIBROUS SEPTUMMARKED BY MEDIAN FIBROUS SEPTUM  LINGUAL ARTRY – ECA AT Gr CORNU OFLINGUAL ARTRY – ECA AT Gr CORNU OF HYOID BONEHYOID BONE  DEEP VEIN – LINGUAL VEIN – IJVDEEP VEIN – LINGUAL VEIN – IJV  NERVE SUPPLY –NERVE SUPPLY – A. MOTORA. MOTOR – ALL MUSCLE – HYPOGLOSSAL NERVEALL MUSCLE – HYPOGLOSSAL NERVE – PALATOGLOSSAL – CRANIAL PART OFPALATOGLOSSAL – CRANIAL PART OF SANSAN
B. SENSORYB. SENSORY – ANT 2/3 – LINGUAL NERVE & CORDA TYNPANIANT 2/3 – LINGUAL NERVE & CORDA TYNPANI – POST 1/3 & CIRCUMVALLETE PAPILLAE – IXPOST 1/3 & CIRCUMVALLETE PAPILLAE – IXTHTH NERVE.NERVE. LYMPHATIC DRAINAGELYMPHATIC DRAINAGE – ARISES FROM SUBMUCOSAL PLEXUSARISES FROM SUBMUCOSAL PLEXUS – APICALSET – TIP & FRENULUM – SUBMENTALAPICALSET – TIP & FRENULUM – SUBMENTAL – MARGINAL SET – SIDE OF TONGUE –MARGINAL SET – SIDE OF TONGUE – SUBMANDIBULARSUBMANDIBULAR – CENTRAL SET – DORSUM – JUGULODIAGASTRIC &CENTRAL SET – DORSUM – JUGULODIAGASTRIC & OMOHYOIDOMOHYOID – BASAL SET – POST 1/3 - JUGULODIAGASTRIC &BASAL SET – POST 1/3 - JUGULODIAGASTRIC & OMOHYOIDOMOHYOID IN MIDLINE FREE DECUSSATING OF LYMPHATICIN MIDLINE FREE DECUSSATING OF LYMPHATIC OCCUR & THEY PASSES BILATERALLYOCCUR & THEY PASSES BILATERALLY
 TIP OF TONGUE – RICHEST LYMPHATICTIP OF TONGUE – RICHEST LYMPHATIC DRAINAGEDRAINAGE  PRINCIPAL NODE– JUGULO OMOHYOIDPRINCIPAL NODE– JUGULO OMOHYOID
CARCINOMA TONGUE IS THE SECONDCARCINOMA TONGUE IS THE SECOND MOST COMMON SITE OF ORAL CA AFTERMOST COMMON SITE OF ORAL CA AFTER LIPLIP SITE WISE INCIDENCE :-SITE WISE INCIDENCE :- – MIDDLE 1/3 OF LATERAL BORDER OF TONGUEMIDDLE 1/3 OF LATERAL BORDER OF TONGUE - 47% - COMMONEST SITE- 47% - COMMONEST SITE POST 1/3 -20%POST 1/3 -20% TIP - 15%TIP - 15% – VENTRAL SURFACE & FRENULUM - 9%VENTRAL SURFACE & FRENULUM - 9% – DORSUM - 6.5%DORSUM - 6.5% – FACIO – LINGUAL - 6%FACIO – LINGUAL - 6% AGE OF PRESENTATION = 60 YEARSAGE OF PRESENTATION = 60 YEARS MEN > WOMENMEN > WOMEN
ETIOLOGYETIOLOGY TOBACCO :TOBACCO :  90% OF PATIENTS WITH CANCER USE90% OF PATIENTS WITH CANCER USE TOBACCO.TOBACCO.  RISK OF CARCINOMA INCREASES WITHRISK OF CARCINOMA INCREASES WITH AMOUNT OF TOBACCO USED & DURATION OFAMOUNT OF TOBACCO USED & DURATION OF HABIT.HABIT.  EXPOSURE TO TOBACCO CAUSESEXPOSURE TO TOBACCO CAUSES PROGRESSIVE SEQUENTIAL MORPHOLOGICPROGRESSIVE SEQUENTIAL MORPHOLOGIC CHANGES OF MUCOSA LEADING TOCHANGES OF MUCOSA LEADING TO NEOPLASTIC TRANSFORMATION.NEOPLASTIC TRANSFORMATION.  SUCH CHANGES M/b REVERSIBLE IFSUCH CHANGES M/b REVERSIBLE IF TOBACCO EXPOSURE IS ELIMINATED EARLY.TOBACCO EXPOSURE IS ELIMINATED EARLY.  SO IT IS A PREVENTABLE DISEASESO IT IS A PREVENTABLE DISEASE
 40% OF PATIENTS WHO PERSISTED40% OF PATIENTS WHO PERSISTED SMOKING AFTER PRESUMABLESMOKING AFTER PRESUMABLE CURE OF ORAL CANCERCURE OF ORAL CANCER DEVELOPED SECOND CANCERDEVELOPED SECOND CANCER COMPARED TO 6% OF THOSE WHOCOMPARED TO 6% OF THOSE WHO STOPPED SMOKINGSTOPPED SMOKING  TOBACCO CONTAINS CARCINOGENSTOBACCO CONTAINS CARCINOGENS THAT ACT DIRECTLY ON MUCOSATHAT ACT DIRECTLY ON MUCOSA  INCIDENCE IN WOMEN ISINCIDENCE IN WOMEN IS INCREASING BECAUSE OFINCREASING BECAUSE OF INCREASING HABIT OF SMOKING &INCREASING HABIT OF SMOKING & DRINKING.
