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Tongue Intrinsic Muscle Cancer

Dr. Marianne Abouyared, Md - Otolaryngology (ENT) April 22, 2025 Rx Musculoskeletal System (A - Z)

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Cancer of the tongue intrinsic muscles is a form of oral cancer in which malignant cells develop within the muscles that lie entirely inside the tongue. These intrinsic muscles change the tongue’s shape—helping you speak, swallow, and eat. When cancer arises here, it can invade nearby tissues and spread to lymph nodes or distant organs if not caught early. Early detection and treatment greatly improve outcomes.

Anatomy of the Tongue Intrinsic Muscles

Structure

The tongue’s intrinsic muscles are four paired muscle groups made up of interwoven fibers entirely contained within the tongue’s substance. Unlike extrinsic muscles (which attach to bone), these fibers run in different directions—longitudinally, transversely, and vertically—allowing precise shape changes. TeachMeAnatomyWikipedia

Location

All intrinsic muscle fibers lie deep under the tongue’s mucosal lining, from its tip (apex) to its base near the throat. They are arranged in layers: the superior longitudinal just under the top surface, the inferior longitudinal along the underside edges, the transverse across the mid‑portion, and the vertical connecting upper and lower surfaces. TeachMeAnatomyWikipedia

Origin

• Superior longitudinal muscle originates near the epiglottis and median fibrous septum at the tongue’s back.

• Inferior longitudinal muscle arises from the root of the tongue and fibrous septum.

• Transverse muscle originates from the median septum.

• Vertical muscle comes from the dorsum mucosa. WikipediaWikipedia

Insertion

• Superior longitudinal inserts into the tongue’s lateral margins.

• Inferior longitudinal inserts into the tongue’s tip and margins.

• Transverse fibers insert into the sides of the tongue.

• Vertical fibers insert into the inferior surface. WikipediaWikipedia

Blood Supply

The lingual artery (branch of the external carotid) is the main source of arterial blood. Additional small branches arise from the tonsillar branch of the facial artery. Venous blood drains via the lingual veins into the internal jugular vein. Kenhub

Nerve Supply

Motor signals travel via the hypoglossal nerve (CN XII) to all intrinsic muscles. Sensory feedback (touch and taste) comes via the lingual nerve (CN V₃) for general sensation and the chorda tympani branch of CN VII for taste in the anterior two‑thirds, and via CN IX and CN X for the posterior third. NCBIKenhub

Key Functions

1. Shortening the tongue (pulling tip backward)

2. Lengthening the tongue (making it longer)

3. Curling the tip upward (for sounds like “r”)

4. Curling the tip downward (for certain swallowing movements)

5. Flattening the tongue (to press food against teeth)

6. Narrowing the tongue (for precise articulation) TeachMeAnatomyWikipedia

Types of Tongue Intrinsic Muscle Cancer

1. Squamous Cell Carcinoma (SCC): Most common, arising from surface lining cells.

2. Verrucous Carcinoma: Slow‑growing, warty appearance.

3. Spindle Cell Carcinoma: Rare, aggressive variant of SCC.

4. Basaloid SCC: High‑grade, poor prognosis.

5. Melanoma: Originates from pigment cells—very rare in tongue.

6. Rhabdomyosarcoma: Cancer of muscle precursor cells—very uncommon.

7. Leiomyosarcoma: Smooth muscle cancer—rare in tongue.

8. Granular Cell Tumor: Usually benign but can transform.

9. Mucoepidermoid Carcinoma: From minor salivary glands within tongue.

10. Adenoid Cystic Carcinoma: Slow‑growing salivary gland cancer.

Causes

Each of the following can increase risk of tongue intrinsic muscle cancer:

1. Tobacco smoking (cigarettes, cigars, pipes)

2. Smokeless tobacco (chewing, snuff)

3. Heavy alcohol use (especially combined with tobacco)

4. Human papillomavirus (HPV) infection (high‑risk types 16/18)

5. Betel nut chewing

6. Poor oral hygiene

7. Chronic mechanical trauma (sharp teeth, ill‑fitting dentures)

8. Chronic inflammation (oral lichen planus)

9. Age over 50 years

10. Male sex (2:1 higher incidence)

11. Genetic predisposition (family history)

12. Immunosuppression (HIV, transplant)

13. Nutritional deficiencies (low fruits/vegetables)

14. Occupational exposures (wood dust, formaldehyde)

15. Radiation exposure (prior head/neck radiation)

16. Syphilis (historic association)

17. Chronic Candida infection

18. Epstein–Barr virus (rare role)

19. Diet high in processed meats

20. Poorly controlled diabetes

Symptoms

Early signs may be subtle. Look for:

