Clinicopathological presentation of tongue cancers and early cancer treatment.

OBJECTIVE

To analyze clinicopathological presentation of tongue cancers and to calculate survival rates (SR) with disease free survival rates (DFSR) and recurrence rates (RR) in different treatment modalities and to compare the results of surgery alone and radiotherapy alone in stage I and stage II disease and to calculate better option of treatment in early tongue cancers.

DESIGN

A longitudinal study.

PLACE AND DURATION OF STUDY

Department of Otolaryngology and Head and Neck Surgery, Pakistan Institute of Medical Sciences, Islamabad (PIMS) from January 1987 to June 1998.

PATIENTS AND METHODS

Case histories of 67 patients were collected from departmental record. Clinical data included age at diagnosis, gender of patient, location of tumour, presenting symptoms and their duration, biopsy report, predominant histological pattern of tumour, nodal status, stage of tumour, treatment modality employed, tumour recurrence, metastasis and survival rates with disease-free survival rates after 2 year s follow-up.

RESULTS

Among 67 patients there were 31 males and 36 females. Mean age was 50 years (range 20 to 80 years). Sixtyseven patients with primary cancer of tongue constituted 38.8% of oral cavity cancers during period of 1987 to 1998 in PIMS. Smoking, poor orodental hygiene (PODH) and betel nuts chewing were the main risk factors. Odynophagia and painful ulcers on lateral border of tongue were the main clinical symptoms with average duration of 7 months. Regional lymph nodes were palpable in 32.8%, 5.5% was in stage I, 35.8% in stage II, 29.8% in stage III, and 28.3% was in stage IV. No patient was found to have distant metastasis. Histopathology in 94% of cases was squamous cell carcinoma (SCC). Recurrence and survival rates were determined in 49 patients. Average time of recurrence was 12.5 months. Recurrence was 100% loco regional (LR). It was 85.7% in patients treated with radiotherapy (RT) alone, 42.1% in patients treated with surgery alone and 31.2% in patients treated with combination of surgery and radiotherapy (RT). Two years survival was 64.2%, 84.2%, 93.7% and 2 years disease-free survival was 14.2%, 57.8% and 68.7% in patients treated with radiotherapy, surgery and combination of radiotherapy (RT) and surgery respectively.

CONCLUSION

In early stages of SCC of tongue either surgery or RT could be used but surgery is better option to decrease the recurrence and to improve the quality of life. In late stages combination of surgery and RT is better than single modality treatment.