Cancer of language is a malignant new growth of language, mobile muscular body which in a quiet state occupies the most part of an oral cavity. Cancer of language belongs to tumors of an oral cavity which in oncology often are considered together because of similarity of an etiology, clinic, types of cancer, the principles of treatment and the further forecast. To 30% of patients with primary tumor of an oral cavity have secondary tumors of the same arrangement.
Traditionally it is considered that the disease is characteristic of men 60 years are more senior. But statistical data of clinics of the USA showed more than 100% growth of incidence for the last four decades at young women of white race. In general among all tumors of an oral cavity malignant tumors of language are on the second place after a lip cancer. Geographically the tumor is found throughout the world, but is most widespread in Asia Minor and the Indian peninsula that is connected with the reasons of development of cancer of language.
Etiology and pathogeny.
The etiology of some cases of cancer of language is not clear. Among studied the major pathogenetic factor of a malignancy – damage of DNA of a cell of language by compounds of polycyclic aromatic hydrocarbons or other carcinogens. Chronic influence of carcinogens and traumatic factors leads consistently to a hyperplasia of an epithelium, a dysplasia, and then and to cancer. As precancerous conditions of cancer of language are considered: a simple chronic ulcer and an erosion, papillomas, a leukoplakia (simple, verrukozny, erosive), ulcer and erosive and giperkeratotichesky a form flat depriving also of a lupus erythematosus, and also Bowen's illness. Risk factors for development of cancer of language:
- Smoking and alcohol abuse. All malignant tumors of an oral cavity including language cancer, I have close interrelation with alcohol intake and smoking of tobacco. Tobacco is the reason of malignant defeats of language in 80% of cases. Smoking and alcohol work synergy, both of these factors increase a possibility of development of a malignant tumor twice, in comparison with the single reason. There is also an interrelation between a dose of tobacco and alcohol and reaction: the more the person smokes or uses alcohol, the risk is more. Passive smoking, chewing of tobacco mixes (a betel, us), smoking of cigars I act also negatively, as well as smoking of usual cigarettes. In districts for which chewing of tonic mixes on the basis of tobacco is traditional cancer of language is eurysynusic.
- Persistent viral infection. The close interrelation between the virus of papilloma of the person (VPP), a herpes simplex virus, the human immunodeficiency virus (HIV) and cancer cases of language is established. Influence of viruses consists in their intervention in functions of genes suppressors of tumors.
- Other risk factors include immunodeficiency (for example, after reception of immunooverwhelming drugs); contact with harmful industrial factors (asbestos, perchloroethylene, salts of heavy metals, oil distillation products); genetic predisposition; long carrying badly adjusted dentures; bad hygiene of an oral cavity and untimely sanitation.
The vast majority of malignant new growths of language has planocellular type, that is forms in flat cells of a lingual epithelium. Other histologic types are statistically rare. In the place of education distinguish cancer of a root of language of 20% and a cancer of a body of language of 70% (as a rule, on lateral surfaces), the tumor develops in 10% of cases on the lower lingual surface. Two anatomic areas of language (a root and a body) have a different embryonal origin that matters for the choice of medical tactics.
Allocate three macroscopic growth forms of malignant tumors of language: ulcer, papillary and infiltrative (endophytic). Respectively primary tumor can develop as a superficial ulcer, papillary education / outgrowth, or dense hilly infiltrate without clear boundary.
At the initial stage the malignant course of a tumor is defined only histologically, external manifestations do not differ from high-quality new growths. Further the tumor progresses and ulcerates. At an ulcer form primary center will be transformed to an ulcer with the crateriform deepening or dense reinforced edge. The ulcer from painless becomes sharply painful and sanguifluous, its color – from red to whitish-pink. In T3-T4 stages depending on localization of a tumor regional lymph nodes are surprised (mental, submaxillary, retropharyngeal and zashilovidny) and there is a disintegration of primary tumor. The remote metastasises at planocellular type of lingual cancer, as a rule, are not observed. The liver, bones and lungs are affected by metastasises at language adenocarcinomas.
At poll and survey the following symptoms can come to light:
- constant ulcers in language of red or whitish color,
- constant pharyngalgia,
- painful site of language,
- pain when swallowing,
- not taking place numbness of some part of language,
- the inexplicable bleeding from language which is not connected with damage
- a fetid smell from a mouth,
- hypersalivation and the complicated saliva swallowing,
- the complicated breath,
- complexity with pronouncing sounds.
The course of a disease on symptomatology can be divided into three stages conditionally: initial, developed and started. As a rule, the first address of patients happens in developed or the started disease period when to the forefront there are a pain syndrome and distribution of a tumor.
The diagnosis is made on the basis of poll, careful survey and a palpation, and also by results of histologic and cytologic researches.
Depending on a stage of a tumor and its localization in a body or a root of language treatment strategy is chosen. As methods the surgery, radiation therapy and chemotherapy can be applied. For tumors of the small sizes and an arrangement in a language body the best way of treatment allowing to eliminate quickly and effectively a tumor is surgical intervention. At a root arrangement of a tumor of stages 1 and 2 apply a contact or remote gamma therapy, interstitial radiation (brachytherapy). For larger tumors with distribution on lymph nodes removal of primary center and regional lymph nodes combine with radiation therapy. Operation on removal of cervical lymph nodes is called "radical dissection of a neck", its carrying out allows to reduce risk of repeated development of a tumor.
If the malignant new growth reached the considerable sizes and took the most part of language (T3 – T4), then operation on total or half removal of language, in especially started cases with a resection of a mandible and a throat is performed. Because of heavy functional disturbances which can arise after such operation – difficulties in swallowing or disturbances of the speech, the preferred way of treatment in this case as well as at a root arrangement, the remote gamma therapy is considered. The combination with polychemotherapy allows to improve results of radiation therapy.
The general five-year survival after treatment of tumors of language fluctuates from 60 to 95% according to the Russian data and 30-70% on foreign, patients with an early stage of a disease and with a language body tumor have the best survival.
It is obvious that the majority of the reasons causing development of malignant new growths of language is connected with way of life. For prevention of cancer of language it is necessary to fight against addictions – smoking, chewing of tobacco mixes and a drinking habit. For early detection of precancerous conditions of an oral cavity it is necessary to pass annually survey of the dentist and, in case of need, to be treated.