Cancer mostly affects older adults but ‘tongue cancer’ hits younger people

People tend to think of cancer as a disease that mostly affects older adults, except leukemia (blood cancer). In reality, most cancers occur in middle-aged and older people exposed to carcinogens for a long time resulting, for instance, from smoking or drinking alcohol.

However, some cancers are not uncommon in younger people before 30. A case in point is “tongue cancer,” a cancer on the tongue.

Tongue cancer is often mistaken for an ulcer in the mouth, leading to a delay in diagnosis and treatment. The tongue senses the taste, temperature, and texture of food. It's a flexible, muscular organ that allows people to bite down and swallow food, and it's one of the most common places in the mouth for cancer to develop.

July 27 is World Head and Neck Cancer Day established by the Union for International Cancer Control (UICC) to promote a better understanding of head and neck cancer and emphasize the importance of prevention.

The number of tongue cancer patients is increasing every year.

According to the National Cancer Registry Annual Report, new head and neck cancer cases increased 29 percent in the last five years, from 32,147 in 2017 to 41,460 in 2021. Of these, tongue cancer increased by 33 percent, from 748 in 2017 to 993 in 2021. It was the largest increase among head and neck cancer organs, except for oral cancer (lip cancer), which has relatively fewer cases.

Tongue cancer is notable for the number of new cases in younger age groups. In 2021, people in their 20s and 30s accounted for 80 new cases of tongue cancer, or 8 percent. People in their 20s and 50s accounted for 46 percent of new cases. Nearly half of all new cases of tongue cancer were diagnosed before 60.

Early symptoms of tongue cancer include circular white necrotic inflammatory ulcers, thick white patches of leukoplakia, and red patches. In more than half of tongue cancer cases, the tumor develops on the side of the tongue and may not be painful at first. However, if the cancer invades the nerves of the tongue, it can cause severe pain.

The initial symptoms of tongue cancer can be similar to those of a canker sore caused by a weakened immune system due to excessive stress or fatigue, a bacterial infection from a wound caused by physical stimulation, or an irritating food or allergic reaction.

Canker sores usually resolve within a week or two, but if the symptoms don't go away for more than three weeks or if the lesions get bigger, people should suspect tongue cancer. Compared to canker sores, tongue cancer has a wider range of lesions. Look for a firm, palpable lump under the jaw or on the side of the neck, as it’s more likely to bleed, cause pain, and spread to the lymph nodes around the neck.

If tongue cancer is diagnosed, imaging studies will be performed to assess the extent of invasion of surrounding tissues and whether it has metastasized.

Treatment consists of surgery to completely remove the lesion, including the normal tissue surrounding the tumor. Tongue cancer often metastasizes to the lymph nodes around the neck. Depending on the thickness of the lesion, surgery to remove the lymph nodes around the neck is required. If more than half of the tongue is removed, reconstruction using skin and muscles from the wrist or thigh is performed, depending on the extent of the lesion. After surgery, radiation therapy or chemotherapy may be added depending on the individual's condition.

Tongue cancer is a difficult cancer to treat, but if caught and treated early, it can preserve the function of the tongue. However, if treatment is missed, the cancer can spread quickly and the cure rate decreases. Recognizing the early symptoms and visiting a specialist immediately is essential if one has suspicions.

“To prevent tongue cancer, it is important to reduce smoking and alcohol consumption, prevent tooth decay and periodontal disease, and maintain thorough oral hygiene such as mouthwash,” said Professor Han Seung-hoon of the Department of Otorhinolaryngology at Hallym University Dongtan Sacred Heart Hospital. “I hope that the World Head and Neck Cancer Day will raise awareness of tongue cancer and make people aware of the importance of early diagnosis.”