ALCOHOLALCOHOL  75-80% OF PATIENTS WITH CANCER75-80% OF PATIENTS WITH CANCER CONSUME ALCOHOL.CONSUME ALCOHOL.  6 TIMES > IN DRINKER THAN NON6 TIMES > IN DRINKER THAN NON DRINKERDRINKER  ALCOHOL ACT AS DIRECT IRRITANTALCOHOL ACT AS DIRECT IRRITANT & ADD NUTRITIONAL DEFICIENCY.& ADD NUTRITIONAL DEFICIENCY.  STUDY SHOWS THAT DYSPLASTICSTUDY SHOWS THAT DYSPLASTIC CHANGES IN THE MUCOSA OF NONCHANGES IN THE MUCOSA OF NON SMOKING ALCOHOLIC PATIENTS,SMOKING ALCOHOLIC PATIENTS, SUGGESTING THAT ALCOHOL ITSELFSUGGESTING THAT ALCOHOL ITSELF IS A CARCINOGEN.IS A CARCINOGEN.  PERSONS USES BOTH ALCOHOL &PERSONS USES BOTH ALCOHOL & TOBACCO ARE AT HIGHER RISKTOBACCO ARE AT HIGHER RISK THAN THOSE USE ONE.THAN THOSE USE ONE.
 POOR ORAL & DENTALPOOR ORAL & DENTAL HYGIENE.HYGIENE.  CHRONIC IRRITATION FROMCHRONIC IRRITATION FROM SHARP TOOTH, ORAL SEPSIS,SHARP TOOTH, ORAL SEPSIS, SPICESSPICES  SYPHILISSYPHILIS  PLUMMER-VINSONPLUMMER-VINSON SYNDROME.SYNDROME.
 VIT. A DEFICIENCYVIT. A DEFICIENCY  ATAXA TELANGIECTASIA,ATAXA TELANGIECTASIA, FANCONI ANEMIAFANCONI ANEMIA  MARIJUANA = INCREASINGMARIJUANA = INCREASING INCIDENCE TO TONGUE CANCERINCIDENCE TO TONGUE CANCER IN YOUNG MALE.IN YOUNG MALE.  VIRUS = HSV-I & HPV 2, 11, 16VIRUS = HSV-I & HPV 2, 11, 16  FRESH FRUITS & VEGETABLESFRESH FRUITS & VEGETABLES ARE PROTECTIVE.ARE PROTECTIVE.
PATHOLOGYPATHOLOGY  95% OF TONGUE CANCER ARE SCC95% OF TONGUE CANCER ARE SCC  RATIO OF SCC ANT 2/3 TO POST 1/3RATIO OF SCC ANT 2/3 TO POST 1/3 = 4:1= 4:1  OTHERS – MELANOMA, SARCOMA,OTHERS – MELANOMA, SARCOMA, MINOR SALIVARY GLAND CANCERMINOR SALIVARY GLAND CANCER ADENOCYSTIC CARCINOMA,ADENOCYSTIC CARCINOMA, ADENOCARCINOMAADENOCARCINOMA  METASTATIC CA TONGUE IS RAREMETASTATIC CA TONGUE IS RARE
PREMALIGNANT CONDITIONPREMALIGNANT CONDITION DEFINIT RISK OF MALIGNANT CHANGES:-DEFINIT RISK OF MALIGNANT CHANGES:- 1.1. LEUCOPLAKIALEUCOPLAKIA 2.2. ERYTHROPLAKIAERYTHROPLAKIA 3.3. CHRONIC HYPERPLASTIC CANDISIASISCHRONIC HYPERPLASTIC CANDISIASIS
LEUCOPLAKIALEUCOPLAKIA  WHITE PLAQUE ON MUCOSA THAT CANWHITE PLAQUE ON MUCOSA THAT CAN NOT BE REMOVED BY SCRAPING AND CANNOT BE REMOVED BY SCRAPING AND CAN NOT BE CLASSIFIED CLINICALLY ORNOT BE CLASSIFIED CLINICALLY OR PATHOLOGICALLY AS ANY OTHERPATHOLOGICALLY AS ANY OTHER DISEASE.DISEASE.  SMALL CIRCUMSCRIBED WHITE PLAQUESMALL CIRCUMSCRIBED WHITE PLAQUE  SMOOTH, WRINKLED WITH FISSURESSMOOTH, WRINKLED WITH FISSURES  WHITE TO YELLOWISH OR GREYWHITE TO YELLOWISH OR GREY  HOMOGENOUS OR NODULAR SPECKLEDHOMOGENOUS OR NODULAR SPECKLED  NODULAR & SPECKLED ARE MOST LIKELYNODULAR & SPECKLED ARE MOST LIKELY TO UNDERGO MALIGNANT CHANGESTO UNDERGO MALIGNANT CHANGES
 INCIDENCE OF MALIGNANT CHANGESINCIDENCE OF MALIGNANT CHANGES INCREASESINCREASES WITHWITH THE AGE OFTHE AGE OF LEUCOPLAKIALEUCOPLAKIA  2.4% MALIGNANT TRANSFORMATION RATE2.4% MALIGNANT TRANSFORMATION RATE AT 10 YR.AT 10 YR.  4% MALIGNANT TRANSFORMATION RATE4% MALIGNANT TRANSFORMATION RATE AT 20 YR.AT 20 YR.  MALIGNANT TRANSFORMATION RISKMALIGNANT TRANSFORMATION RISK INCREASES WITH THE AGE OF PATIENTSINCREASES WITH THE AGE OF PATIENTS  < 50 YR.< 50 YR. – 1%– 1%  70 - 89 YR.70 - 89 YR. – 7.5%– 7.5% DURING 5 YEARS OBSERVATION
 LEUCOPLAKIA OF FLOOR OFLEUCOPLAKIA OF FLOOR OF MOUTH & VENTRAL SURFACE OFMOUTH & VENTRAL SURFACE OF TONGUE HAS HIGH INCIDENCE OFTONGUE HAS HIGH INCIDENCE OF MALIGNANCYMALIGNANCY  INDURATIONS S/o MALIGNANTINDURATIONS S/o MALIGNANT CHANGES, INDICATION FORCHANGES, INDICATION FOR BIOPSYBIOPSY  TRETMENT WITH SURGICALTRETMENT WITH SURGICAL EXCESION OR CO2 LASEREXCESION OR CO2 LASER
ERYTHROPLAKIAERYTHROPLAKIA  ANY LESION OF ORAL MUCOSA THATANY LESION OF ORAL MUCOSA THAT PRESENT AS BRIGHT RED VELVETYPRESENT AS BRIGHT RED VELVETY PLAQUE THAT CAN NOT BEPLAQUE THAT CAN NOT BE CHARACTERIZED CLINICALLY ORCHARACTERIZED CLINICALLY OR PATHOLOGICALLY ANY OTHER DISEASEPATHOLOGICALLY ANY OTHER DISEASE  IRREGULAR & CLEARLY DEMARCATEDIRREGULAR & CLEARLY DEMARCATED FROM NORMAL EPITHELIUMFROM NORMAL EPITHELIUM  INCIDENCE OF MALIGNANT CHANGES ISINCIDENCE OF MALIGNANT CHANGES IS 17 TIME HIGHER THAN LEUCOPLAKIA17 TIME HIGHER THAN LEUCOPLAKIA  MUST BE EXCISED SURGICALLY.MUST BE EXCISED SURGICALLY.
