Oral cancer located in the mouth, tongue or oropharynx is a significant health problem throughout the world. It's the eight most common cancer worldwide with 300.000 new cases reported annually [1]. Many countries feature incidence rates in oral cancer that vary in men from 1 to 10 cases per 100 000 population [2]. Developing countries suffer from higher incidence rates in oral cancer than developed countries [3]. Worryingly, the incidence of the disease is reportedly rising in most countries such as central and Eastern Europe and the USA [2, 3]. The overall five-year-survival rate for patients with oral cancer stagnated for the last 20 years [4]. The survival rate is only 54% in industrial countries, one of the lowest rates of all major cancers. Five-year survival rates in developing countries reached the rate of 30% hardly [5]. The middle east is geographically located in the high incidence and mortality of oral cancers. Oral cancer is the second most common malignancy in both genders in Pakistan [1] and there is an epidemic alert of Oral cancers in Pakistan in the year 2030 by WHO [2].
First report of the tongue in medical literature was in 1635 [3]. But Only a limited number of studies have examined larger series of tongue cancer. Spiro and Strong evaluated 314 patients (1957-1963) with tongue cancer and found an overall 5-year survival rate of only 42% [3].
The incidence of tongue carcinoma in male is 6.5 per 100 000 per annum and in some parts of Europe and South Asia is up to 8.0 per 100 000 per annum. The tongue remains the most common intraoral site for oral cancer worldwide [4].
In contrast to other sites of oral cancer the incidence of the tongue carcinoma increasing in especially younger age group [5–7]. This is linked with Human papilloma etiology of tongue cancers [8]. This increase in the incidence needs more expertise and sharing of the experiences of the tongue carcinoma.
The optimum structural and functional integrity of this muscular organ of the Human body is vital for the life of the suffering patients. The speech, swallowing and breathing is associated with integrity of the reconstructed tongue muscles after surgical resection [9]. The anatomical and physiological milking muscle action predispose to an early invasion and metastasis of tongue carcinoma [10]. This results in extensive resection of not only the tongue tissue but also floor of mouth, oropharynx, tonsillar area along with cervical lymph nodes dissection even in clinical N0 status for the complete palliation of the occult metastasis [11].
The various treatment options for the tongue carcinoma include Surgery, radiotherapy, chemotherapy and combined Modalities [12]. Due to the mutilating affects of the surgical management of tongue carcinoma on the quality of life, organ preservation techniques and treatment protocols have been discussed. The choice of the treatment depends upon tumor factors such as site, size (T stage), location and multiplicity, proximity to bone, pathological features, histology grade and depth of invasion. The patient factors include status of cervical lymph nodes, previous treatments medical condition of the patient. The various flaps for mobile tongue include local (mucosal, Buccinator flaps), local neck flap(infrahyoid),free flaps (forearm free flap, antero-lateral thigh flap); For the base of tongue local neck flap (infrahyoid), free flaps (Latissimus dorsi free flap, Antero-lateral free flap, Rectus-abdominis free flap). The micro-vascular flap revolutionised the reconstruction of tongue and it was used first time in 1963 [13] in general surgery and in head and neck reconstruction in 1975 [14].
The resection defect classification guides clinicians for the decision of the reconstructive flap design. According to Urken et al tongue defects are difficult to classify; the volume and function of residual tissue does the quantification of the defect. He classified tongue resection defects as soft tissue defects of mobile tongue TM, base of tongue TB and total glossectomy TG defects along with neural defects. Further classification of TM is done by longitudinal division in quarters and finally grouping of defects with reconstructive guidelines is described [15].
The purpose of the present study was to give a precise description of our experience with surgical based therapy of tongue cancer during 12 years in a country with limited Human expertise and finances. Furthermore, prognostic factors for survival were analyzed in order to obtain valid criteria for therapeutic decision-making in clinical routine.