# Oral tongue and floor of mouth cancer

Source: https://onco.cc/cancers/oral-tongue-cancer/  
OnCo record `oral-tongue-cancer` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer of the front of the tongue or the floor of the mouth is treated first with surgery, and a Tata Memorial trial settled that the neck lymph nodes should be removed at the same operation even when scans look clear. How deep the tumour has grown is now the number that decides staging and the need to treat the neck.

## Summary

Squamous cell carcinoma of the oral tongue (the mobile anterior two-thirds) and floor of mouth usually presents as a persistent ulcer or lump, often painful, sometimes with ear pain or a neck node. Tobacco, alcohol and betel quid are the causes in most patients, but tongue cancer in young adults without these exposures is increasing in several countries and is not HPV-related. The tongue's rich lymphatic drainage means that a substantial minority of patients with a clinically clear neck already harbour nodal metastases, and depth of invasion, which entered the staging system in 2017, is the best predictor of that risk.

Treatment is surgical: partial glossectomy or floor-of-mouth resection with margins of at least 5 mm, and treatment of the neck. The Tata Memorial trial of elective versus therapeutic neck dissection in 596 patients with early node-negative oral cancer, reported by D'Cruz in 2015, showed three-year overall survival of 80.0 percent with elective neck dissection against 67.5 percent with watchful waiting, ending a fifty-year debate; sentinel node biopsy, validated in the European SENT study, is an alternative for small tumours. Larger defects are reconstructed with free radial forearm or anterolateral thigh flaps to preserve speech and swallowing, and brachytherapy, once common for small tongue cancers, has largely given way to surgery.

Postoperative radiotherapy is given for stage III to IV disease, perineural invasion, close margins or multiple nodes, and cisplatin chemoradiation for extranodal extension or positive margins. Recurrent or metastatic disease is treated as for other head and neck squamous cell carcinoma with pembrolizumab-based therapy, or with oral metronomic methotrexate-celecoxib where resources are limited. Second primaries in the mouth, pharynx, oesophagus and lung are common in smokers, so cessation and surveillance matter.

## Fields

- Kind: Cancer
- Last checked: 2026-09-17
- Also known as: Tongue cancer; Anterior two-thirds of tongue cancer; Floor of mouth cancer; Oral tongue squamous cell carcinoma
- Tags: subtype-page; head-and-neck
- Group: head and neck
- Burden: The tongue is the commonest oral cavity site in Western countries, and tongue cancer is rising in young adults who neither smoke nor drink for reasons still unknown; the floor of mouth is the classic tobacco and alcohol site.
- Subtypes: Oral tongue (anterior two-thirds) squamous cell carcinoma; Floor of mouth squamous cell carcinoma; Tongue cancer in young non-smokers; Thin (depth of invasion 5 mm or less) versus thick tumours; Verrucous carcinoma of the tongue and floor of mouth
- Biomarkers: Depth of invasion (staging and elective neck dissection); Worst pattern of invasion and perineural invasion; Margin status; Extranodal extension; TP53 mutation; PD-L1 combined positive score (recurrent disease)

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/oral-tongue-cancer/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/oral-tongue-cancer/#overview [3 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/oral-tongue-cancer/#what-it-is [5 subtypes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/oral-tongue-cancer/#finding-it [6 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/oral-tongue-cancer/#treating-it [5 settings, 3 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/oral-tongue-cancer/#evidence [5 trials, 3 key papers, 4 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/oral-tongue-cancer/#science [2 targets]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/oral-tongue-cancer/where-you-are/
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/oral-tongue-cancer/#living-with-it [18 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/oral-tongue-cancer/coming/ [4 medicines, 1 trial, 4 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/oral-tongue-cancer/data/ [30 connected records]

