Squamous Cell Carcinoma of Tongue

doi:10.21203/rs.3.rs-3237919/v1

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Case Report

Squamous Cell Carcinoma of Tongue

https://doi.org/10.21203/rs.3.rs-3237919/v1

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BACKGROUND

Squamous cell carcinoma (SCC) of the tongue is the most common oral cancer. Most cases occur on the lateral border of the tongue and only very rarely on the dorsum. The most common type of tongue cancer is squamous cell carcinoma (SCC). Squamous cells are the flat, skin-like cells that cover the lining of the mouth, nose, larynx, thyroid, and throat. Squamous cell carcinoma is the name for a cancer that starts in these cells. SCCs are classified according to the location where they appear, being frequently found in the skin, head and neck, esophagus, lung, cervix, and more rarely in the pancreas, thyroid, bladder, and prostate ¹. This case report highly suggests that poor nutritional status and lifestyle habits (Tobacco chewing) will have a major impact on the health status of the individual.

Case Presentation

We present the case of a 45-year aged Woman who was referred to the oncology department for the examination of an oral ulcer. The MRI -Neck Contrast report of the client reveals that Symmetry between, both sides of the tongue, and the lesion are in the anterior 2/3rd posterior, and 1/3rd and left lateral border of the tongue. Now admitted for further management of the condition. This case report explains about the oral ulcer associated with the oral intake of tobacco chewing products, is a major factor to develop oral & tongue cancer. The following investigations revealed the diagnosis of cancer tongue which is always associated with a high intake of tobacco consumption which indicates the poor lifestyle habit. LSH of tobacco consumption has developed an oral ulcer in the lateral side of the tongue developing ulcers with complaints of pain in the tongue.

Conclusion:

We herein report a Squamous cell Carcinoma of Tongue associated with Tobacco Chewing

Oncology

Squamous Cell Carcinoma of Tongue

Life Style Modifications

Tongue squamous cell carcinoma is one of the most aggressive tumours in behaviour. Even at early stages may the patient need to be submitted to a treatment plan consisting of radio/chemotherapy besides surgical removal of the tumor. There may be therefore a group of patients with stage I and II tumors who suffer from constant recurrent events despite being treated accordingly to their stage and who even die because of their illness. More than 90% of malignant tumors diagnosed in the oral cavity are Oral Squamous Cell Carcinomas (OSCC) whose preferred location is the tongue. Classically, this disease has affected men preferentially, although recent studies suggest that trends are changing and the proportion of women with OSCC is increasing. In addition, the prevalence of oral cancer is also determined by some risk factors as alcohol consumption and tobacco. Currently, the Tumor, Node, Metastasis (TNM) classification is employed to define tumor stage and based on this guide specific treatments are established. However, 5-year survival does not exceed 50% of cases. The objective of this study is to determine whether a histological risk pattern indicative of higher recurrence might be present in T1-T2 tumors located in the anterior two-thirds of the tongue.¹¹

A 45-year aged Woman from India presented with chief complaints of Tongue pain, and the growth of a lump in the lateral border of the tongue for the past 2weeks, has been admitted to the hospital and underwent lab investigations after a physical examination, has been diagnosed with carcinoma of the tongue. She had other clinical manifestations which includes, oral irritation & discomfort, loss of appetite, poor oral hygiene along with dehydration symptoms. Tongue cancer is a malignancy in two third anterior of the tongue, usually occurring in younger ages between 40–50 years of age. These cancers are more common is men than women, they black people are common in white people, and the most common risk of developing and cavity and oropharyngeal cancer is about 60(17%). Various classification is available, including Partial damage. ² Tongue thrusting, Fissured tongue Patient hypo glossal duct and cyst, lingual thyroid, and median rhomboidal glossitis. Further Leucoplakia is classified into small circumscribed white plaque, smooth, wrinkled with fissures, white or yellowish or grey, homogenous or Nodular speckled. This is (Nodular speckled) are most likely to undergo malignant changes. ³

Diagnostic Assessment

Investigations such as USG doppler scan report revealed that the veins are normal, But the biopsy Report of the tongue ulcer reveals Squamous Cell Carcinoma, Grade − 2

Other investigations such as Chest X-ray revealed that Bilaterally Fields Normal and additional Endoscopy DLDP of the structures reveals normal for the client. therapeutic intervention The client planned for radiation Therapy, which was given through the external beam radiation used for oral. The techniques as, three diminished com formal radiation therapy, intensity modulated radiation therapy, proton beam radiation therapy, hypo & hyper fraction accelerated fraction. The patient underwent 6 cycles of chemotherapy, the most common chemo drug used was Inj.Cisplatin-500 mg and Inj. Carboplatin Inj-500mg. The patient was suggested to include a high-protein diet and Fluid Therapy. She was on other medical management which includes T. Ultracet-37.5mg, T. Domstal-10mg, T. Shelcal-500mg- orally.

