Medical Malpractice
Tongue cancer (squamous cell carcinoma of the tongue) is a type of oral cancer that appears in the front or back of the tongue. Oral cancers include cancer of the tongue, tonsils, mouth, and lips.
There are different subtypes of tongue cancer depending on what specific cells are involved. Most tongue cancer tumors form in the flat squamous cells on the surface area of the tongue. Tongue cancer cases are categorized based on the location of the tumor:
- Oral Tongue Cancer: When a tumor appears in the anterior (front) portion of the tongue or mouth area, it is referred to as oral tongue cancer. This type of tongue cancer is usually detected much earlier, and the tumors tend to be smaller and easier to treat.
- Base of Tongue Cancer: This type of tongue cancer occurs in the very back area of the tongue near the throat. Cancer involving the base of the tongue is generally classified as oropharyngeal cancer. It is often not diagnosed until later stages because tumors in this area can be difficult to see during a routine examination.
What Are the Early Signs of Tongue Cancer?
The most notable symptom of tongue cancer is often the appearance of a sore on the tongue at the location of the tumor. In cases of base of tongue cancer, where the tumor appears in the back of the tongue, the sore may not be visible. Other potential signs of tongue cancer include:
- Prolonged discomfort in the tongue or jaw
- A lump or persistent swelling in the mouth
- White or red patches on the tongue or other places within the mouth
- Persistent sore throat or sensation of having something caught in the throat
- Trouble swallowing or moving jaw
A definitive diagnosis of tongue cancer will usually require a biopsy. A CT scan or an MRI can also be used to identify or evaluate the tumor and determine whether the cancer has spread.
What Are the Biggest Risk Factors for Tongue Cancer?
The primary risk factors for tongue cancer are heavy smoking and alcohol use, which are known to damage DNA and impair DNA repair mechanisms. Additionally, human papillomavirus (HPV) infection has emerged as a significant risk factor, particularly for cancers at the base of the tongue, where it is associated with a better response to treatment and improved survival rates compared to HPV-negative counterparts.
More recent studies have shown a significant increase in tongue cancer incidence among younger individuals aged 20 to 39 years. If confirmed, this change highlights a shifting epidemiological trend towards younger demographics being affected by this disease.
What Can Be Mistaken for Tongue Cancer?
Several less serious conditions can look similar to tongue cancer. For instance, oral leukoplakia and erythroplakia show up as white or red spots on the tongue and might seem worrisome, but they are not always cancerous. Oral lichen planus features white, web-like patterns on the tongue, which can also cause concern.
Fungal infections, like oral thrush, create white, creamy patches that can also be mistaken for cancer signs. Even benign growths such as fibromas and papillomas appear as lumps on the tongue, similar to how some cancers might look. Common mouth ulcers, known as canker sores, and some systemic diseases like syphilis might cause lesions that mimic those caused by tongue cancer. Getting the right diagnosis usually involves a doctor examining the mouth and possibly doing a biopsy to check for cancer.
What Are the Treatment Options for Tongue Cancer?
Treatment of tongue cancer typically involves some combination of surgery, radiation, and chemotherapy. Surgical treatment for tongue cancer depends on the size and location of the tumor. When the cancer is in early stages, a partial glossectomy might be a viable option. More advanced cancers may require removal of a larger portion of the tongue and, in some cases, a total glossectomy. Surgery may be followed by reconstructive surgery and targeted radiation. Chemotherapy with cisplatin is also used in the treatment of some tongue cancers.
What Are the Survival Rates for Oral Cancer?
The overall survival rates for tongue and other types of oral cancer are comparatively good, and they are getting better. Survival depends heavily on where the cancer is located and how far it has spread when it is diagnosed. In general, oral cancers diagnosed and treated in early stages have much better survival rates than cancers that have spread to lymph nodes or distant parts of the body.
Notably, 90% of oral cavity cancers are squamous cell carcinomas (SCCA). Despite advancements in treatment, advanced-stage SCCA of the tongue remains much more difficult to treat successfully.
What Is the Difference Between Oral Cancer and Tongue Cancer?
There is a distinction between tongue cancer and oral cancer, though they are closely related within the broader category of cancers affecting the mouth and throat.
Oral cancer encompasses cancers of the entire oral cavity, which includes the lips, inner lining of the cheeks, gums, front two-thirds of the tongue, the floor and roof of the mouth, and the area around the wisdom teeth.