## Standard of care

- Diagnosis and staging: Biopsy, MRI or CT of the tongue and neck to measure depth of invasion and nodes, chest imaging or PET-CT for advanced stage, and dental assessment before radiotherapy. ([PET/CT](https://onco.cc/technologies/pet-ct/))
- Primary treatment (T1 to T2, clinically node-negative): Partial glossectomy or floor-of-mouth resection with at least 5 mm margins and elective neck dissection (Tata Memorial trial); sentinel node biopsy as an alternative in small tumours. ([Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial)](https://onco.cc/trials/elective-neck-dissection-tmh/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/))
- Locally advanced (T3 to T4 or node-positive): Resection with neck dissection and free-flap reconstruction, then postoperative radiotherapy, or cisplatin chemoradiation for extranodal extension or positive margins. ([IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/))
- Recurrent or metastatic: Pembrolizumab alone or with platinum-fluorouracil (KEYNOTE-048); oral metronomic methotrexate-celecoxib where resources are limited. ([Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [KEYNOTE-048](https://onco.cc/trials/keynote-048/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)](https://onco.cc/trials/metronomic-vs-cisplatin-tmh/), [Recurrent or metastatic head and neck squamous cell carcinoma](https://onco.cc/cancers/recurrent-metastatic-hnscc/))
- Prevention: Tobacco, alcohol and betel quid cessation; treatment of leukoplakia and erythroplakia; oral examination in high-risk people. ([Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/), [Alcohol reduction, pricing and cancer warning labels](https://onco.cc/technologies/alcohol-reduction-labelling/), [Oral cancer visual screening](https://onco.cc/technologies/oral-visual-screening/))

## State of the art

- Elective neck dissection for early tongue cancer is a category 1 recommendation on the strength of one Indian randomised trial.
- Depth of invasion has replaced tumour thickness and diameter as the driver of staging.
- Free-flap reconstruction preserves intelligible speech and oral swallowing after large resections.

## Open problems

- Why tongue cancer is rising in young non-smokers.
- Whether sentinel node biopsy can replace elective neck dissection safely.
- Speech and swallowing after resection of more than half the tongue.
- Second primaries in the treated field.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Oral_cancer
- Wikipedia: https://en.wikipedia.org/wiki/Oral_cancer

## Connected records

- cancers: [Buccal mucosa and gingivobuccal cancer (oral cancer in India)](https://onco.cc/cancers/buccal-mucosa-cancer/), [Lip cancer](https://onco.cc/cancers/lip-cancer/), [Oral cavity cancer (mouth and tongue)](https://onco.cc/cancers/oral-cavity-cancer/), [Recurrent or metastatic head and neck squamous cell carcinoma](https://onco.cc/cancers/recurrent-metastatic-hnscc/)
- drugs: [Celecoxib](https://onco.cc/drugs/celecoxib/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/)
- terms: [CDKN2A/B homozygous deletion](https://onco.cc/terms/cdkn2a-homozygous-deletion/), [Chemoradiation (chemoradiotherapy, CRT)](https://onco.cc/terms/chemoradiation/), [Depth of invasion (DOI)](https://onco.cc/terms/depth-of-invasion/), [Extranodal extension (ENE)](https://onco.cc/terms/extranodal-extension/)
- key papers: [Elective versus therapeutic neck dissection in node-negative oral cancer](https://onco.cc/key-papers/paper-dcruz-elective-neck-dissection-nejm-2015/), [EORTC 22931: postoperative irradiation with or without concomitant cisplatin for locally advanced head and neck cancer](https://onco.cc/key-papers/paper-bernier-eortc-22931-nejm-2004/), [KEYNOTE-048: pembrolizumab, alone or with chemotherapy, as first treatment for recurrent or metastatic head and neck cancer](https://onco.cc/key-papers/paper-keynote-048-lancet-2019/)
- trials: [Elective vs therapeutic neck dissection in node-negative oral cancer (Tata Memorial)](https://onco.cc/trials/elective-neck-dissection-tmh/), [KEYNOTE-048](https://onco.cc/trials/keynote-048/), [KEYNOTE-689](https://onco.cc/trials/keynote-689/), [NIVOPOSTOP (GORTEC 2018-01)](https://onco.cc/trials/nivopostop/), [Oral metronomic chemotherapy vs intravenous cisplatin (Tata Memorial)](https://onco.cc/trials/metronomic-vs-cisplatin-tmh/)
- technologies: [Alcohol reduction, pricing and cancer warning labels](https://onco.cc/technologies/alcohol-reduction-labelling/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Oral cancer visual screening](https://onco.cc/technologies/oral-visual-screening/), [PET/CT](https://onco.cc/technologies/pet-ct/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/), [Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/)

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JSON: https://onco.cc/api/v1/entities/oral-tongue-cancer.json