Outcome and follow-up

After the First cycle of Radiation therapy and chemotherapy, the patient was advised for discharged and to come for the II and cycle of radiation therapy after 12 wks.

Squamous cell carcinoma of the tongue has tobacco smoking and alcohol ingestion as major risk factors and spans two regions: the anterior two-thirds (oral tongue) is a common subtype of squamous cell carcinoma of the oral cavity whereas the posterior third (base of tongue) is considered part of the oropharynx Approximately 20% of all SCCs of the oral cavity arise from the tongue, and approximately 75% of all squamous cell carcinomas of the tongue arise from the anterior two-thirds of the tongue (oral part) ³ Squamous cell carcinoma of the tongue usually arises from the ventrolateral aspect of the mid and posterior tongue, probably due to adjacent pooling of carcinogens⁴. Despite the ease of inspecting the tongue by both patient and physician, they often present late, as they are usually painless and often ignored by the patient. Eventually, they present as a non-healing ulcer which demonstrates growth over time ⁵. Due to the extensive lymphatic drainage of the tongue, nodal metastases are common (37–58%) ^6,7 at the time of diagnosis (more common than any other site in the oral cavity). The client has a chronic history of lifestyle modifications which has made tremendous damage to the oral cavity due to the consumption of tobacco usage at a higher rate. The diagnosis has been made with the oral examination of the client and also based on the laboratory findings of the Biopsy Report reveals that the Squamous Cell Carcinoma, Grade − 2 type, and MRI -Neck Contrast report reveals that Symmetry between, both sides of the tongue, lesion in anterior 2/3rd posterior and 1/3rd and left lateral border of the tongue. Okubo M states that the study retrospectively investigated the incidence of SCC of the tongue dorsum in our department between April 2006 and March 2015. Of the 368 patients with tongue cancer, only 3 had SCC of the tongue dorsum (incidence, 0.8%). All patients with advanced cancer of the tongue dorsum underwent super selective intra-arterial chemoradiotherapy for organ preservation. We discuss the present findings in relation to past case reports and series in the English language literature as well as discuss treatments for SCC of the tongue dorsum. Several authors reported that SCC of the dorsum of the tongue arose from median rhomboid glossitis or oral lichen planus. On the contrary, no lesions prior to developing SCC arose on the tongue dorsum in any patients. There seems to be no relationship between median rhomboid glossitis and carcinoma, although a biopsy should be performed for lesions with an irregular border, increased size, induration, or accompanying tenderness or pain. In our series, lesions on the tongue dorsum prior to SCC arising were geographic and fissured tongue with chronic glossitis, and lichen planus. However, we consider lesions excluding lichen planus not to be precancerous.⁸ Gaillard F says the that for small tumours excision is possible with a hemi glossectomy or partial hemi glossectomy. Reconstruction of the tongue depends on the size of the defect. When less than a third of the tongue has been resected primary closure is possible. Larger defects require pedicle or free-flap reconstruction ^1,4. Larger lesions that cross the midline, although sometimes technically resectable with a total glossectomy, are usually not resected due to the operation being poorly tolerated ¹. In tumors that extend laterally across the floor of the mouth and into the mandible, resection is challenging often requiring segmental mandibulectomy and reconstruction ⁵. Radiotherapy is often used either in conjunction with surgery or alone in advanced cases ⁹.

Squamous Cell Carcinoma (SCC) of the Tongue is very common in the oral intake of tobacco usage. It may be found with other benign oral lesions. Therefore, biopsy and histological examination are the main sources of diagnosis of the disease condition. The case report highlights that oral carcinoma is mainly caused by the consumption of tobacco. It is indeed necessary to create awareness among the younger population to avoid the development of poor lifestyle habits which will cause serious ill effects on health. Thereby early and Prompt diagnosis followed by proper collaborative management of the tongue cancer can have a good prognosis.

SCC-Squamous Cell Carcinoma

LSH- Life style habits

Ethics Approval and consent

Not applicable

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Availability of data and materials

Not applicable

Competing interests

The authors declare that they have no competing interests.

Funding – Not applicable.

Authors detail:

A.L Mahalakshmi

Professor Cum Vice Principal

Department of Medical-Surgical Nursing

Shri Sathya Sai College of Nursing,

Sri Balaji Vidyapeeth (Deemed to be University)

Author Contribution

A L M drafted the manuscript of the Case Report

Acknowledgments

Not applicable

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Squamous Cell Carcinoma of Tongue

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Abstract

BACKGROUND

Case Presentation

Conclusion:

Figures

Background

Case presentation

Diagnostic Assessment

Outcome and follow-up

Discussion

Conclusions

Abbreviations

Declarations

References

Supplementary Files

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