Surgery beats chemotherapy for tongue cancer, U-M study finds
Patients with tongue cancer who started their treatment with a course of chemotherapy fared significantly worse than patients who received surgery first, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.
This is contrary to protocols for larynx cancer, in which a single dose of chemotherapy helps determine which patients fare better with chemotherapy and radiation and which patients should elect for surgery. In larynx cancer, this approach, which was pioneered and extensively researched at U-M, has led to better patient survival and functional outcomes.
But this new study, which appears in JAMA Otolaryngology Head and Neck Surgery, describes a clear failure.
“To a young person with tongue cancer, chemotherapy may sound like a better option than surgery with extensive reconstruction. But patients with oral cavity cancer can’t tolerate induction chemotherapy as well as they can handle surgery with follow-up radiation. Our techniques of reconstruction are advanced and offer patients better survival and functional outcomes,” says study author Douglas Chepeha, M.D., MSPH, professor of otolaryngology – head and neck surgery at the University of Michigan Medical School.
The study enrolled 19 people with advanced oral cavity cancer. Patients received an initial dose of chemotherapy, called induction chemotherapy. Those whose cancer shrunk by half went on to receive additional chemotherapy combined with radiation treatment. Those whose cancer did not respond well had surgery followed by radiation.
Enrollment in the trial was stopped early because results were so poor.
As the name implies, tongue cancer is a cancer of the tongue. Depending on where the cancer is located on the tongue, it can fall into one of two categories: oral cavity cancer or oropharyngeal cancer. If the cancer is in the two-thirds of the tongue that is towards the front, it is considered oral cavity cancer. Alternatively, if it is in back third of the tongue, it is called oropharyngeal cancer. One in 348 people will be affected by tongue cancer at some point; however, the key to combating it is early detection and awareness of tongue cancer symptoms.
Oral cavity cancer is not only cancer of the tongue, but also the lips, cheeks, hard palate, floor of mouth, minor salivary glands, and gums. It can spread from one part to another, so it is important to be aware of the symptoms of oral cavity cancer in all of its forms, including tongue cancer symptoms. Some symptoms are quite evident while others are a little less obvious.
One of the main tongue cancer symptoms is a patch or several patches of red or white on the tongue. The patches can also be found on the lining of the mouth or the gums. Some people who experience tongue cancer symptoms have problems swallowing or chewing their food, while others have a persistent sore throat. Other signs of tongue cancer include abnormal bleeding in the mouth, sores in the mouth or tongue, lumps on the tongue or in the mouth, a change in the sound of the voice, earaches, and alterations in the way that dentures fit inside the mouth.
The other kind of tongue cancer is oropharyngeal cancer. It is separate for oral cavity cancer and includes the back one-third of the tongue, the tonsils, the soft palate, the walls of the pharynx, and the tonsilar arches. Many times oropharyngeal cancer is discovered by the patient’s dentist, since there may not be any symptoms at the beginning.
There are several symptoms for oropharyngeal cancer, many which are directly associated with the back of the tongue. For example, there may be difficulty swallowing food or liquids, an unexplainable loss of weight, or a lump in the back of the throat. There may also be a pain in the ear area, or a lump on the neck from swollen lymph nodes. One of the classic symptoms is a persistent sore throat. This can be the result of an ulcer in the mouth or of a tumor that is pushing against nerves.
Early detection and treatment are key factors to surviving any form of cancer. People who are aware of their bodies and who are knowledgeable of tongue cancer symptoms may be able to seek medical treatment sooner than those people who are unaware. Any concerns should be addressed by a physician.
Ten of the patients had a response to the chemotherapy, and of that group, only three had a complete response from the treatment and were cancer-free five years later. Of the nine patients who had surgery after the induction chemotherapy, only two were alive and cancer-free after five years.
The researchers then looked at a comparable group of patients who had surgery and sophisticated reconstruction followed by radiation therapy and found significantly better survival rates and functional outcomes.
What are some Tongue Cancer Causes?
It’s hard to pin down tongue cancer causes because sometimes people who do not fit any of the risk factors still get tongue cancer. However, most of the time people with tongue cancer do fit one or more of the common tongue cancer causes.
First, tongue cancer is not “catchable” or contagious in any way. There are studies that show a family history of cancer can increase a person’s risk for cancer, but that has nothing to do with exposure to a person with cancer.
Tongue cancer is twice as common in men than women, and most cases of tongue cancer are found in people over the age of 40, especially after 60. It is not normally a young person’s cancer because most things that cause tongue cancer only do so after long exposure or heavy use.
For example, the largest tongue cancer cause is the heavy use of tobacco products (smoking, chewing, or snuffing of any sort). Alcohol consumption is also highly related to tongue cancer.
Studies have shown that the more alcohol consumed, the higher the risk of oral cancer. And 3 out of 4 people who have tongue cancer or another type of oral cancer smoke, consume large amounts of alcohol, or both smoke and drink regularly.
Put simply, the tongue can’t handle abuse from chemicals in tobacco and alcohol when used regularly or excessively.
Regular exposure to the sun without a sunscreen lip balm or other protection can increase the risk of oral cancers beginning on the lips and then spreading to the tongue.
If a person has already contracted another type of head or neck cancer, he or she has an increased risk for tongue cancer.
“The mouth is a very sensitive area,” Chepeha says. “We know the immune system is critical in oral cavity cancer, and chemotherapy suppresses the immune system. If a person is already debilitated, they don’t do well with chemotherapy.”
“Despite the proven success of this strategy in laryngeal cancer, induction chemotherapy should not be an option for oral cavity cancer, and in fact it results in worse treatment-related complications compared to surgery,” Chepeha adds.
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Tongue cancer statistics: 13,590 Americans will be diagnosed with tongue cancer this year and 2,070 will die from the disease, according to the American Cancer Society
Additional authors: Steven B. Chinn, M.D., MPH; Matthew E. Spector, M.D.; Emily L. Bellile, MS; Laura S. Rozek, Ph.D.; Tasha Lin; Theodoros N. Teknos, M.D.; Mark E. Prince, M.D.; Carol R. Bradford, M.D.; Susan G. Urba, M.D.; Thomas E. Carey, Ph.D.; Avraham Eisbruch, M.D.; Gregory T. Wolf, M.D.; Francis P. Worden, M.D.
Funding: University of Michigan, National Cancer Institute SPORE grant P50 CA97248, National Institute of Dental and Craniofacial Research grant R01 DE019126
Disclosure: None
Reference: JAMA Otolaryngology Head and Neck Surgery, doi: 10.1001/jamaoto.2013.5892, published online Dec. 26, 2013
Resources: U-M Cancer AnswerLine, 800-865-1125