History

As in all head and neck cancers, it is essential to gather a thorough history, with an emphasis on common risk factors such as tobacco and alcohol use. Patients with base of tongue tumors may present with dysphagia, odynophagia, foreign body sensation, referred otalgia, oral bleeding, or a neck mass. In advanced disease, patients can present with obstructive symptoms such as dyspnea and inability to tolerate secretions. General health status, including cardiac and pulmonary history, previous surgery or radiation treatment, and use of anticoagulation therapy, are also important to evaluate given the potential implications on treatment and outcomes.

Physical Examination

A comprehensive head and neck examination is recommended for all patients, including detailed cranial nerve examination and palpation of the neck to assess for regional metastatic lymphadenopathy. Inspection and palpation of the tongue base may be limited by inadequate access to equipment, poor patient compliance, or submucosal extent of disease. Office indirect or flexible fiberoptic laryngoscopy is a useful adjunct to the physical examination.

Workup

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Media Gallery

An axial positron emission tomography (PET) scan shows asymmetrical hypermetabolic uptake within the left base of the tongue/tonsillar region consistent with a primary tumor. Intense hypermetabolic left cervical lymphadenopathy is also seen and is concerning for metastatic disease.
A sagittal computed tomography (CT) scan of the neck with contrast demonstrates a pedunculated soft tissue lesion at the left base of the tongue without invasion of the floor of the mouth or adjacent structures. The mass measures approximately 2.7 x 1.8 x 2.8 cm.
An axial CT scan of the neck with contrast again demonstrates a soft tissue left base of tongue lesion with slight extension into the glossotonsillar sulcus. There is also an enlarged, pathologic-appearing, left level II cervical lymph node.

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Author

Rishi Sethia, MD Resident Physician, Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center

Rishi Sethia, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Medical Student Association/Foundation, American Rhinologic Society, The Ohio Academy of Science

Disclosure: Nothing to disclose.

Coauthor(s)

Akash N Naik, MD Resident Physician, Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexner Medical Center

Akash N Naik, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Nolan B Seim, MD Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Division of Head and Neck Cranial Baase and Microvascular Reconstructive Surgery, James Cancer Hospital and Solove Research Institute, Director of Medical Student Education, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center; Course Director, International Head and Neck Oncologic Surgery Resident Dissection Course, Wright State University, Boonshoft School of Medicine

Nolan B Seim, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, Student National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Nader Sadeghi, MD, FRCSC Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, McGill University Faculty of Medicine; Chief Otolaryngologist, MUHC; Director, McGill Head and Neck Cancer Program, Royal Victoria Hospital, Canada

Nader Sadeghi, MD, FRCSC is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Thyroid Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; Ryte; Neosoma; MI10<br/>Received income in an amount equal to or greater than $250 from: Neosoma; Cyberionix (CYBX)<br/>Received ownership interest from Cerescan for consulting for: Neosoma, MI10.

Additional Contributors

Benoit J Gosselin, MD, FRCSC Associate Professor of Surgery, Dartmouth Medical School; Director, Comprehensive Head and Neck Oncology Program, Norris Cotton Cancer Center; Staff Otolaryngologist, Division of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center

Benoit J Gosselin, MD, FRCSC is a member of the following medical societies: American Head and Neck Society, American Academy of Facial Plastic and Reconstructive Surgery, North American Skull Base Society, American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Rhinologic Society, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, College of Physicians and Surgeons of Ontario, New Hampshire Medical Society, Ontario Medical Association

Disclosure: Nothing to disclose.

Talib Najjar, DMD, MDS, PhD Professor of Oral and Maxillofacial Surgery and Pathology, Rutgers School of Dental Medicine

Talib Najjar, DMD, MDS, PhD is a member of the following medical societies: American Society for Clinical Pathology

Disclosure: Nothing to disclose.