Tongue cancer

Tongue cancer in frequency is in second place among tumors of the mouth and is about 1.5% of all malignancies. Men suffer 5-6 times more often than women.Precancerous diseases are leukoplakia, leykokeratozy, papilloma. The important role played by adverse factors and bad habits: the constant trauma caused by dental caries, smoking, alcohol use hot and spicy food, chewing tobacco.
The clinical picture often is the appearance of painful, gradually increasing that is resistant to medical treatment of ulceration. If it affects the posterior parts of the body may experience difficulty in swallowing, and when the tumor in the tongue usually occur in great pain, to which the propagation of the infiltration of the epiglottis and valekulam join dysphagia and in perhivanie.
The most common cancer sites - the lateral surface of the tongue (62%), root of the tongue is affected in 27%, dorsum of tongue - 7%, the tip of the tongue - 2% of patients. Histological examination in 95% of patients exhibit a squamous cell carcinoma. Adenogennye tumor originating from the minor salivary glands, account for 2-3% of malignant neoplasms of the language, even rarer basal-cell lymph-foepiteliomy, usually localized in the posterior parts of the language.
Cancer metastases front and middle parts of the language appeared first in the mandibular and middle jugular deep cervical lymph nodes. Cancer of the posterior parts of the language meta-staziruet primarily in the upper jugular and deep cervical lymph nodes.
Tongue tumor visualized by special methods examination, the extent of their distribution is specified by X-ray studies and computed tomography. The main method of assessment of regional lymph nodes remain palpation. Morphological confirmation of the diagnosis carried out by research scraping ~ Pun-ktata or biopsy of the tumor. To verify the condition of enlarged lymph nodes is recommended to puncture even in the presence of morphologically confirmed cancer of the tongue.
The classification of cancer of the tongue on the TNM system is fully consistent with those used in cancer of the lower lip.
Treatment of tumors of language is surgical, combined, radiation and complex methods. Tactics of treatment is determined by the prevalence of cancer. At stage I and II are the leading methods of radiation and combined.
Surgical treatment is carried out in patients with early stage when the tumor on the side and back by ½ electroscission language with access through the mouth. Patients with advanced tumors at the bottom of the mouth or in the midline of the volume of surgery expand, digged tissue floor of the mouth, the body of the mandible with the removal of half or whole language.
When moving metastases is fascial-foot polar excision of tissue, during germination of metastasis in the rough-dino-clavicular-mastoid muscle is shown Cryle operation-excision of tissue, salivary glands and the lymphatic system of the neck with resection of the sternocleidomastoid muscle.
Combined treatment. During preoperative radiation therapy is subjected to irradiation the primary focus and regional lymph nodes. Treatment of tumors that does not go over the middle line or at the bottom of the mouth, without multiple mobile or limited mobility of single metastases was carried out using methods of interstitial irradiation with radioactive cobalt, tantalum, iridium or cesium. When interstitial irradiation b0So total doses can be: 54 Gy over 4 days, 60 Gy in 6 days, 63 Gy in 7 days.
With the availability of the tumor to take stock of the tube and the depth of invasion did not spend more than 4 mm intraoral exposure to blizkofokusnyh rentgenoterapevticheskih installations, bringing the total dose to 55-60 Gy in two to three weeks. Internal ripolostnaya elektronoterapiya on betatron energy of 12.9 MeV is carried out at a dose of 60 Gy in 4-5 weeks.
Combined radiation therapy is used for tumors that pass over the middle line or at the bottom of the mouth, as well as the presence of individual mobility or multiple mobile metastases. Irradiation begins with external beam radiotherapy with two lateral fields, located on either side of the face, or anterior and lateral fields on the side of the lesion with a 45 ° wedge filters. In the presence of metastases in lymph nodes of the submandibular region, they must also irradiated with the primary centers. After reaching the dose of 50 Gy in the hearth for 5 weeks to the tumor with an additional sum of one side of the field still 25-30 Gy to the LEA or betatron electron beam with energy about 18 MeV. Combined radiation therapy is also possible in different types and combinations of remote methods of interstitial irradiation.
Teleirradiation used as a standalone method when it is impossible for the combined treatment or combined radiation therapy (general contraindications or the presence of unresectable metastases). This involves the split or multiple split course of irradiation. Patients irradiated at 3 Gy daily to the course dose of 15 Gy, and then make a break for two weeks. If the patient's condition allows, spend four such courses to a total dose of 60 Gy.
Radiation therapy of tongue cancer as a sensitizer systemically or locally applied metronidazole is widely used microwave and UHF hyperthermia.
In terms of comprehensive treatment before irradiation or surgery in some cases carry system chemotherapy vinblastine, methotrexate, bleomycin. Chemotherapy is carried out with generalized forms of the disease. Wide enough for tumors of the language used by regional intra-arterial chemotherapy, which is implemented through a catheter inserted into the superficial temporal artery to the level of the lingual artery.For regional infusion of drugs used are the same as that of a systemic chemotherapy.
Five-year survival rate for stage I tongue cancer is 85%, stage II - 70-75% with stage III - 35-35%. When the tumor in the back of the tongue prognosis is much worse than its location in the anterior two thirds of the body. Bilateral metastasis and recurrence of cancer of the tongue make the prognosis poor.