OTHERS LESIONSOTHERS LESIONS  ORAL SUBMUCOUSORAL SUBMUCOUS FIBROSISFIBROSIS SYPHILITIC GLOSSITISSYPHILITIC GLOSSITIS SIDEROPENICSIDEROPENIC DYSPHASIADYSPHASIA ORAL LICHEN PLANUSORAL LICHEN PLANUS
PATHOLOGICAL VARIETIESPATHOLOGICAL VARIETIES 1.1. ULCERATIVEULCERATIVE 2.2. WARTY GROWTHWARTY GROWTH 3.3. INDURATED PLAQUE OR MASSINDURATED PLAQUE OR MASS 4.4. FISSUREFISSURE  ULCERATIVE VARIETY COMMONESTULCERATIVE VARIETY COMMONEST  IRREGULAR WITH EVERTED EDGES &IRREGULAR WITH EVERTED EDGES & INDURATED BASEINDURATED BASE  WARTY GROWTH IS USUALLYWARTY GROWTH IS USUALLY SUPERIMPOSED ON PREVIOUSSUPERIMPOSED ON PREVIOUS LEUCOPLAKIALEUCOPLAKIA  FISSURE IS CHRONIC & FOLLOWSFISSURE IS CHRONIC & FOLLOWS CHRONIC SUPERFECIAL GLOSSITITS ORCHRONIC SUPERFECIAL GLOSSITITS OR SYPHILISSYPHILIS
MODE OF SPREADMODE OF SPREAD LOCAL SPREADLOCAL SPREAD  BY INFILTRATION & INVASIONBY INFILTRATION & INVASION  ANT 2/3 OF TONGUE – FLOOR OF MOUTH,ANT 2/3 OF TONGUE – FLOOR OF MOUTH, CROSS THE MIDLINECROSS THE MIDLINE  MANDIBLE INFILTRATION OCCUR THROUGHMANDIBLE INFILTRATION OCCUR THROUGH ITS DENTAL SOCKET OR EDENTULOUSITS DENTAL SOCKET OR EDENTULOUS ALVEOLAR RIDGE, CELLS PROCEED ALONGALVEOLAR RIDGE, CELLS PROCEED ALONG THE ROOT OF TOOTH INTO THETHE ROOT OF TOOTH INTO THE CANCELLOUS PART OF MANDIBLE & THANCANCELLOUS PART OF MANDIBLE & THAN ALONG THE MANDIBULAR CANAL.ALONG THE MANDIBULAR CANAL.  POST 1/3 OF TONGUE – TONSIL, PHARYNX,POST 1/3 OF TONGUE – TONSIL, PHARYNX, PALATE, EPIGLOTTIS.PALATE, EPIGLOTTIS.
LYMPHATIC SPREAD:LYMPHATIC SPREAD:  FREQUENTLY METASTASIZES B/LFREQUENTLY METASTASIZES B/L  POST 1/3 EMBOLIC SPREAD NOT BYPOST 1/3 EMBOLIC SPREAD NOT BY PERMEATIONPERMEATION  B/L SPREAD - 25%B/L SPREAD - 25%  CONTRALATRAL SPREAD - 3%CONTRALATRAL SPREAD - 3% BLOOD SPREAD ISBLOOD SPREAD IS RARE MOSTLY WITH POST 1/3RARE MOSTLY WITH POST 1/3
CLINICAL FEATURESCLINICAL FEATURES  COMMEST PRESENTATION IS PAINLESSCOMMEST PRESENTATION IS PAINLESS LUMP OR ULCER ON THE SURFACE OFLUMP OR ULCER ON THE SURFACE OF TONGUE.TONGUE.  EXCESSIVE SALIVATION – ELDERLY MANEXCESSIVE SALIVATION – ELDERLY MAN SITTING IN OPD WITH FREQUENTSITTING IN OPD WITH FREQUENT SPITTING IN TO HANDKERCHIEF .SPITTING IN TO HANDKERCHIEF .  PAIN – LATE FEATUREPAIN – LATE FEATURE – DUE TO INVOLVEMENT OF NERVESDUE TO INVOLVEMENT OF NERVES – LOCALISED OR REFERRED TO EARLOCALISED OR REFERRED TO EAR – ON SWALLOWING – IN POST 1/3 TONGUE CAON SWALLOWING – IN POST 1/3 TONGUE CA
 DIFFICULTY IN SPEECH – POST 1/3DIFFICULTY IN SPEECH – POST 1/3 TONGUE CANCERTONGUE CANCER  INFILTRATION OF MUSCLES & FLOORINFILTRATION OF MUSCLES & FLOOR OF MOUTH – ANKYLO GLOSSIAOF MOUTH – ANKYLO GLOSSIA  FETOR ORIS, BLEEDING PRESENTFETOR ORIS, BLEEDING PRESENT DUE TO TUMOR NECROSIS &DUE TO TUMOR NECROSIS & INFECTION.INFECTION.  TRISMUS - INVOLVEMENT OFTRISMUS - INVOLVEMENT OF PTERYGOID MUSCLEPTERYGOID MUSCLE  MANDIBULAR ANESTHESIA – BONEMANDIBULAR ANESTHESIA – BONE EROSION WITH INVOLMENT OFEROSION WITH INVOLMENT OF ALVEOLAR NERVE.ALVEOLAR NERVE.
