Tongue Cancer
The front two thirds of the tongue (oral tongue) are treated like a mouth cancer.
Early cancer means your cancer is smaller than 4cm and is contained within the tongue.
The most common treatment is surgery to remove the affected area. You might also have radiotherapy after surgery to try to prevent a cancer from coming back. This is known as adjuvant radiotherapy.
Some people with early stage oral tongue cancer might have radiotherapy first. This may be because they are not fit enough to have surgery.
You might also have surgery to remove lymph nodes in your neck. This is to check if cancer has spread to the lymph nodes. You may have a sentinel lymph node biopsy or a neck dissection.
Locally advanced cancer means your cancer is larger than 4cm. Or it has grown outside the tongue to nearby tissue or lymph nodes. Advanced means it has spread to other parts of the body.
You are most likely to have a combination of these treatments:
surgery to remove the cancer from your tongue and the lymph nodes in your neck
reconstructive surgery to rebuild the tongue
radiotherapy after surgery
chemotherapy
chemotherapy with radiotherapy (chemoradiotherapy)
a targeted drug (cetuximab) with platinum chemotherapy for squamous cell cancer
an immunotherapy drug (pembrolizumab or nivolumab) for squamous cell cancer
Treatment is also given to control symptoms. For example, radiotherapy to help control pain.
Read more about treatment for mouth cancer
The back third of the tongue (base of the tongue) is treated like oropharyngeal cancer. Oropharyngeal cancer starts in the part of the throat just behind the mouth.
Early cancer means your cancer is smaller than 4cm and is contained within the tongue.
You might have either:
surgery to remove the cancer and some of the lymph nodes in your neck
radiotherapy to the throat and neck
You might need radiotherapy or chemoradiotherapy after surgery. This is if your doctor thinks there is a high risk that your cancer will come back. Chemoradiotherapy means you have chemotherapy and radiotherapy together.
This means the cancer has grown outside the tongue, and has spread to nearby tissues or lymph nodes (locally advanced). Or it has spread to other parts of the body (advanced).
You might have one of the following:
chemotherapy and radiotherapy together (chemoradiotherapy) to your throat and neck
surgery to remove part of the throat, including all or part of the tongue. Your surgeon may also remove some of the lymph nodes in your neck. This is followed by radiotherapy or chemoradiotherapy
radiotherapy on its own
a targeted drug (cetuximab) with radiotherapy for squamous cell cancer
an immunotherapy drug (pembrolizumab or nivolumab) for squamous cell cancer
You might have radiotherapy, chemotherapy or surgery to control symptoms of advanced cancer.
Your surgeon removes the cancer and an area (margin) of normal tissue around it. This helps to make sure that they have removed all the cancer. The operation is called a primary tumour resection.
There are different types of primary tumour resection. It depends on where the cancer is.
You might only need a simple operation if the cancer is very small. This can be done using local anaesthetic or with laser surgery. So you don't need to stay overnight in hospital.
For larger cancers, you might need a more complicated operation and stay in hospital for a while. You might have an operation to remove part or all of your tongue (a glossectomy). This is quite a big operation. Your surgeon will rebuild (reconstruct) your tongue.
Read about types of surgery for mouth and oropharyngeal cancer
The surgeon usually removes the lymph nodes from one or both sides of your neck. This operation is called a neck dissection. It lowers the risk of your cancer coming back in the future.
Read about surgery to remove lymph nodes in your neck
You will have some pain after most types of surgery, but this is usually well controlled. Your doctors and nurses give you painkillers by drip, tablets, or liquids if you need them.
Having an operation to your mouth may affect eating and drinking for a while afterwards. Depending on the type of surgery you have it might also affect your speech or swallowing.
Talk to your doctor or specialist nurse before your operation. You can ask them how it will affect you and what support there is.
Read more about preparing for surgery, your operation and after surgery
Radiotherapy uses high energy waves similar to x-rays to kill cancer cells. You might have radiotherapy:
on its own as your main treatment for cancer in the base of the tongue or after surgery
combined with chemotherapy (chemoradiotherapy) as your main treatment for a cancer in the base of the tongue or after surgery
to help relieve the symptoms of advanced tongue cancer
You have radiotherapy to the part of the tongue affected by cancer. And the doctor might also treat the lymph nodes in your neck.
You usually have radiotherapy treatment once a day, Monday to Friday for a few weeks.
Radiotherapy to the head and neck area can cause several side effects. These include a dry, sore mouth and taste changes.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer.
You might have chemotherapy combined with radiotherapy (chemoradiotherapy). The chemotherapy helps the radiotherapy work better. You might have this:
after surgery if there is a high risk of your cancer coming back
as your main treatment for a cancer in the base of the tongue
for an advanced cancer in the base of the tongue
You usually have a PET-CT scan a few months after chemoradiotherapy. This is to check if your lymph nodes contain cancer. If there are signs of cancer, you usually have surgery to remove the lymph nodes.
Some people have chemotherapy to shrink the cancer before the main treatment, although this isn’t very common. This is called neo adjuvant treatment.
The most commonly used drug is cisplatin. You might have this with fluorouracil (5FU). Some people have carboplatin instead of cisplatin.
The side effects of chemotherapy include feeling sick and lower resistance to infections. Your side effects also depend on the drug you have and whether you have it with other treatments.
Cetuximab is a type of targeted cancer drug called a .
You might have cetuximab:
with radiotherapy for locally advanced mouth and oropharyngeal cancer
with chemotherapy for squamous cell mouth cancer that has come back or has spread to other parts of the body
Nivolumab is a type of . This type of treatment stimulates the body’s to fight cancer cells.
You have nivolumab if you have squamous cell cancer and:
your cancer has come back or has spread to other parts of the body
you had platinum based chemotherapy, and your cancer has started to grow within 6 months of having chemotherapy
In Scotland, you can have nivolumab if your cancer continues to grow. This is while you are on or after having platinum based chemotherapy.
You can have it for up to 2 years.
Pembrolizumab is also a type of immunotherapy.
You might have pembrolizumab if you have squamous cell cancer and:
you haven’t had any treatment for an advanced cancer
your cancer has come back and you can’t have surgery to remove the cancer
the cancer shows a type of protein called programmed cell death ligand 1 (PD-L1)
Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.
Find out more about research for mouth and oropharyngeal cancer
Lots of people say it helps to talk to others who know what they're going through. If you're seeing a specialist in head and neck cancer, ask them if they can put you in touch with any other patients. That way, they might be nearby.
There are organisations that can offer support for people with cancer of the head and neck.
Go to our information about mouth and oropharyngeal cancer resources
Treatment to the tongue can cause problems with your speech, changes with eating and drinking, or swallowing. These could be permanent changes for some people.
You will have a speech and language therapist as part of the team looking after you. They will help as much as possible to restore your speech.
Talk to your doctor or specialist nurse before your treatment. You can ask them about how it will affect you.
Find out more about living with mouth and oropharyngeal cancer
Last reviewed: 24 Sept 2024
Next review due: 24 Sept 2027
Tongue cancer is classed as a mouth or oropharyngeal cancer. This depends on where in the tongue the cancer starts.
The stage of a cancer tells you about its size and whether it has spread. The type means the type of cell the cancer started from. The grade means how abnormal the cells look under the microscope.
Getting practical and emotional support can help you cope with your diagnosis, and life during and after treatment.
Your treatment depends on where in your mouth or oropharynx your cancer is, the type, how big it is, whether it has spread anywhere else in your body and your general health.
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