Tongue cancer pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Genes involved in the pathogenesis of tongue cancer include TP53, c-myc, and erb-b1. On gross pathology, exophytic, ulcerative, and infiltarative growth patterns are characteristic findings of tongue cancer.

Pathophysiology

Genetics

The mutations in tumor suppressor genes has been reported in patients with tongue cancer. Genes involved in the pathogenesis of tongue cancer include TP53, which is located on chromosome 17. Other oncogenes associated with squamous cell cancers of the tongue include c-myc and erb -b1.

Gross pathology

Squamous cell carcinoma is the most common malignancy of the tongue. It typically has three gross morphologic growth patterns: exophytic, ulcerative, and infiltrative. The infiltrative and ulcerative are the types most commonly observed on the tongue.The macroscopic appearance of tongue cancer depends on the following:

• Duration of the lesion
• The amount of keratinization
• The changes in the adjoining mucosa

A fully developed tongue lesion appears as an exophytic bulky lesion that is gray to grayish-red and has a rough, shaggy, or papillomatous surface.

Microscopic Pathology

• Microscopically, tongue cancers are broadly based and invasive through papillary fronds.
• Tongue cancer constitutes of highly differentiated squamous cells lacking frank cytologic criteria of malignancy with rare mitoses. The surface of the lesion is covered with compressed invaginating folds of keratin layers. An astromalike inflammatory reaction and a blunt pushing margin may be seen.

Pathogenesis

• Leukoplakia and erythroplakia have the greatest potential for malignant transformation in tongue cancer. Leukoplakia is defined as a white patch of the mucosa that cannot be characterized clinically or pathologically as any other disease.
• Leukoplakia is considered a premalignant condition from the chronic irritation of the mucous membranes, resulting in increased rates of epithelial and connective tissue proliferation.
• Leukoplakia usually occurs after the age of 40 years, with the peak incidence before age 50 years. Leukoplakia is 2-3 times more common in men than in women.
• The rates of malignant transformation of leukoplakic lesions range from less than 1% to as high as 17.5%, averaging 4.5-6%. Erythroleukoplakia (leukoplakia erosiva) and nodular leukoplakia exhibit the highest rate of malignant transformation.
• Erythroplakia is defined as a red, velvety plaque found on the oral mucosa that cannot be ascribed to any other predetermined condition. No sex predilection is recognized in erythroplakia and it is rarely found on the tongue compared with other sites in the oral cavity. Erothroplakia is considered as the earliest sign of asymptomatic cancer by Mashberg.

The two most common types of pre-cancerous conditions on the tongue are called leukoplakia and erythroplakia and they can usually be easily spotted by a dentist or dental hygienist. While these spots start off harmless and do not initially spread to any other part of the body, they exhibit characteristics that could develop into cancer. Leukoplakia is usually a white or grayish patch and erythroplakia is a red patch. According to the American Cancer Society about 1 out of every 5 cases of leukoplakia is cancerous or will develop into cancer if not treated. Erythroplakia is less common, but more serious. The majority of found erythroplakia cases are cancerous or will develop into it. After having pre-cancerous spots removed it is important that you have regular check ups with a dentist or doctor to monitor your tongue and check for a recurrence of pre-cancerous spots.