DIAGNOSTIC STUDYDIAGNOSTIC STUDY  CLINICAL EXAMINATION WITH HIGH INDEX OFCLINICAL EXAMINATION WITH HIGH INDEX OF CLINICAL SUSPICION.CLINICAL SUSPICION.  BIOPSY- INCISIONAL BIOPSY OF MOSTBIOPSY- INCISIONAL BIOPSY OF MOST SUSPICIOUS PART WITH NORMAL ADJOININGSUSPICIOUS PART WITH NORMAL ADJOINING MUCOSA IS MANDATORY BEFORE PLANNINGMUCOSA IS MANDATORY BEFORE PLANNING TREATMENT. BIOPSY CAN BE TAKEN UNDERTREATMENT. BIOPSY CAN BE TAKEN UNDER LA.LA.  FNAC – FROM NECK NODES.FNAC – FROM NECK NODES.  ORTHOPANTOMOGRAM (OPG) OR OBLIQUEORTHOPANTOMOGRAM (OPG) OR OBLIQUE VIEW RADIOGRAPH OF MANDIBLE ISVIEW RADIOGRAPH OF MANDIBLE IS EFFECTIVE INITIAL INVESTIGATION TOEFFECTIVE INITIAL INVESTIGATION TO ASSESS MANDIBULAR INVASION.ASSESS MANDIBULAR INVASION.
 CT SCANCT SCAN - FOR CERVICAL METASTASIS- FOR CERVICAL METASTASIS INFILTRATION OF MANDIBLE.INFILTRATION OF MANDIBLE.  MRI –MRI – INVESTIGATION OF CHOICE FORINVESTIGATION OF CHOICE FOR IMAGING SOFT TISSUE INFILTRATION. CANIMAGING SOFT TISSUE INFILTRATION. CAN DETECT PERINEURAL INVASION.DETECT PERINEURAL INVASION.  X-RAY –X-RAY – LIMITED VALUE D/T COMPLEXITYLIMITED VALUE D/T COMPLEXITY OF FASICAL BONE. MAY SHOWOF FASICAL BONE. MAY SHOW PULMONARY METASTASIS.PULMONARY METASTASIS.  ROUTINE INVESTIGATION WITH VDRL/ROUTINE INVESTIGATION WITH VDRL/ KHANS TEST ETC.KHANS TEST ETC.  DIRECT LARYNGOSCOPY – FOR BASE OFDIRECT LARYNGOSCOPY – FOR BASE OF TONGUE CA & TO KNOW THE FIELDTONGUE CA & TO KNOW THE FIELD CANCERIZATION (SYNCHRONOS ANDCANCERIZATION (SYNCHRONOS AND METACHRONOUS SECONDMETACHRONOUS SECOND MALIGNANCIES)MALIGNANCIES)
STAGING OF TONGUE CANCERSTAGING OF TONGUE CANCER  PRIMARY TUMOR (T)PRIMARY TUMOR (T) TxTx -- TUMOR CAN NOT BE ASSESSEDTUMOR CAN NOT BE ASSESSED T0T0 -- NO EVIDENCE OF PNO EVIDENCE OF P00 TUMORTUMOR TisTis -- CARCINOMA IN SITUCARCINOMA IN SITU T1T1 -- GREATEST DIAMETER =GREATEST DIAMETER = ≤ 2 cm.≤ 2 cm. T2T2 -- > 2 cm. TO 4 cm.> 2 cm. TO 4 cm. T3T3 -- > 4 cm.> 4 cm.
T4T4 -- ORAL TONGUEORAL TONGUE T4aT4a -- INVASION OF CORTICAL BONE,INVASION OF CORTICAL BONE, DEEP EXTRINSIC MUSCLE,DEEP EXTRINSIC MUSCLE, MAXILLARY SINUS, SKIN OFMAXILLARY SINUS, SKIN OF FACE.FACE. T4bT4b -- PTERYGOID PLATE SKULLPTERYGOID PLATE SKULL BASE, INVOLVEMENT OF ICABASE, INVOLVEMENT OF ICA T4T4 -- BASE OF TONGUEBASE OF TONGUE T4aT4a -- LARYNX, MEDIAL PTERYGOID,LARYNX, MEDIAL PTERYGOID, HARD PALATE, MANDIBLEHARD PALATE, MANDIBLE T4bT4b -- LATERAL PTERYGOID,LATERAL PTERYGOID, NASOPHARYNX , ICA,.NASOPHARYNX , ICA,.
LYMPH NODELYMPH NODE  Nx – REGIONAL LN CAN NOT BE ASSESSEDNx – REGIONAL LN CAN NOT BE ASSESSED  N0 – NO NODAL METASTASISN0 – NO NODAL METASTASIS  N1 – IPSILATERAL SINGLE LNN1 – IPSILATERAL SINGLE LN ≤≤ 3cm.3cm.  N2 :N2 : – N2A – IPSILATERAL SINGLE LN > 3cm. - 6 cm.N2A – IPSILATERAL SINGLE LN > 3cm. - 6 cm. – N2B – IPSILATERAL MULTIPLE LNN2B – IPSILATERAL MULTIPLE LN ≤ 6 cm.≤ 6 cm. – N2C – BILATERAL / CONTRALATERAL LNN2C – BILATERAL / CONTRALATERAL LN ≤ 6 cm.≤ 6 cm.  N3 – ANY NODE > 6 cm.N3 – ANY NODE > 6 cm.  MIDLINE NODES ARE CONSIDERED ASMIDLINE NODES ARE CONSIDERED AS IPSILATERALIPSILATERAL
DISTANT METASTASISDISTANT METASTASIS  MxMx –– CAN NOT BECAN NOT BE ASSESSEDASSESSED  M0M0 –– NO DETECTABLENO DETECTABLE DISTANTDISTANT METASTASISMETASTASIS  M1M1 –– DISTANTDISTANT METASTASISMETASTASIS PRESENTPRESENT
CLINICAL STAGING GROUPINGCLINICAL STAGING GROUPING STAGE T N M I T1 N0 M0 II T2 N0 M0 III T1 N1 M0 T2 N1 M0 T3 NO/N1 M0 IV A T4 N0 M0 T4 N1 M0 ANY T N2 M0 IV B ANY T N3 M0 IV C ANY T ANY N M1
TREATMENTSTREATMENTS  CHOICE OF TREATMENT DEPENDSCHOICE OF TREATMENT DEPENDS UPON VARIOUS FACTORSUPON VARIOUS FACTORS  SITE OF DISEASESITE OF DISEASE  STAGE OF DISEASE:STAGE OF DISEASE: – EARLYEARLY – SURGERY– SURGERY – INTERMEDIATE – BOTH (Surgery & RT)INTERMEDIATE – BOTH (Surgery & RT) – ADVANCEDADVANCED – BOTH (Surgery & RT)– BOTH (Surgery & RT)
 PREVIOUS IRRADIATIONPREVIOUS IRRADIATION  PATIENTS PHYSICAL / SOCIAL &PATIENTS PHYSICAL / SOCIAL & PERSONAL STATUSPERSONAL STATUS  SURGEON'S EXPERIENCE & SKILLSURGEON'S EXPERIENCE & SKILL  AVAILABILITY OF TREATMENTAVAILABILITY OF TREATMENT FACILITIESFACILITIES
SURGICAL TREATMENTSSURGICAL TREATMENTS AIMs OF SURGERYAIMs OF SURGERY  COMPLETE EXCISION OF PRIMARY,COMPLETE EXCISION OF PRIMARY, THREE DIMENSIONALLY WITH RoTHREE DIMENSIONALLY WITH Ro (MICROSCOPICALLY CLEAR) MARGINS.(MICROSCOPICALLY CLEAR) MARGINS.  Rx OF LNRx OF LN  RECONSTRUCTION OF TISSUE LOSS TORECONSTRUCTION OF TISSUE LOSS TO PROVIDE RAPID HEALING,PROVIDE RAPID HEALING, RESTORATION OF FUNCTION &RESTORATION OF FUNCTION & APPEARANCE TO IMPROVE QUALITY OFAPPEARANCE TO IMPROVE QUALITY OF LIFE.LIFE.
