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1. A CASE PRESENTATION ON
CARCINOMA TONGUE
Under the Guidance of
Prof. Dr. S.P. Gayathre M.S. D.G.O
Professor and Head of the Department
Department of General Surgery
Stanley Medical College Hospital
By Dr. C.V. Aruneshwar
2nd Year General Surgical Resident
Stanley Medical College Hospital
Chennai

2. Name : Mr. Subramani
Age : 55
Gender : Male
Residence : Chennai
Occupation : Petrol tanker cleaner
Chief Complaints :
C/o growth over the tongue for 3 months
History of presenting Illness :
Patient presented to the surgical OP department with history of trauma to the tongue
months back following which the patient developed a growth over the tongue, initially
was small and confined to the right side of the tongue, now has grown rapidly to involve
the tip of the tongue. The lesion is associated with pain.

3. H/o difficulty in speech +
H/o excessive salivation +
H/o difficulty in chewing +
H/o difficulty in protrusion of tongue +
No H/o halitosis
No H/o diffculty in swallowing
H/o loss/loosening of teeth +
No H/o loose fitting dentures
H/o ear pain +
H/o other swellings elsewhere in the oral cavity or neck
No H/o chest pain
No H/o cough/breathlessness
No H/o loss of weight or appetite

4. Past History :
No H/o previous similar illness in the past
No H/o prior radiation exposure
H/o Previous surgery - Laparatomy done for ?Perforation peritonitis 30 years back,
records not available.
Comorbid History
Not a k/c/o T2DM/SHTN/BA/Epilepsy/TB
Personal History :
Not a smoker,not a tobacco chewer, He is a social drinker
Chronic betel nut chewer for several years
Family History :
No relevant family history

5. SUMMARY
A 55 year old male patient, from chennai, a petrol tank cleaner by occupation,
chronic betel nut chewer, not a smoker, came with chief complaints of a growth
over the tongue for the past 3months following trauma to the tongue
insiduous onset, rapidly progressive in size, associated with pain over the
lesion, ear pain, difficulty in speech, difficulty in chewing, difficulty in protrusion
of tongue loss of teeth, excessive salivation, with no family history of cancer.

6. EXAMINATION
Patient was made comfortable and examined in a well lit room after obtaining consent
Patient is conscious, oriented to time place and person.
Hydration - adequate
ECOG Performance status 1
Vitals :
Temperature 98.6 F
Pulse 70/min
Blood pressure 120/70 mmHg
SpO2 99% Room air
No pallor, icterus, cyanosis, clubbing, generalised lymphadenopathy or pitting pedal
edema

7. ORAL EXAMINATION
Mouth opening Adequate
No Facial asymmetry
Dental hygiene poor
Multiple tooth loss +
Dental Formula
Halitosis absent
2100 0100
0000 0000

8. INSPECTION
Ankyloglossia present
Proliferative growth extending from the right lateral border of the tongue at the juncton of
the anterior 1/3rd and middle 1/3rd and crosses the midline and involves the tip of the
tongue and the left anterior 1/3rd of the tongue measuring 4 x 3 cm. Teeth impression
seen over the growth.
Irregular in shape
Well defined margins
Fixity to the floor of the mouth +
Posterior 1/3rd of the tongue is free
Buccal mucosa free
No other ulcer or swelling in the buccal cavity, lips, upper lower alveolus and the hard
palate, fauces, pillars, posterior pharyngel wall

10. PALPATION
Proliferative growth extending from the right lateral border of the tongue at the juncton of
the anterior 1/3rd and middle 1/3rd and crosses the midline and involves the tip of the
tongue and the left anterior 1/3rd of the tongue measuring 4 x 3 cm
Not bleeding on touch
Pooling of saliva +
Friable in consistency
Mild tenderness present
Margins well defined with fissuring at the margins
Surrounding induraton +
Fixity of the lesion noted to the underlying floor of the mouth
No other lesion palpable over the lip, buccal mucosa, alveoli, hard palate.
No thickness, tenderness over the mandible

11. LYMPH NODE EXAMINATION
Right sided level 2 cervical node 2x2 cm , mobile
Left sided level 2 cervical node measuring 1 x 1 cm, mobile
Right sided level 1b node, measuring 2 x 2 cm, fixed not mobile.

12. SUMMARY
A 55 year old male patient, from chennai, a petrol tank cleaner by occupation, chronic
betel nut chewer, not a smoker, came with chief complaints of a growth over the
tongue for the past 3months following trauma to the tongue
insiduous onset, rapidly progressive in size, associated with pain over the lesion, ear
pain, difficulty in speech, difficulty in chewing, difficulty in protrusion of tongue loss of
teeth, excessive salivation, with no family history of cancer.
Proliferative growth extending from the right lateral border of the tongue at the juncton
of the anterior 1/3rd and middle 1/3rd and crosses the midline and involves the tip of
the tongue and the left anterior 1/3rd of the tongue.Fixity of the lesion noted to the
underlying floor of the mouth, with bilateral enlarged level 2 mobile nodes, right
enlarged and fixed 1b node.

13. DIAGNOSIS
Carcinoma of the Tongue with intrinsic muscle involvement
with bilateral Lymph nodal metastasis
Clinical Stage : T4a N2c Mo

15. MANAGEMENT
Investigations
Routine Investigations
Ultrasonogram of the neck
Contrast enhanced CT scan of the neck/ MRI of the oral cavity’
Edge wedge biopsy of the ulcer
Treatment :
Subtotal glossectomy with bilateral modified radical neck dissection followed by
adjuvant RT with regular followup