How this miracle surgery saved the tongue of a 32-year-old woman in Mumbai

In 2022, Shahnaz Fatima (32) noticed an uncommon white scar forming on her tongue, informs her husband, Mohammad Israr. Over time, this scar transformed into a persistent non-healing ulcer, remaining on her tongue for months. Concerned about the ulcer's persistence, the couple opted to consult local medical professionals in their hometown Sidhartha Nagar, Uttar Pradesh, seeking advice and treatment.

Following consultations with several doctors, they were advised that the condition was leukoplakia. However, Israr found the diagnosis to be less than convincing and felt prompted to take his wife to Mumbai for a more thorough and accurate diagnosis.

Upon reaching Mumbai, Shahnaz received a diagnosis of carcinoma at the Head and Neck Cancer Institute of India. The prognosis initially included the possibility of tongue amputation, which would have resulted in her losing the ability to speak. However, following the tongue cancer surgery conducted three months ago, a portion of her tongue was successfully removed, and she has since regained her ability to speak.

Dr Kanav Kumar, a surgical oncologist at the Head and Neck Cancer Institute of India, along with Dr Sultan Pradhan, Dr Rajan Kannan, and Dr Mohsin Shaikh conducted surgery on Shahnaz, ultimately saving her from losing her tongue. In an exclusive interview with Midday, Dr Kumar sheds light on the symptoms, diagnosis and treatment of tongue carcinoma:

Dr Mohsin Shaikh, Dr Kanav Kumar, Dr Sultan Pradhan

What were the symptoms that led to the diagnosis of tongue carcinoma?
Kumar: The specific characteristics of the ulcer on the tongue that led to the diagnosis of carcinoma included its non-healing nature and painlessness. Typically, malignant ulcers, such as carcinomas, exhibit a lack of healing and are initially painless.

In this case, the patient had been experiencing a non-healing ulcer over the tongue for the past month, which raised concerns regarding its nature. The absence of pain initially is a common feature of cancerous ulcers, as the disease progresses and involves surrounding nerves, pain may develop as a later symptom.

The combination of the ulcer's persistence and painlessness prompted further investigation to rule out malignancy. While non-malignant ulcers can also occur for various reasons, the duration of one month without signs of healing, coupled with the lack of pain, raised suspicion for carcinoma.

Additionally, considering the location on the tongue, which is a common site for oral cancers, heightened the concern for malignancy. Consequently, the patient likely underwent diagnostic tests such as a biopsy to confirm the diagnosis of carcinoma and initiate appropriate treatment.

What was the extent of the surgery performed to remove the cancer from the tongue and ensure clear margins?
Kumar: The tongue cancer surgery performed on Shahnaz aimed to ensure complete eradication of the tumour while preserving as much healthy tissue as possible. The procedure involved excising the tumour along with a surrounding margin of approximately 1cm of normal tissue. This margin was crucial to ensure that any potentially cancerous cells were completely removed, minimising the risk of recurrence.

To verify the adequacy of the resection and ensure clear margins, the excised tissue was immediately subjected to examination using a technique called frozen section analysis. This process involves quickly freezing the tissue sample and then slicing it thinly for microscopic examination. The advantage of frozen section analysis lies in its rapid turnaround time, providing results within 10-15 minutes while the patient is still in the operating room. This immediate feedback allows the surgical team to assess whether the margins are free of tumour cells and if further resection is necessary to achieve clear margins.

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Were there any signs of metastasis?
Kumar: During Shahnaz's surgery, lymph nodes from the same side of her neck were meticulously cleared as part of the procedure. This step was essential to assess whether the cancer had spread beyond the primary site in her tongue to nearby lymph nodes, a common pathway for cancer metastasis.

Fortunately, the findings from the lymph node clearance were reassuring. Despite the potential risk of metastasis, no definitive signs of cancer spread were observed during the surgery. This initial assessment was further confirmed upon final histopathological examination of the excised lymph nodes.

This outcome was particularly encouraging as the presence of metastasis in the lymph nodes would have significantly impacted her prognosis and treatment plan. The absence of lymph node involvement suggests that the cancer was localised to the tongue without spreading to other parts of the body, indicating a more favourable prognosis for Shahnaz.

Side effects associated with the surgical removal of tongue cancer and lymph nodes
Kumar: The surgical removal of tongue cancer and lymph nodes, while crucial for treating the disease, can potentially lead to various complications and side effects. One significant concern is the impact on speech and swallowing function.

Since the tongue plays a vital role in articulating sounds and manipulating food during swallowing, its removal or significant alteration can result in speech difficulties and swallowing problems. Patients may require speech therapy and dietary modifications to manage these challenges effectively.

Additionally, the surgery can cause changes in taste sensation and mouth dryness, affecting the overall quality of life. Patients may experience discomfort, pain and swelling in the surgical area following the procedure. Moreover, there is a risk of infection at the surgical site, which requires vigilant monitoring and prompt treatment to prevent complications.

Furthermore, the removal of lymph nodes can disrupt the normal drainage of lymph fluid, leading to lymphedema, a condition characterised by swelling in the affected area. Lymphedema management typically involves physical therapy and compression garments to alleviate symptoms.

Despite these potential complications, it is essential to note that advancements in surgical techniques and post-operative care have significantly reduced the incidence and severity of complications associated with tongue cancer surgery.

Moreover, in the case of Shahnaz, the absence of cancer spreading beyond the primary site to other parts of the body, as confirmed by examinations and investigations such as X-ray and MRI, suggests a more favourable prognosis and lower risk of systemic complications.

Are there any factors that may affect their long-term outcome?
Kumar: Following surgery, the prognosis for Shahnaz appears favourable, particularly considering the absence of cancer spread beyond the primary site and the successful removal of the tumour and affected lymph nodes.

However, the long-term outcome for patients with tongue cancer can be influenced by various factors, including the stage of the disease, the extent of surgical intervention and the presence of any underlying health conditions.

In her case, the early detection of the cancer played a crucial role in minimising potential side effects and improving the prognosis. Early-stage cancers typically require less extensive surgical intervention, reducing the risk of complications such as speech alteration, swallowing difficulties and shoulder stiffness. Moreover, early detection allows for more conservative treatment approaches, preserving as much healthy tissue and function as possible.

Nevertheless, factors such as the aggressiveness of the cancer, the presence of any residual tumour cells and the patient's overall health and response to treatment can also impact the long-term outcome. Adjuvant therapies such as radiation therapy or chemotherapy may be recommended based on these factors to further reduce the risk of cancer recurrence and improve survival rates.

Are there any lifestyle changes for such patients to reduce the risk of recurrence or further complications?
Kumar: In addition to undergoing surgery and potentially adjuvant therapies, there are several lifestyle changes and precautions that patients of carcinoma need to consider. First and foremost, avoiding tobacco and alcohol consumption is paramount, as both are significant risk factors for the development and progression of oral cancers, including tongue cancer.

Maintaining excellent oral hygiene is also essential in preventing oral health issues and reducing the risk of complications. Regular brushing and flossing can help remove plaque and bacteria from the mouth, reducing the likelihood of oral infections and other dental problems.

Another important consideration is the use of well-fitting dentures. Ill-fitting dentures can cause irritation and trauma to the oral tissues, increasing the risk of complications and potentially hindering the healing process following surgery.

Furthermore, regular follow-up appointments with medical professionals are crucial for monitoring progress, detecting any signs of cancer recurrence or complications early, and adjusting treatment plans as needed.

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