Tongue cancer specifically refers to cancer that originates in the cells of the tongue and is further subdivided into two types based on location. The first type, oral tongue cancer, affects the front two-thirds of the tongue and falls under the broader classification of oral cancers. The second type, oropharyngeal or base of the tongue cancer, affects the back third of the tongue, extending into the throat, and is categorized as a form of oropharyngeal cancer.
How Misdiagnosis of Tongue Cancer Often Becomes a Medical Malpractice Lawsuit
Tongue cancer, like many other types of cancer, can be misdiagnosed. Misdiagnosis can have severe consequences as it can delay appropriate treatment and affect prognosis. Here are six common focuses of tongue cancer medical malpractice lawsuits, and reasons tongue cancer is too often misdiagnosed:
- Similar Symptoms: The initial symptoms of tongue cancer, such as a persistent sore throat, difficulty swallowing, a white or red patch on the tongue, or a sore that doesn’t heal, can mimic other, less severe conditions. This includes oral thrush (a yeast infection), ulcers, or other benign oral lesions. Our malpractice lawyers have also seen cases where early symptoms of tongue cancer are mistaken for oral herpes and dental abscess.
- Lack of Awareness: In its early stages, tongue cancer might not cause any pain, which can further complicate the detection process and lead to oral cancer misdiagnosis. If healthcare providers are not thorough in performing oral examinations, early signs of tongue cancer can easily be overlooked. Vigilance in both dental and medical examinations is crucial to catch such abnormalities early.
- Limited Visibility: The location of tongue cancer can also hinder diagnosis. Cancers located at the base of the tongue or in the oropharyngeal region are not easily visible during routine oral exams. This area requires specific attention and techniques for proper inspection. If not performed meticulously, it may result in missed tumors.
- Biopsy or Imaging Errors: Once a potential tumor is located, a biopsy will usually be done to conclusively diagnose it as cancer. The problem is that doctors often dismiss the initial symptoms of tongue cancer and don’t perform more advanced diagnostic testing until later on. This can be a big problem with tongue cancer because early detection and treatment is absolutely critical. Imaging studies, like MRI or CT scans, are also used to diagnose or evaluate tongue lesions. There are also tongue cancer medical malpractice lawsuits from biopsy errors. While this is not common, the lab can make a mistake in getting and handling the biopsy sample. Most typically, the sampled area misses the cancerous tissue, or the doctor does not correctly interpret the results. Medical malpractice in interpretation will lead to tongue cancer misdiagnosis by the pathologist.
- Communication Failures: Miscommunication between different healthcare providers (e.g., between general practitioners, dentists, and specialists) can lead to critical information being overlooked or misinterpreted. Similarly, inadequate patient-doctor communication can result in missed symptoms or failure to conduct thorough examinations based on the patient’s reported experiences that lead to failure to diagnose oral cancer.
- Age and Risk Factors: Tongue cancer is more common in older individuals and those with significant risk factors like tobacco and alcohol use. Doctors let down their guard with younger people who have no apparent risk factors.
Dentist Defendants
Dentists are often in the position to act on the symptoms of oral cancer. It requires adequate clinical examinations and the ability to recognize the signs and symptoms of oral cancer. If there is a concern, there is sometimes wisdom in keeping a watch on signs or symptoms of suspected oral cancer. But when a lesion persists, worsens, or looks suspicious, a dentist may need to refer the patient for further evaluation or biopsy.
A dental patient may complain to their dentist about chronic lesions that will not heal, soft tissue pain (including in the tongue), and persistent swelling or bumps. In this case, cancer should be part of the differential diagnosis until it is reasonably ruled out. Smart dentists refer out the patient for a biopsy when the clinical picture warrants it.
Is it a lot to put on a dentist to diagnose tongue cancer? Yes. Accurately diagnosing mouth cancer in primary dental and medical settings can be challenging. But that is not what a dentist must do. Instead, they need to maintain a high level of suspicion when the symptoms warrant it and refer out potential problems to an appropriate specialist.
- Example of a tongue cancer misdiagnosis lawsuit
- Cancer misdiagnosis claims
- Sample settlements and verdicts involving oncologists
What Makes a Tongue Cancer Misdiagnosis Case?
The central issue in most tongue cancer misdiagnosis lawsuits is not simply that the cancer was missed. The question is what would have happened if the cancer had been diagnosed when it reasonably should have been.
Our lawyers look closely at when the lesion or symptoms first should have triggered additional testing, when a biopsy should have been performed, what stage the cancer was at that time, and what changed during the delay.
