Management of Early Stage Carcinoma of the Oral Tongue: A Case Report and Review of Current Treatment Algorithms

Early stage squamous cell carcinoma (SCC) of the oral cavity has always remained a controversy when it comes to management. While one line of thought has always been towards conservative management limited to Wide Excision of the primary tumour and only observation for the neck, the opposing view is of an aggressive approach involving management of the primary along with neck and the need for Post Operative Adjuvant Therapy (PORT) as and when indicated. Certain subsites within the oral cavity, especially the oral tongue and Floor of Mouth (FOM) present further challenges to this controversy. The presence of higher number of lymphatic channels along with the reported phenomenon of “occult” and “skip” metastasis add fuel to fire. Most of the local or regional failures in treatment when only the primary is addressed are reported within the first 24 months of the primary treatment. As opposed to simple observation various treatment modalities have been suggested for the management of the neck namely elective neck dissection (END) and elective neck irradiation (ENR). Further, the limit of neck dissection, that is, the levels of lymph nodes excised, have also been suggested. Here we present a case report of a of biopsy proven early SCC of the oral tongue with no cervical metastasis in a 45 year female patient and highlight the various opinions expressed in literature regarding the management of such lesions.