1. Persistent sore or ulcer on tongue lasting >2 weeks

2. Red or white patches (erythroplakia/leukoplakia)

3. Lump or thickening in tongue

4. Pain or burning in tongue

5. Bleeding from tongue lesion

6. Difficulty swallowing (dysphagia)

7. Difficulty speaking (dysarthria)

8. Change in voice quality

9. Numbness of tongue

10. Ear pain (referred)

11. Swelling of jaw

12. Loose teeth near tumor

13. Bad breath (halitosis)

14. Unexplained weight loss

15. Reduced appetite

16. Limited tongue movement

17. Pain when opening mouth

18. Salivary changes (thick or bloody saliva)

19. Neck lump (lymph node spread)

20. Fatigue (advanced disease)

Diagnostic Tests

1. Clinical oral exam by dentist or doctor

2. Incisional biopsy (tissue sampling)

3. Brush biopsy (cell sampling)

4. Cytology smear

5. Histopathology (microscope analysis)

6. HPV testing (p16 immunohistochemistry)

7. Panendoscopy (camera exam of throat)

8. CT scan of head and neck

9. MRI for soft‑tissue detail

10. PET–CT for metastases detection

11. Ultrasound of neck lymph nodes

12. Fine‑needle aspiration of lymph node

13. Chest X‑ray (lung spread)

14. Chest CT (if needed)

15. Toluidine blue staining (lesion mapping)

16. Fluorescence imaging (area delineation)

17. Sentinel lymph node biopsy

18. Blood tests (CBC, liver/kidney function)

19. Nutrition assessment

20. Dental evaluation (to plan reconstruction)

Non‑Pharmacological Treatments

1. Partial glossectomy (surgical removal)

2. Hemiglossectomy

3. Wide local excision

4. Marginal mandibulectomy

5. Selective neck dissection

6. Radical neck dissection

7. Free flap reconstruction (microvascular)

8. Speech therapy (rehab)

9. Swallowing therapy

10. Nutritional counseling

11. Photodynamic therapy

12. Laser ablation

13. Cryotherapy

14. Radiation therapy

15. Hyperbaric oxygen therapy

16. Acupuncture for pain relief

17. Massage therapy (lymphatic drainage)

18. Physiotherapy (jaw exercises)

19. Oral stents to protect tissue

20. Dental prosthetics (molds)

21. Topical mouthwashes (alkaline/rinse)

22. Low‑level laser therapy (mucositis)

23. Oral hygiene optimization

24. Prosthetic speech devices

25. Yogic breathing exercises

26. Mindfulness meditation (stress)

27. Psychological counseling

28. Support groups (peer)

29. Dietary modifications (soft foods)

30. Physical exercise (overall health)

Note: Surgical and radiation-based approaches are listed here because they are non‑drug therapies.

Drugs

1. Cisplatin – platinum‑based chemotherapy

2. Carboplatin

3. 5‑Fluorouracil (5‑FU)

4. Docetaxel

5. Paclitaxel

6. Methotrexate

7. Bleomycin

8. Capecitabine

9. Gemcitabine

10. Cetuximab – EGFR inhibitor

11. Panitumumab

12. Pembrolizumab – PD‑1 inhibitor

13. Nivolumab – PD‑1 inhibitor

14. Durvalumab – PD‑L1 inhibitor

15. Ipilimumab – CTLA‑4 inhibitor

16. Interferon‑α

17. Erlotinib – EGFR TKI

18. Gefitinib

19. Sunitinib – multi‑TKI

20. Bortezomib – proteasome inhibitor

Surgeries

1. Partial glossectomy (remove part of tongue)

2. Hemiglossectomy (half of tongue)

3. Total glossectomy (whole tongue)

4. Wide local excision (tumor plus margin)

5. Marginal mandibulectomy (jaw margin)

6. Selective neck dissection (certain lymph nodes)

7. Radical neck dissection (all lymph nodes)

8. Sentinel lymph node biopsy

9. Microvascular free flap reconstruction (tissue transfer)

10. Dental and mandibular reconstruction (prosthetics)

Prevention Strategies

1. Don’t smoke or use any tobacco

2. Limit alcohol consumption

3. Get HPV vaccine (ages 9–26)

4. Maintain good oral hygiene

5. Regular dental check‑ups

6. Protect lips from sun (use SPF)

7. Avoid betel nut chewing

8. Manage chronic mouth sores promptly

9. Eat a balanced diet rich in fruits and vegetables

10. Control diabetes and immunosuppression

When to See a Doctor

• A sore or ulcer on the tongue lasting more than two weeks

• Any lump, thickening, or patch in the mouth or tongue

• Pain when swallowing, speaking, or moving the tongue

• Unexplained bleeding from mouth or tongue

• Any referred ear pain without ear disease

• Rapid weight loss or difficulty maintaining nutrition

Early evaluation by a dentist or ENT specialist is crucial—especially if symptoms persist despite home care.

Frequently Asked Questions

1. What is the survival rate for tongue intrinsic muscle cancer?
   Five‑year survival ranges from 50–70%, higher in early stages.

2. Can HPV vaccination lower my risk?
   Yes—vaccines against HPV 16/18 reduce risk of HPV‑related tongue cancers.

3. How fast does tongue cancer grow?
   Growth varies by type; squamous cell carcinomas can progress over weeks to months.

4. Is biopsy painful?
   Local anesthetic makes it tolerable; mild soreness may follow.

5. Can tongue cancer spread to lymph nodes?
   Yes—early spread often to nearby neck lymph nodes.

6. Will I lose my voice after treatment?
   Partial tongue removal can affect speech; speech therapy helps recovery.

7. What imaging is best for staging?
   MRI provides detailed soft‑tissue images; PET–CT finds distant spread.

8. Are there clinical trials for new treatments?
   Yes—immunotherapy and targeted therapy trials are ongoing.

9. How is nutrition managed?
   Dietitians may recommend soft or tube feeding during healing.

10. Can tongue intrinsic muscle cancer recur?
    Yes—regular follow‑up visits and imaging are essential for early detection.

11. Does radiation therapy damage healthy tissue?
    It can cause side effects like dry mouth; modern techniques limit exposure.

12. Are herbal remedies effective?
    No proven cure—always discuss supplements with your oncologist.

13. Is reconstructive surgery available?
    Yes—microvascular flaps and prosthetics restore function and appearance.

14. How long is recovery after surgery?
    Hospital stay is typically 1–2 weeks; full recovery may take months.

15. What support services exist?
    Speech therapy, nutrition counseling, and counseling/support groups are widely available.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: April 22, 2025.