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Q. Is whole body PET scan required to check the spread of tongue cancer?

Answered by
Dr. Satya Narayan
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 25, 2016 and last reviewed on: Oct 09, 2018

Hi doctor,

My father is 65 years old and in excellent health. He is a diabetic and also has BP. But, his sugar levels and BP are very much in control. He is taking oral medication for both diabetes and BP. He is taking Telvas 20 mg for BP, Gluconorm for diabetes and taking thyroid medication for hypothyroidism (25 mg). He has been diagnosed with initial stage squamous cell carcinoma of the tongue. We first noticed symptoms around two months back, because of a blister on my father's tongue which did not heal despite of vitamin B complex medication and antibiotics. The medical oncologist we were referred to examined my father and said that it is in the very initial stage and it is highly unlikely to spread. Even if it has, at the maximum it would be in the lymph nodes near the tongue. We opted for a PET CT scan to be sure and the doctor prescribed only a head and neck scan. The scan results mentioned an SUV level of 5.3, suggesting malignancy on the tongue and an SUV level of 3.1 in level I, II and III lymph nodes, which the radiologist mentioned were non-specific. I would like to add that my father had a minor cold when the scan was done. Based on the scan results our doctor has suggested surgery to remove the cancerous portion of the tongue and the lymph nodes, though it is not clear whether they are affected or not. He also mentioned that after removal again the lymph nodes would be tested for malignancy. He underwent PET CT scan, serum creatinine, CBC and blood tests. My question is should we have to go for a full body scan instead of just the head and neck? With respect to the lymph nodes, is the SUV number suggestive of cancer? Or could it be higher because of the cold my father had? Thank you very much for your response in advance.

#

Hello,

Welcome to icliniq.com.

  • No, he did not need whole body PET scan now.
  • Yes, the standardized uptake value (SUV) number indicates the probability of cancer as it increases, but it is not confirmative.
  • The SUV number can be increased in case of infection, inflammatory condition and cancer. But, we would never make a final conclusion about a diagnosis without a biopsy and examining it under the microscope.

The Probable causes:

Tobacco use in the form of smoking or chewing tobacco and alcohol consumption are the most important risk factors.

Investigations to be done:

1. Complete head and neck examination (mirror examination or fiberoptic examination if required after clinical examination).
2. Dental evaluation.
3. Biopsy of lesion.
4. Routine blood investigation, complete blood count, renal function test, blood sugar, liver function test and electrolyte study (Na+, K+, Cl-) should be performed.
5. Imaging chest x-ray posteroanterior view (PA view), ultrasonogram - USG abdomen and pelvis as routine investigation need to be carried out.

Differential diagnosis:

1. Cancer tongue.
2. Chronic inflammation condition (infection).

Probable diagnosis:

Cancer of the tongue with secondary neck.

Treatment plan:

If the disease involves anterior two-third of the tongue then it can be considered for surgery. Later treatment plan will be decided according to histopathology report.

If the disease involves posterior one-third or base of the tongue then directly plan for concurrent chemoradiotherapy.

Preventive measures:

1. Stop smoking and avoid alcohol intake.
2. Maintaining oral hygiene is very important.
3. Proper diet and nutrition has to be taken.

Regarding follow up:

Revert back after all the investigations to a radiation oncologist online.---> https://www.icliniq.com/ask-a-doctor-online/radiation-oncologist


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