A delay can be particularly significant if the cancer spreads to lymph nodes, if a patient who could have undergone a partial glossectomy later requires removal of a much larger portion of the tongue, or if the delay results in chemotherapy, radiation, reconstructive surgery, or a worse prognosis.
The defense in these cases will often argue that the delay did not change the outcome. The doctor’s lawyer may concede that the cancer should have been diagnosed earlier but argue that the patient would have needed the same treatment anyway. That causation issue is often the central fight in a tongue cancer malpractice case.
Verdicts and Settlements for Tongue Cancer Misdiagnosis Cases
Below is a summary of several reported settlements and verdicts in medical malpractice cases based on misdiagnosis of tongue cancer. These cases are summarized for informational purposes only. Our lawyers primarily practice in Maryland but tongue cancer medical malpractice lawsuits are not common. So we do not have verdicts and settlements from Maryland to share.
You cannot use these cases alone to determine the value of your potential claim. But that, along with an understanding of Maryland’s cap on damages in malpractice cases, helps you better understand the potential value of your claim.
- Pennsylvania – 2025 — $11 million verdict: A Luzerne County jury awarded $11 million, including $8 million in punitive damages, to a 68-year-old woman who alleged that her dentist failed to timely biopsy a worsening tongue lesion over several months. The delayed diagnosis of squamous cell carcinoma led to removal of part of her tongue, lymph-node surgery, chemotherapy, radiation, and permanent speech and eating difficulties. The verdict was later upheld on appeal.
- Connecticut – 2023 — $2,000,000 Settlement: A 69-year-old man died from metastatic tongue cancer following an alleged delayed diagnosis by Department of Veterans Affairs doctors. Initially, a neck X-ray and CAT scan indicated a mass at the base of his tongue, which was misinterpreted as a swollen spit gland. Despite the abnormality noted, the primary care physician prescribed antibiotics and did not refer him for further specialist evaluation. It took 18 months before a correct diagnosis of tongue cancer was made by an external specialist. He was then treated aggressively with radiation and chemotherapy at Yale New Haven Hospital but died less than two years after the correct diagnosis. The legal claim argued that earlier detection and treatment could have significantly increased his chances of survival. The parties reached a $2 million settlement just days before the scheduled trial, after negotiations that began with the plaintiff’s initial demand of $6 million and a government offer of $900,000.
- South Carolina – 2021 — $2 million verdict: A 61-year-old man was referred by his local dentist to an oral surgeon to evaluate a lesion on his tongue, suspecting potential cancer. The oral surgeon attributed the lesion to a sharp wisdom tooth but did not schedule a follow-up or express any urgency. Seven months later, due to pain, he revisited the dentist and was again referred to the oral surgeon. This time, the oral surgeon extracted the tooth and conducted a biopsy, diagnosing stage 3 squamous cell carcinoma. As a result, the patient underwent several surgeries, including the removal of lymph nodes and a significant portion of his tongue. He also underwent reconstructive surgery, six weeks of radiation, and chemotherapy. The patient, an airline pilot, had to forego the last three years of his flying career. He faced challenges relearning how to eat and speak and was concerned about a reduced life expectancy. His malpractice claim argued that if the lesion had been addressed as potentially cancerous from the start and followed up on promptly, the invasive cancer and subsequent treatments could have been avoided. During the trial, the oral surgeon’s defense was that it was his routine practice to inform all patients about potential cancer risks. However, this claim was inconsistent with office records and communications with the referring dentist. An expert witness for the oral surgeon initially supported the surgeon’s actions but conceded, after reviewing medical charts, that the surgeon probably didn’t mention cancer because he didn’t suspect it. After a week-long trial, the jury awarded the patient $2 million, which was reduced to $1.2 million due to a 40% comparative fault finding. Why did the jury also blame the patient? The jury thought the man waited too long to address the problem.
- New York – 2017 — $2.4 million settlement: A woman died from oral cancer. Her family alleged that the physicians’ failure to timely diagnose tongue cancer caused it to metastasize, resulting in a glossectomy and a laryngectomy. This case settled for $2.4 million.
- Michigan – 2016 — $1.5 million verdict: A 67-year-old woman sought a dentist for her tongue lesion. The dentist interpreted the lesion as benign. Thirteen months later, the woman was diagnosed with oral cancer. She died about a year later. Her family alleged that the dentist’s failure to biopsy delayed her cancer diagnosis, resulting in her death. The jury awarded $1.5 million.
