• symptoms:

• red, white, or dark patches on the tongue
• a sore throat that does not go away
• a sore spot (ulcer) or lump on the tongue that does not go away
• pain when swallowing
• mouth numbness
• bleeding from the tongue

• diagnosis:

A biopsy is the first step in the diagnosis of tongue cancer. During a biopsy, a small amount of tissue is taken from the part of the tongue where cancer is suspected. The tissue is sent to a pathologist, who examines it under a microscope and helps to make the diagnosis.

CT scans, MRIs, may be done. These imaging tests provide more details about cancer. If cancer is found in your tongue, these images can show how deep the cancer is and if it has spread.

• Treatment:

Early stage

Early cancer means your cancer is smaller than 4cm and is contained within the tongue.

The most common treatment is surgery to remove the affected area. You might also have radiotherapy after surgery to try to prevent cancer from coming back. This is known as adjuvant radiotherapy. 

Some people with early-stage oral tongue cancer might have radiotherapy first. This may be because they are not fit enough to have surgery. 

You might also have surgery to remove lymph nodes in your neck. This is to check if cancer has spread to the lymph nodes. You may have a sentinel lymph node biopsy or a neck dissection. 

Locally advanced and advanced cancer 

Locally advanced cancer means your cancer is larger than 4cm. Or it has grown outside the tongue to nearby tissue or lymph nodes. Advanced means it has spread to other parts of the body. 

You are most likely to have a combination of these treatments:

• surgery to remove the cancer from your tongue and the lymph nodes in your neck
• reconstructive surgery to rebuild the tongue
• radiotherapy after surgery
• chemotherapy
• chemotherapy with radiotherapy (chemoradiotherapy)
• targeted and immunotherapy drugs

• Treating the back of the tongue

The back third of the tongue (base of the tongue) is treated like oropharyngeal cancer. Oropharyngeal cancer starts in the part of the throat just behind the mouth.

• You might need radiotherapy or chemoradiotherapy after surgery if your doctor thinks there is a high risk that your cancer will come back.
• Chemoradiotherapy means you have chemotherapy and radiotherapy together.

You might have radiotherapy, chemotherapy or surgery to control symptoms of advanced cancer.

• Surgery

Your surgeon removes the cancer and an area (margin) of normal tissue around it. This helps to make sure that they have removed all the cancer. The operation is called primary tumor resection. 

There are different types of primary tumor resection. It depends on where the cancer is.  You might only need a simple operation if the cancer is very small. This can be done using local anesthetic or with laser surgery. So, you don't need to stay overnight in hospital. 

For larger cancers, you might need a more complicated operation and stay in hospital for a while. You might have an operation to remove part or all of your tongue (a glossectomy). This is quite a big operation. Your surgeon will rebuild (reconstruct) your tongue.  The surgeon usually removes the lymph nodes from one or both sides of your neck. This operation is called a neck dissection. It lowers the risk of your cancer coming back in the future.

• After Surgery

You will have some pain after most types of surgery, but this is usually well controlled. Your doctors and nurses give you painkillers by drip, tablets, or liquids if you need them. Having an operation to your mouth may affect eating and drinking for a while afterwards. Depending on the type of surgery you have it might also affect your speech. 

Talk to your doctor or specialist nurse before your operation. You can ask them how it will affect you and what support there is. 

• Radiotherapy

Radiotherapy uses high energy waves similar to x-rays to kill cancer cells. You might have radiotherapy:

• on its own as your main treatment or after surgery
• combined with chemotherapy (chemoradiotherapy) as your main treatment or after surgery
• to help relieve the symptoms of advanced tongue cancer

You usually have radiotherapy treatment once a day

Side effects, Radiotherapy to the head and neck area can cause several side effects. These include a dry, sore mouth and taste changes.

• Chemotherapy

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer.

You might have chemotherapy combined with radiotherapy, after surgery if there is a high risk of your cancer coming back or as your main treatment if your cancer has spread to nearby tissue (locally advanced cancer) or to other parts of the body (secondary or advanced cancer)

You usually have a PET-CT scan a few months after chemoradiotherapy. This is to check if your lymph nodes contain cancer. If there are signs of cancer, you usually have surgery to remove the lymph nodes.Some people have chemotherapy to shrink the cancer before the main treatment, although this isn’t very common. This is called neo adjuvant treatment.

The most commonly used drug is cisplatin. You might have this with fluorouracil (5FU). Some people have carboplatin instead of cisplatin.

