Principal Director, Medical Oncology & Hemato-Oncology, Fortis Hospital, Bannerghatta Road, Bengaluru, India
Part 10 of 12 in Diagnosing Common Cancers & Blood Disorders
Oral Cancer: Recognizing a Non-Healing Ulcer Early
August 28, 2026
A 55-year-old farmer and chronic tobacco chewer presented with a non-healing ulcer on the right lateral border of his tongue that had been present for two months. Dr. Raizada noted that chronic tobacco use is not the only contributor to this kind of lesion; ongoing mechanical irritation, from a sharp tooth, for example, can also play a role. This patient also used alcohol.
Why the delay in presentation happens, and what changed it
Initially, the ulcer was only mildly painful, which Dr. Raizada suggested may have delayed the patient seeking care. He eventually presented when he developed difficulty swallowing as the tongue pain worsened. On inspection, there was a 3 by 2 centimetre ulcerated mass on the right lateral border of the tongue, with irregular, everted edges and an indurated base. Examination of the neck revealed palpable cervical lymph nodes, and the clinical impression was carcinoma of the tongue with cervical lymphadenopathy.
Confirming the diagnosis and staging it
An incisional biopsy showed moderately differentiated squamous cell carcinoma. Imaging measured the lesion at 3.2 by 2.1 centimetres, with a depth of invasion of 6 millimetres, a measurement that matters for staging oral cancers independent of surface size. Fine-needle aspiration cytology of the cervical lymph node was also positive for squamous cell carcinoma, staging the disease as T2N1.
The patient was offered definitive surgical management. Dr. Raizada was direct about the prognosis when surgery achieves clear margins: the patient can be considered cured.
The self-examination routine that catches this earlier
Dr. Raizada recommended a monthly oral self-examination for everyone, done in front of a mirror under good lighting. The routine covers the tongue, both cheeks, the soft and hard palate, the lips including their inner surface, and palpation of the neck for any lump. Any unusual finding, a red patch, a white patch, or a thickened area of mucosa known as submucous fibrosis, warrants prompt medical evaluation rather than watchful waiting.
Tongue cancer, she noted, remains a common malignancy across the regions represented on the call, closely tied to tobacco and alcohol use. A two-month history of an ulcer that has not healed, as in this case, is well past the point where self-examination should have prompted a visit to a clinician.
This guide is based on a live Jivo Masterclass — Dr. Niti Raizada taught doctors across Africa on February 1, 2026.
FROM THE LIVE Q&A
Host (Varun, Jivo Healthcare)
Can a general practitioner also perform a clinical breast examination, or does it need to be a specialist?
Dr. Niti Raizada
Self-examination should be done by the woman herself, using the opposite hand on the opposite breast with three fingers held flat, including the axilla and neck. Clinical breast examination should be done by anyone properly trained, which can include nurse practitioners, physician assistants, internal medicine doctors, general surgeons, gynaecologists and oncologists. Training, not job title, is what matters, since missing lesions is common when the examiner has not been trained. GPs and internal medicine doctors should learn the technique and offer it to every woman who comes to the clinic.
Frequently Asked Questions
What further investigations are needed to assess disease extension before starting management of this cervical cancer case?▼
Once the diagnosis is confirmed by biopsy, a staging scan, often a PET scan, establishes the exact stage, including whether the bladder, rectum, parametrium or lymph nodes are involved. Fitness for treatment is then assessed with kidney function testing (GFR) and audiometry, since some chemotherapy agents can affect hearing. Weekly chemotherapy is then given alongside radiation, with the potential radiation side effects explained to the patient beforehand.
Between MRI and CT scan, which is the better imaging modality for staging this cervical cancer case?▼
MRI of the pelvis is excellent for local pelvic structures, but the upper abdomen and chest still need to be assessed, which is better done on CT. The recommendation is CT of the thorax combined with CT of the abdomen and pelvis with contrast, or alternatively MRI of the abdomen and pelvis with contrast combined with a CT of the chest. The chest is generally better seen on CT, and the pelvis is generally better seen on MRI.
I am seeing a Stage III breast cancer patient currently on filgrastim 300 micrograms for 3 days. What further treatment plan would you initiate for this patient?▼
Treatment depends on the patient's oestrogen receptor, progesterone receptor and HER2 status, and on whether she is receiving neoadjuvant chemotherapy followed by surgery, or surgery followed by adjuvant chemotherapy. Filgrastim is supportive care only, a white blood cell growth factor given to prevent a drop in counts after chemotherapy; it is not the primary cancer treatment. Its use depends on which chemotherapy protocol is being followed, but the treatment plan for the cancer itself is a separate, biology-driven decision.
Can the HPV vaccine still be given to a patient who has already tested positive for HPV?▼
Yes. If a nine-valent vaccine is given and the patient is positive for one strain of HPV, the vaccine still confers protection against the remaining eight strains it covers.
Are there any specific concerns in monitoring chronic liver disease, for example the frequency of ultrasound and the skill set of the radiographer?▼
Ultrasound should be done once every 6 months for a chronic liver disease patient, along with alpha-fetoprotein testing every 6 months. The skill of the radiographer matters because ultrasound is a subjective, operator-dependent test. If there is any doubt on ultrasound, a triple-phase CT scan or a multiphasic MRI should be done immediately.
What are the warning signs of a tongue ulcer that should prompt urgent evaluation?▼
An ulcer that has not healed after a couple of months, especially with irregular, everted edges and an indurated base, along with new difficulty swallowing or palpable lymph nodes in the neck, should prompt urgent evaluation rather than continued observation.
What does depth of invasion mean in staging oral cancer, and why does it matter?▼
Depth of invasion measures how far the tumour has grown into the tissue below the surface, independent of the ulcer's surface size. It is a factor in staging because it affects the risk of lymph node spread even when the visible lesion appears small.
What does a monthly oral self-examination involve?▼
The routine is done in front of a mirror under good lighting and covers the tongue, both cheeks, the soft and hard palate, the lips including their inner surface, and palpation of the neck for any lump. Any red patch, white patch, or thickened area of mucosa warrants prompt evaluation.
What is the prognosis for tongue cancer when surgery achieves clear margins?▼
When surgical margins are clear, the patient can be considered cured, which underscores why an early, accurate diagnosis and definitive surgical management matter as much as recognising the lesion in the first place.
In This Series: Diagnosing Common Cancers & Blood Disorders
- 1.Diagnosing Common Cancers and Blood Disorders
- 2.Breast Cancer in Young Women: Reading the Red Flags Beyond Age
- 3.Breast Cancer Screening: What to Do at 18, 30 and 40
- 4.When a Persistent Cough Isn't Tuberculosis: Diagnosing Lung Cancer
- 5.Colon Cancer, Lynch Syndrome and the Case for Cascade Testing
- 6.Ovarian Cancer: The Silent Killer and Its Diagnostic Trail
- 7.Cervical Cancer: From Diagnosis to Concurrent Chemoradiation
- 8.HPV Vaccination: Who Needs It and What It Prevents
- 9.Hepatocellular Carcinoma: Diagnosing Liver Cancer in Chronic Liver Disease
- 10.Oral Cancer: Recognizing a Non-Healing Ulcer Early
- 11.Acute Promyelocytic Leukaemia: A Bleeding Emergency Hiding in Plain Sight
- 12.The Basic Blood Panel: A GP's First Line of Defence Against Missed Cancers