| Abstrakt: |
772 carcinomas of the tongue, observed in the Cancer Institute of Milano from 1928 to 1951, are considered from a statistical, clinical and therapeutical standpoint. Their incidence corresponds to the 3,5 per cent of all malignant tumours observed in the same period. Male patients represent the 84 per cent; mean age 62 years.. Tabagism, dental or prosthetic trauma, leukoplakia and papillomatosis, syphilis, are to be looked upon as pathogenetic factors. In the 70 per cent the neoplasm is arising from the lingual margins, in the 15 per cent from the base. The 95 per cent of cases were spinocellular carcinomas. The subjective symptomatology is often moderate, even in relatively advanced stages. A bioptical examination is always advised, notwithstanding the rather easy diagnosis. Interstitial radium therapy, by needles and cells implant, is still the most used treatment; a reawakened interest in surgery, either alone or in combination with radiation, is however observed, especially as concerns a block removal of the tumour and node metastases with or without mandibular resection. The 77 per cent of patients showed a satisfactory response to the therapy. 5 years survivals were observed in the 21,4 per cent of the cases treated from 1928 to 1935 and in the 38,6 per cent of those treated from 1936 to 1950. Curability rate was higher in the forms involving the tongue dorsum, and in women. Cervical lymph nodes metastases are frequent (about 60 per cent of cases) and often difficult to detect at early stages; the prevailing seat is the homolateral jugular chain. Such metastases are only treated by surgical operation, consisting in homolateral neck dissection which must be systematically carried out after treatment of the tongue cancer. A radical dissection can be performed, being operatory risk unsignificant and late results good (42 per cent 5 years survivals out of 212 operated patients in comparison with 35,3 per cent ouf of 181 less advanced cases not submitted to dissection). The importance of a precautionary neck dissection is emphasized. Further improvements in the treatment of the primary tumour and a larger adoption of a block removal of tumour and metastases in the most advanced cases are advocated. |