LOCAL EXCISIONLOCAL EXCISION  PER ORAL RESECTION IN SMALLPER ORAL RESECTION IN SMALL LESION (≤ 2cm.) LOCATED AT TIP,LESION (≤ 2cm.) LOCATED AT TIP, LATERAL BORDER ANT 2/3 OFLATERAL BORDER ANT 2/3 OF TONGUE THAT ARETONGUE THAT ARE APPROACHABLE 2 cm. MARGINAPPROACHABLE 2 cm. MARGIN  LOCALISED PREMALIGNANTLOCALISED PREMALIGNANT LESION ARE ALSO TREATED BYLESION ARE ALSO TREATED BY THIS METHOD.THIS METHOD.  LASER EXCESION – MINIMALLASER EXCESION – MINIMAL BLEED, SCAR&RAPID HEALINGBLEED, SCAR&RAPID HEALING
PARTIAL GLOSSECTOMY WITHPARTIAL GLOSSECTOMY WITH SPARING OF MANDIBLESPARING OF MANDIBLE  APPLICABLE FOR SMALL SUPERFICIAL WELLAPPLICABLE FOR SMALL SUPERFICIAL WELL DIFFERENTIATED LESION OF ORAL TONGUEDIFFERENTIATED LESION OF ORAL TONGUE WHICH ARE TWO LARGE FOR LOCALWHICH ARE TWO LARGE FOR LOCAL EXCISION & TUMOR NOT INVOLVING THEEXCISION & TUMOR NOT INVOLVING THE MANDIBLE.MANDIBLE.  USUALLY DONE ALONG WITH BLOCKUSUALLY DONE ALONG WITH BLOCK DISSECTION OF NECKDISSECTION OF NECK  INCISION: MASTOID TIP TO MID LINE CHININCISION: MASTOID TIP TO MID LINE CHIN TWO FINGER BELOW THE LOWER BORDERTWO FINGER BELOW THE LOWER BORDER OF MANDIBLEOF MANDIBLE  RIGHT ANGLE TO UPPER INCISION & POST TORIGHT ANGLE TO UPPER INCISION & POST TO CAROTID ARTERY & DOWNWORD UP TO THECAROTID ARTERY & DOWNWORD UP TO THE CLAVICLECLAVICLE
 BLOCK DISSECTION ISBLOCK DISSECTION IS COMPLETED TO THE LEVEL OFCOMPLETED TO THE LEVEL OF HYOID & CAROTID BIFURCATIONHYOID & CAROTID BIFURCATION  LINGUAL ARTERY IS LEGATEDLINGUAL ARTERY IS LEGATED NEAR THE HYOIDNEAR THE HYOID  IPSILATERAL SUBMANDIBULARIPSILATERAL SUBMANDIBULAR GLAND IS SEPARATED FROMGLAND IS SEPARATED FROM INFERIOR SURFACE OF MANDIBLEINFERIOR SURFACE OF MANDIBLE  FACIAL VESSELS ARE LIGATEDFACIAL VESSELS ARE LIGATED  LIP IS SPLIT IN MIDLINE.LIP IS SPLIT IN MIDLINE. PERIOSTEUM IS ELEVATED FROMPERIOSTEUM IS ELEVATED FROM EXT. SURFACE OF MANDIBLE FOREXT. SURFACE OF MANDIBLE FOR 2 cm. IN BOTH THE DIRECTION2 cm. IN BOTH THE DIRECTION
 INNER PERIOSTEUM ELEVATEDINNER PERIOSTEUM ELEVATED FROM SYMPHISIS TO ANGLEFROM SYMPHISIS TO ANGLE  TOOTH , LATERAL INCISOR ISTOOTH , LATERAL INCISOR IS EXTRACTEDEXTRACTED  MANDIBLE IS DIVIDED JUST OFFMANDIBLE IS DIVIDED JUST OFF THE MIDLINE WITH GIGLI SAW.THE MIDLINE WITH GIGLI SAW.  MUCOSAL INCISION IS MADE INMUCOSAL INCISION IS MADE IN GINGIVO LINGUAL SULCUSGINGIVO LINGUAL SULCUS FROM THE POINT OFFROM THE POINT OF MANDIBULAR DIVISION TO THEMANDIBULAR DIVISION TO THE ANT PILLARANT PILLAR
 LEAVING 5MM OF FREE MUCOSALEAVING 5MM OF FREE MUCOSA ATTACHED TO MANDIBLEATTACHED TO MANDIBLE  MANDIBLE IS RETRACTED LATERALLYMANDIBLE IS RETRACTED LATERALLY  TRACTION SUTURES ARE APPLIED INTRACTION SUTURES ARE APPLIED IN THE TIP OF TONGUETHE TIP OF TONGUE  GLOSSECTOMY IS PERFORMED WITHGLOSSECTOMY IS PERFORMED WITH DIATHERMY TO MAXIMIZEDIATHERMY TO MAXIMIZE HEMOSTASIS & 2 CM MARGIN OFHEMOSTASIS & 2 CM MARGIN OF NORMAL TONGUE IS MAINTAIND INNORMAL TONGUE IS MAINTAIND IN ALL DIRECTION.ALL DIRECTION.  CAUTRY INCISION IS MADE IN MIDLINECAUTRY INCISION IS MADE IN MIDLINE OF TONGUE FROM ANT TO POST.OF TONGUE FROM ANT TO POST.