- Florida – 2007 – $6.4 million verdict: A 51-year-old social worker was referred to defendant doctors regarding discomfort in his neck and throat. Defendants failed to diagnose tongue cancer and allegedly never came up with any conclusive diagnosis of plaintiff’s condition. Plaintiff later sought a second opinion from another doctor and was immediately diagnosed with tongue cancer. By that point, however, the cancer had advanced, and plaintiff had to have his entire tongue removed. The surgery left him unable to speak or eat without assistance of a feeding tube. A jury in Broward County awarded $6.4 million in damages.
- Pennsylvania – 2003 — $4.1 million verdict: In this Philadelphia case, the defendant ENT doctor was allegedly negligent in misdiagnosing the plaintiff’s tongue cancer. The misdiagnosis resulted in a significant delay in treatment. By the time tongue cancer was diagnosed, it had spread significantly, and the plaintiff died soon after. The jury in Philadelphia awarded damages of $4.1 million.
- Tennessee – 2004 — $1.8 million verdict: Plaintiff was a 61-year-old pharmacist, and he went to the doctor complaining of persistent neck tenderness. An initial ultrasound showed a suspicious mass, so a CT scan was performed. The radiologist interpreted the CT scan as normal and diagnosed the mass as an enlarged jugular vein. A year later the plaintiff’s neck pain was worse and was starting to impact his voice. He was referred to an otolaryngologist (ENT) who diagnosed the plaintiff with cancer at the base of the tongue. By then, the cancer was in advanced stages and had already spread to the plaintiff’s chest, and he died 16 months later. Subsequent wrongful death action was brought against radiologist and family doctor for failing to diagnose the cancer a year earlier, which would have increased plaintiff’s survival chances. Jury in Nashville awarded $1.8 million.
- Florida – 2001 – $2.7 million verdict: Plaintiff in this case was a 74-year-old truck driver. He went to his doctor about a lesion on his tongue, and he was referred to the defendant’s doctor for a biopsy. The defendant did not biopsy the lesion initially to determine whether it was cancerous. It was not until 7 months later that the defendant doctor actually took a biopsy and diagnosed plaintiff with squamous cell cancer of the tongue. During the 7-month delay, the cancer grew from a T1 tumor to a T2 tumor. Following radiation treatment the cancer recurred and eventually grew to T3 at which point 75% of plaintiff’s tongue had to be surgically removed. The malpractice action alleged negligence in the delayed diagnosis of plaintiff’s tongue cancer resulting in a reduced prognosis and treatment options. Plaintiff rejected a settlement offer of $250,000 and went to trial where a jury in Dade County awarded $2.7 million.
Additional Thoughts on Tongue Cancer Malpractice Lawsuits
- Tongue cancer can spread two ways. There are little lymph channels that pick up excess fluid that then drain into lymph nodes. These are the same lymph nodes that can become enlarged in your neck when you get an infection, and then eventually these empty back into the bloodstream.
- Cancer can spread through the lymphatic system into nearby lymph nodes. Another method that the cancer can spread is via the arteries that bring blood to the tongue. These cancer cells can then get into the body, break loose, and enter the general circulation, sending them to other parts of the body.
- Sometimes, tongue cancer is insidious, particularly cancer at the base of the tongue. In these cases, patients may not have symptoms until the disease has reached an advanced stage because these tumors can remain hidden for quite some time before they are diagnosed.
- A lesion on the lateral border of the tongue is a common presentation of tongue cancer, so doctors and dentists should be particularly alert when a persistent lesion appears in that area.
- Squamous cell carcinoma is the most common form of oral cancer. It accounts for more than 90% of all oral cancers. Squamous cell carcinoma develops from the squamous epithelium that lines the soft tissues of the oral cavity. The most common oral location for this cancer is the tongue. Chronic exposure to tobacco smoke is a major risk factor for oral squamous cell carcinoma.
- A common defense in any cancer misdiagnosis case is causation. The doctor’s lawyer argues that even if the cancer had been caught in time, it would not have made a difference. This will often be one of the central arguments in a tongue cancer malpractice lawsuit.
Contact Miller & Zois About Tongue Cancer Misdiagnosis
If you or someone you are familiar with has tongue or oral cancer that was misdiagnosed or diagnosed after a long delay, contact the malpractice attorneys at Miller & Zois for a free case evaluation. Call us at 1.800.553.8082 or submit a request for a free consultation.