Carcinoma of the Base if the Tongue

Etiology: Risk factors for the development of base of tongue carcinoma include chronic alcohol and tobacco use, older age, geographic location, and family history of upper aerodigestive tract cancers. Environmental exposure to polycyclic aromatic hydrocarbons, asbestos, and welding fumes may increase the risk of pharyngeal cancer. Nutritional deficiencies and infectious agents (especially papillomavirus and fungi) also may play a significant role. The most common symptoms associated with malignant neoplasms of the tongue base are dysphagia, odynophagia, sensation of a mass in the throat, or the presence of a mass in the neck. Patients also may complain of referred ear pain or hemoptysis. Delay in diagnosis is not uncommon because of the common and sometimes vague nature of symptoms and the relative inaccessibility of the base of the tongue to examination. Upon physical examination, a mass is usually palpable in this area. Extensive submucosal disease or a strong gag reflex may make palpation more difficult. Patients may have bilateral palpable adenopathy because of the midline location and the high propensity for regional lymph node metastases. Indirect or flexible fiberoptic laryngoscopy in the office is a useful adjunct to the physical examination.