 ANT FROM TIP TO FLOOR &FROMANT FROM TIP TO FLOOR &FROM POST TURNING TO LATERALLY UP TOPOST TURNING TO LATERALLY UP TO THE ANT PILLAR.THE ANT PILLAR.  WHOLE TISSUE IS TAKEN WITHWHOLE TISSUE IS TAKEN WITH BLOCK DISSECTION SPECIMEN.BLOCK DISSECTION SPECIMEN. MANDIBULAR FRAGMENTS AREMANDIBULAR FRAGMENTS ARE REALIGNED &STABILISED WITHREALIGNED &STABILISED WITH STEEL WIRE OR TITANEUM PLATESTEEL WIRE OR TITANEUM PLATE  TONGUE DEFECT CAN BE COVEREDTONGUE DEFECT CAN BE COVERED WITH FREE SKIN GRAFT OR PMMCWITH FREE SKIN GRAFT OR PMMC FLAPFLAP  WOUND IS CLOSED UNDER VACUUMWOUND IS CLOSED UNDER VACUUM SUCTION.SUCTION.
MARGINAN MANDIBULECTOMYMARGINAN MANDIBULECTOMY  INDICATED IN CANCER IN CLOSEINDICATED IN CANCER IN CLOSE PROXIMITY TO LOWER GINGIVAL ORPROXIMITY TO LOWER GINGIVAL OR EXTENDING TO MANDIBLE WITHOUTEXTENDING TO MANDIBLE WITHOUT CLINICAL OR RADIOLOGICALCLINICAL OR RADIOLOGICAL INVOLVEMENT OR WITH MINIMALINVOLVEMENT OR WITH MINIMAL CORTICAL INVASION.CORTICAL INVASION.  INVOLVES THE INCONTINUITY EXCESIONINVOLVES THE INCONTINUITY EXCESION OF TUMOR WITH MARGIN OF MANDIBLEOF TUMOR WITH MARGIN OF MANDIBLE AND OVERLYING GINGIVAL.AND OVERLYING GINGIVAL.  MADIBULAR CONTINUITY IS MAINTAINEDMADIBULAR CONTINUITY IS MAINTAINED AND MUCH BETTER COSMETIC &AND MUCH BETTER COSMETIC & FUNCTIONAL END RESULT ACHIEVED.IFFUNCTIONAL END RESULT ACHIEVED.IF MANDIBLE IS DIRECTLY INVOLVED THANMANDIBLE IS DIRECTLY INVOLVED THAN SEGMENTAL MANDIBULECTOMY IS DONE.SEGMENTAL MANDIBULECTOMY IS DONE.
TOTAL GLOSSECTOMYTOTAL GLOSSECTOMY  INDICATED FOR MASSIVE LOCALINDICATED FOR MASSIVE LOCAL CARCINOMA OF TONGUECARCINOMA OF TONGUE  LIP IS SPLIT IN MIDLINELIP IS SPLIT IN MIDLINE  B/L CHEEK FLAP ARE RAISED BEYONDB/L CHEEK FLAP ARE RAISED BEYOND THE ANGLE OF MANDIBLETHE ANGLE OF MANDIBLE  MUCOSA IS INCISED IN BOTHMUCOSA IS INCISED IN BOTH GINGIVO-BUCCAL SULCUS BACK TOGINGIVO-BUCCAL SULCUS BACK TO THE ANT PILLARTHE ANT PILLAR  ASENDING RAMI OF MANDIBLE ISASENDING RAMI OF MANDIBLE IS DIVIDEDDIVIDED  WHOLE SPECIMEN IS TAKEN OUTWHOLE SPECIMEN IS TAKEN OUT
 K –WIRE CAN BE INSERTED FORK –WIRE CAN BE INSERTED FOR MANDIBLEMANDIBLE  DEFECT OF TOTAL GLOSSECTOMYDEFECT OF TOTAL GLOSSECTOMY CONSISTS OF TONGUE, FLOOR OFCONSISTS OF TONGUE, FLOOR OF MOUTH & SOME TISSUE PHARYNGEALMOUTH & SOME TISSUE PHARYNGEAL & LARYNGEAL MUCOSA.& LARYNGEAL MUCOSA.  PECTORALIS MAJOR FLAP ORPECTORALIS MAJOR FLAP OR TEMPARAL FLAP CAN GIVE GOODTEMPARAL FLAP CAN GIVE GOOD RESULT.RESULT.  CARCINOMA OF BASE OF TONGUECARCINOMA OF BASE OF TONGUE ARE USUALLY ADVANCE & METASTICARE USUALLY ADVANCE & METASTIC AT THE TIME OF PRESENTATIONAT THE TIME OF PRESENTATION
 TREATMENT OF POST 1/3 OF TONGUETREATMENT OF POST 1/3 OF TONGUE IS USUALLY TELE THERAPY SINCEIS USUALLY TELE THERAPY SINCE THE SITE IS ANATOMICALLYTHE SITE IS ANATOMICALLY DIFFICULT FOR BOTH SURGERY ANDDIFFICULT FOR BOTH SURGERY AND FOR INTERSTITIAL IRRADIATION.FOR INTERSTITIAL IRRADIATION. MEDIAN TRANSLINGUIAL PHARYNGOTOMYMEDIAN TRANSLINGUIAL PHARYNGOTOMY  MID LINE OF TONGUE IS INCISED,MID LINE OF TONGUE IS INCISED, BISECTING THE TONGUE IN TWO b/lBISECTING THE TONGUE IN TWO b/l SEGMENTSEGMENT  INCISION EXTEND BACK TO THE AREAINCISION EXTEND BACK TO THE AREA OF TUMOR IN THE BASE OF TONGUE.OF TUMOR IN THE BASE OF TONGUE.