Side effects of chemotherapy include feeling sick and lower resistance to infections. Your side effects also depend on the drug you have and whether you have it with other treatments.

Targeted and immunotherapy cancer drugs

Cetuximab (Erbitux)

Cetuximab is a type of targeted cancer drug called a monoclonal antibody.

You might have cetuximab with radiotherapy You might have it in one of the following situations:

• your platinum chemotherapy (for example cisplatin or carboplatin) is not working
• you cannot have chemotherapy

Nivolumab (OPDIVO)

Nivolumab is a type of immunotherapy.   This type of treatment stimulates the body’s immune system to fight cancer cells.

• squamous cell cancer that has come back or spread to other parts of the body
• had platinum-based chemotherapy (such as cisplatin or carboplatin) and your cancer has started to grow within 6 months of having chemotherapy

You can have it for up to 2 years.

Pembrolizumab (Keytruda)

Pembrolizumab is also a type of immunotherapy.

It is a treatment for squamous cell cancer of the head and neck that has either:

• spread to other parts of the body (advanced) and has not been treated before
• has come back (recurred) and not been treated since it has come back

• is not suitable for surgery
• expresses a certain amount of a protein known as PD-L1

You can have up to 2 years of treatment of pembrolizumab.

____________________________________________________________________________

• Diagnosis:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• tumor markers
• inflammation indicators (CRP, ESR)
• CT / MRI scan (on indication)
• general otolaryngological examination
• Endoscopic, image guided or excisional biopsy (on indication)
• histological and cytological examination (on indication)
• nursing services
• tumor board involving oncologist, radiologist, surgeon
• consultation of the chief physician and all leading experts
• development of individual treatment plan
• written statement

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: On request

Type of program: Outpatient

Expected duration of the program: 5 days

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• Surgery:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• biochemical analysis of blood
• TSH-basal, fT3, fT4
• tumor markers
• inflammation indicators (CRP, ESR)
• indicators blood coagulation
• CT/MRI scans
• general otolaryngological examination
• endoscopic, image guided or excisional biopsy
• preoperative care
• operative: tumor resection (glossectomy) with or without neck lymph nodes dissection, tongue reconstruction may be an option (as indicated clinically).
• histologically and immunohistochemically examination of the removed tissues
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 11 days

______________________________________________________________________________________

• Chemo-radiotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• CT /MRI (if indicated clinically) 
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• tumor markers (If indicated clinically)
• indicators of inflammation (CRP, ESR)
• indicators of blood coagulation
• CT simulation and planning of radiation therapy
• Physics calculation
• full course of radiation therapy with different modalities (3D, IMRT, VMAT) according to your treatment plan.
• individual plan of the chemotherapy, the cost of medicines is included
• symptomatic treatment (for side effects of chemo and radiotherapy that may developed).
• cost of essential medicines and materials
• nursing services
• control examinations
• consultations of related specialists
• explanation of future recommendation

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will elaborate the chemotherapy regimen, conduct radiotherapy CT or MRI SIMULATION then planning, make the permanent tattoo marks on the skin to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy and radiation therapy are carried out as the day hospital procedure, without mandatory admission to the hospital. At each visit, the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded linear accelerator radiation therapy room.

Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will visit the hospital from 1 to 3-5 times a week.

Chemotherapy may be through intravenous route according to your treatment plan, during the chemotherapy session, after the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

During radiotherapy, you are under close follow-up daily from doctors and nurses.

After the completion of the chemotherapy and radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results

Price from: on request

Type of program: Outpatient

Expected duration of the program: 39 days

_____________________________________________________________________________________

• Chemotherapy and immunotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• analysis of medical records
• physical examination
• laboratory tests:

• complete blood count
• biochemical analysis of blood
• tumor markers
• inflammation indicators
• indicators of blood coagulation
• ultrasound scan, CT / MRI scan (if indicated).
• 1 course of chemotherapy
• consultations of related specialists
• symptomatic and specific treatment
• the cost of essential medicines and materials
• nursing services
• control examinations
• full hospital accommodation
• recommendations for further treatment

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as outpatient according to chemotherapy protocol type. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. After the completion of the chemotherapy course and control examinations you will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• Colonoscopy data, MRI/CT scan (not older than 3 months)
• Biopsy results
• Any recent laboratory results.

Price from: On request (regarding chemotherapy protocol)

Type of program: outpatient