Earlier in November, actress and former Nominated Member of Parliament Janice Koh shared on social media that she had been battling tongue cancer since late July.
The 48-year-old, who is married and has two sons, wrote: “What started out as a small ulcer (which I promptly ignored as I continued to work and travel) turned out to be malignant.”
Over the past three months, she said she underwent two operations followed by chemo-radiation treatments to not only remove any visible cancer, but also reduce the chances of it coming back.
She added that her speech and eating have been impacted significantly, but she has been assured that they will improve with therapy and time.
Dr Wong Seng Weng, medical director and consultant medical oncologist at The Cancer Centre, says tongue cancer is not common in Singapore and is not among the top 10 cancers in men and women.
“The number of new tongue cancer cases in Singapore hovers at about 80 yearly. I look after more foreigners with tongue cancer seeking treatment here than local patients,” he adds.
Dr Lim Chwee Ming, a senior consultant at Singapore General Hospital’s (SGH) department of otorhinolaryngology – head and neck surgery, says the department records 30 to 40 new cases of tongue cancer each year.
According to the Singapore Cancer Registry 50th Anniversary Monograph, there were 411 new cases of tongue cancer between 2013 and 2017.
Experts tell The Straits Times that they are seeing more women diagnosed with tongue cancer.
National Cancer Centre Singapore (NCCS), for instance, has recorded a three- to fourfold increase in tongue cancer cases among women aged 35 to 55 in recent years.
Clinical Assistant Professor Natascha Ekawati Putri, consultant at SGH and NCCS’ department of head and neck surgery, says: “Previously, most patients were men, with the ratio being three men to one woman, but the incidence is now almost equal between the genders.”
The reasons for this trend have not been identified, but might be due to general increased health literacy and awareness about the disease, she adds.
The main causes of tongue cancer include smoking, excessive alcohol consumption, betel nut chewing and the human papillomavirus.
Having a family history of head and neck cancers, and the excessive consumption of preserved or processed food are also contributing factors. Other less common risk factors include the long-term use of mouthwash that contains alcohol, chronic gum infection and wearing poor-fitting dentures.
Dr Wong says: “Tongue cancer is not so common in Singapore because the usual risk factors for this cancer are not very prevalent in our population relative to the rest of the world, namely, smoking, heavy alcohol consumption and betel nut or tobacco chewing.”
Symptoms of tongue cancer include ulcers in the mouth that do not heal, white or red patches in the mouth that cannot be scraped off, lumps on the tongue, swelling in the mouth and pain when chewing or swallowing food.
Ulcers that commonly come about when you accidentally bite your lip or tongue when chewing or talking should resolve within one to two weeks, says Prof Natascha.
It may be worrying if the ulcer lasts more than two weeks, has irregular edges or hard nodules, or is growing quickly, she adds.
Another way to differentiate between a common ulcer and one you should be worried about is the presence of pain.
“Most non-cancerous ulcers are painful due to inflammation. Cancerous ulcers, on the other hand, may not be painful at the beginning, making them more suspicious,” says Dr Wong.
But not all tongue cancers start with an ulcer.
Madam Sia Seow Hong first noticed a small lump on the right side of her neck in 2018, but dismissed it thinking it was due to an infection and would eventually go away. But as the years went by, the lump grew in size and became painful. She could not turn her neck and had to sleep upright at night. By then, she also had a recurring fever.
In April 2020, she finally decided to see a doctor. Apart from her neck, the doctor also found another lump at the back of her tongue. After a biopsy in May that year, she found out she had advanced stage tongue cancer.
“I was not shocked or upset at that point. I prayed, hoping that it would not be cancer, but I was also prepared for the worst news possible,” says the 52-year-old social worker, who is married and has two sons aged 17 and 23.
Treatment typically involves surgery to remove the cancer, radiation therapy and chemotherapy and/or targeted drug therapy if the cancer is found to be at an advanced stage.
If detected early, only a small portion of the tongue needs to be removed. But if the cancer is more advanced, and a larger portion of the tongue needs to be removed, it may affect the patient’s speech and ability to swallow. In such cases, the doctor may recommend reconstruction of the tongue, along with radiotherapy and chemotherapy, says Prof Natascha.
In Madam Sia’s case, she was hospitalised for six weeks and underwent 35 sessions of radiotherapy, which left her unable to eat and speak for almost four months.
Treatment was “traumatising”, she says.
“By the second week, I could not eat because there were so many ulcers in my mouth, throat and on my lips. I was fed water and food intravenously in the hospital,” she adds.
Having a good night’s sleep was also tough because she would wake up to a mouth full of blood due to the ulcers.
“I hated that feeling. I slept only two to three hours a night and was like a zombie during the day. I had no mood to do anything,” she says.
By the sixth week, she was unable to speak and had to communicate with her family by writing on a whiteboard.
Grappling with the side effects of treatment made Madam Sia frustrated and depressed. “At home, I threw things to get attention from my family. I would also cry during mealtimes,” she says.
She turned to art therapy at the Singapore Cancer Society, where she worked through her emotions and feelings on paper.
Madam Sia is now cancer-free. But as a side effect of her treatment, her mouth now hurts if she eats spicy food – which she used to enjoy – or hard foods such as nuts.
Though she can speak normally now, she has to drink water every five to 10 minutes to keep her mouth moist as her salivary glands were damaged during her treatment.
Early-stage tongue cancer, says Dr Wong, has a reasonably high five-year survival rate of 70 to 80 per cent, but falls to 50 per cent for the intermediate to advanced stages.
Madam Sia urges people to see a doctor if they discover a lump, no matter how small it is, on their body.
“It is better to get it checked out as soon as possible. Don’t wait like I did. Now I can’t undo the damage,” she says.