 TUMOR IS EXCISED & WOUNDTUMOR IS EXCISED & WOUND CAN BE CLOSED PRIMARILY.CAN BE CLOSED PRIMARILY.  MID LINE OF TONGUE ISMID LINE OF TONGUE IS INCISED, BISECTING THEINCISED, BISECTING THE TONGUE IN TWO b/l SEGMENTTONGUE IN TWO b/l SEGMENT  INCISION EXTEND BACK TO THEINCISION EXTEND BACK TO THE AREA OF TUMOR IN THE BASEAREA OF TUMOR IN THE BASE OF TONGUE.OF TONGUE.  TUMOR IS EXCISED & WOUNDTUMOR IS EXCISED & WOUND CAN BE CLOSED PRIMARILY.CAN BE CLOSED PRIMARILY.
TRANS HYOID PHARYNGOTOMYTRANS HYOID PHARYNGOTOMY  COLLAR INCISION IS MADE ATCOLLAR INCISION IS MADE AT HYOID LEVEL b/w THE SCMHYOID LEVEL b/w THE SCM MUSCLES.MUSCLES.  SKIN FLAPS ELEVATEDSKIN FLAPS ELEVATED  SUPAR & INFRA HYOIDSUPAR & INFRA HYOID MUSCLES ARE EXCISEDMUSCLES ARE EXCISED  CENTRAL PORTION OF HYOIDCENTRAL PORTION OF HYOID IS EXCISED.IS EXCISED.
 TUMOR AT BASE IS EXCISEDTUMOR AT BASE IS EXCISED WITH 2 cm. MARGIN.WITH 2 cm. MARGIN.  AVOID INJURY TO LINGUALAVOID INJURY TO LINGUAL ARTERY & HYPOGLOSSALARTERY & HYPOGLOSSAL NERVE.NERVE.  DEFECT IS CLOSED PRIMARILY.DEFECT IS CLOSED PRIMARILY.  IF TUMOR HAS INVOLVED THEIF TUMOR HAS INVOLVED THE EPIGLOTTIS & PART OFEPIGLOTTIS & PART OF GLOTTIS. THEN SUPRAGLOTTICGLOTTIS. THEN SUPRAGLOTTIC LARYGECTOMY CAN BE DONE.LARYGECTOMY CAN BE DONE.
 ADVANCE STAGE CARCINOMA OFADVANCE STAGE CARCINOMA OF TONGUE REQUIRED COMBINEDTONGUE REQUIRED COMBINED MODALITY OF RADICAL SURGERYMODALITY OF RADICAL SURGERY WITH RECONSTRUCTIONWITH RECONSTRUCTION FOLLOWED BY POST OPERATIVE RTFOLLOWED BY POST OPERATIVE RT  COMMANDO OPERATION CONSISTSCOMMANDO OPERATION CONSISTS OF COMPOSITE RESECTION OFOF COMPOSITE RESECTION OF PRIMARY MALIGNANCY,PRIMARY MALIGNANCY, HEMIMANDIBULECTOMY WITHHEMIMANDIBULECTOMY WITH IPSILATERAL OR BILATERAL RND.IPSILATERAL OR BILATERAL RND.  USEFUL IN FAR ADVANCEDUSEFUL IN FAR ADVANCED CARCINOMA.CARCINOMA.
DELEOPECTORAL SKIN FLAPDELEOPECTORAL SKIN FLAP
MANDIBULAR TONGUE PROSTHESISMANDIBULAR TONGUE PROSTHESIS
RADIO THERAPYRADIO THERAPY RT & SURGERY HAVE EQUAL SUCCESSRT & SURGERY HAVE EQUAL SUCCESS IN EARLY LESION. RT CAN BE GIVEN:IN EARLY LESION. RT CAN BE GIVEN:  BRACHYTHERPYBRACHYTHERPY  TELE THERAPY – EBRTTELE THERAPY – EBRT  COMBINATION THERAPYCOMBINATION THERAPY  RT MAY HELP IN ORGAN PRESERVTIONRT MAY HELP IN ORGAN PRESERVTION BUT LONG TERM COMPLICATION AREBUT LONG TERM COMPLICATION ARE SIGNIFICANTSIGNIFICANT  XEROSTOMIA, ERYTHEMA, SKINXEROSTOMIA, ERYTHEMA, SKIN SLOUGHING, ULCERATION, DENTALSLOUGHING, ULCERATION, DENTAL CARIES & OSTEORADIONECROSIS.CARIES & OSTEORADIONECROSIS.
 POST OPERATIVE RT IS PREFERRED OVERPOST OPERATIVE RT IS PREFERRED OVER PRE OPERATIVE B/C OF EFFECT ONPRE OPERATIVE B/C OF EFFECT ON WOUND HEALINGWOUND HEALING  PER OPERATIVE RT: INOPERABLE, UNFITPER OPERATIVE RT: INOPERABLE, UNFIT FOR SURGERY& DOWN STAGINGFOR SURGERY& DOWN STAGING  POST RT IS INDICATED IN PATIENTS WITHPOST RT IS INDICATED IN PATIENTS WITH – TT33/T/T44 PRIMARYPRIMARY – POSITIVE SURGICAL MARGINESPOSITIVE SURGICAL MARGINES – PERINEURAL, PERILYMPHATICPERINEURAL, PERILYMPHATIC VASCULAR INVASIONVASCULAR INVASION – MIOROSCOPIC GROSS RESIDUAL TUMORMIOROSCOPIC GROSS RESIDUAL TUMOR – EXTRA CAPSULAR SPREADEXTRA CAPSULAR SPREAD – PATHOLOGICALLY POSITIVE LN AFTERPATHOLOGICALLY POSITIVE LN AFTER SOHNDSOHND
 EBRT DOSE – 6500 TO 7000 RAD TOEBRT DOSE – 6500 TO 7000 RAD TO PRIMARY & NECK FOR CLINICALLYPRIMARY & NECK FOR CLINICALLY EVIDENT DISEASE.EVIDENT DISEASE.  WIDE MARGIN OF TONGUE CAN BEWIDE MARGIN OF TONGUE CAN BE TREATEDTREATED  GIVEN AS 200 RAD PER DAY OVER 5 TOGIVEN AS 200 RAD PER DAY OVER 5 TO 7 WEEKS.7 WEEKS.  BRACHYTHERAPHY CAN DELIVERBRACHYTHERAPHY CAN DELIVER LARGER DOSE TO THE GIVEN TISSUE.LARGER DOSE TO THE GIVEN TISSUE.  IRIDIUM 192,CAESIUM137, NEEDLESIRIDIUM 192,CAESIUM137, NEEDLES ARE USED.ARE USED.  IT REQUIRE ACCURATE SPACING OFIT REQUIRE ACCURATE SPACING OF INTERSTITIAL SEEDS OR NEEDLES TOINTERSTITIAL SEEDS OR NEEDLES TO PREVENT OVERLAPPING OFPREVENT OVERLAPPING OF RADIATION.RADIATION.
 PRECISE DOSIMETRY ACHIEVED BYPRECISE DOSIMETRY ACHIEVED BY AFTER LOADING TECHNIQUE.AFTER LOADING TECHNIQUE.  RADIOACTIV SOURCE IS INSERTED INRADIOACTIV SOURCE IS INSERTED IN TO PREVIOUSLY IMPLANTED HOLLOWTO PREVIOUSLY IMPLANTED HOLLOW NYLON TUBES.NYLON TUBES.  TUBES ARE PLACED UNDER GATUBES ARE PLACED UNDER GA  AS MUCH AS 10000 RAD CAN BEAS MUCH AS 10000 RAD CAN BE DELIVERD TO SMALL AREA WITHDELIVERD TO SMALL AREA WITH GREATER EFFECT.GREATER EFFECT.  PROPHYLACTIC RADIATION IS DONEPROPHYLACTIC RADIATION IS DONE B/C OE HIGH INCIDENCE OF OCCULTB/C OE HIGH INCIDENCE OF OCCULT METASTASIS (40%).METASTASIS (40%).
CHEMOTHERAPYCHEMOTHERAPY  USED IN PALLIATION IN ADVDNCEDUSED IN PALLIATION IN ADVDNCED CA.CA.  AGENTS ARE MTx,5-FU,CISPLATINAGENTS ARE MTx,5-FU,CISPLATIN BLEOMYCIN.BLEOMYCIN.  COMBINED CT IS MORE EFFECTIVECOMBINED CT IS MORE EFFECTIVE THAN SINGLE AGENT.THAN SINGLE AGENT.  RESPONSE TO CISPLATIN+5FURESPONSE TO CISPLATIN+5FU OCCURE IN TWO THIRDS OF PtOCCURE IN TWO THIRDS OF Pt WITH COMPLETE RESPONSE IN 5-WITH COMPLETE RESPONSE IN 5- 15%15%
TREATMENT OF NECKTREATMENT OF NECK  DEPEND ON NODAL STATUS.DEPEND ON NODAL STATUS.  RND IS GOLD STANDARD.RND IS GOLD STANDARD.  MRND GIVE BETTER COSMETIC &MRND GIVE BETTER COSMETIC & FUNCTIONAL RESULT.FUNCTIONAL RESULT.  CLASSIC RND : 5 LEVEL LN WITHCLASSIC RND : 5 LEVEL LN WITH SAN, IJV, SCM.SAN, IJV, SCM.  MRND : 5 LEVEL LN WITHMRND : 5 LEVEL LN WITH PRESERVATION OF THEPRESERVATION OF THE STRUCTURE.STRUCTURE.  TYPE-1 PRESERVE SAN.TYPE-1 PRESERVE SAN.  TYPE-2 PRESERVES AN & IJV.TYPE-2 PRESERVES AN & IJV.
 TYPE-3 PRESERVE SAN IJVTYPE-3 PRESERVE SAN IJV &SCM.&SCM.  N-0 NECK S/B TREATED WITHN-0 NECK S/B TREATED WITH SOHND.SOHND.  PATHOLOGICALLY POSITIVEPATHOLOGICALLY POSITIVE NODE DETECTED ON TABLE BYNODE DETECTED ON TABLE BY FROZEN SECTION S/B TREATEDFROZEN SECTION S/B TREATED BY RND/MRND.BY RND/MRND.  IF DECTED AFTER HPEIF DECTED AFTER HPE FOLLOWING SOHND Pt SHOULDFOLLOWING SOHND Pt SHOULD UNDER GO RTUNDER GO RT
PROGNOSISPROGNOSIS  DEPENDS ON NODAL STATUS & DEPTH OFDEPENDS ON NODAL STATUS & DEPTH OF INVASION PERINEURAL & VASCUALR SPREADINVASION PERINEURAL & VASCUALR SPREAD STAGE 5 YEARS SURVIVAL ORAL TONGUE BASE OF TONGUE I 70% 60% II 40% 40% III 25% 30% IV < 20% 15% OVERALL SURVIVAL OF TOOUNGE CNANCER IS NEAR 50%.
RECURRENT DISEASERECURRENT DISEASE  WHEN A PRIMARY RECUR AFTER RT ORWHEN A PRIMARY RECUR AFTER RT OR SURGERY CRYOSURGERY OR LASERSURGERY CRYOSURGERY OR LASER VAPORIZATION CAN BE USED FORVAPORIZATION CAN BE USED FOR PALLIATION.PALLIATION. TERMINAL EVENTSTERMINAL EVENTS  CANCER CACHEXIA & STARVATIONSCANCER CACHEXIA & STARVATIONS  INHALATION BRONCHOPNEUMONIAINHALATION BRONCHOPNEUMONIA  ASPHYXIA D/T OEDEMA OR PRESSUREASPHYXIA D/T OEDEMA OR PRESSURE ON AIR PASSAGE FROM A FIXED LNON AIR PASSAGE FROM A FIXED LN  EROSION OF ICA IN POST 1/3 CANCEREROSION OF ICA IN POST 1/3 CANCER  EROSION OF LINGUAL ARTRY IN ARTEROSION OF LINGUAL ARTRY IN ART 2/3 CANCER2/3 CANCER
Tongue carcinoma