Base of tongue carcinoma.

Vigilance must remain high in order to detect the rare occurrence of base of tongue carcinoma. The combination of ubiquitous and nonspecific complaints coupled with difficult physical examination of this area contribute to delays in diagnosis, with patients often presenting at an advanced stage. This advanced presentation creates challenging treatment decisions in which adequate tumor control must be balanced with subsequent patient quality of life. The result is controversy over the primary treatment modality--external beam radiation, with or without brachytherapy, alone or in combination with surgical extirpation. Though the role of neck dissection in patients with neck disease is widely accepted, timing and implementation in patients whose neck disease completely responds to radiation are also contentious issues. Although evolving surgical reconstruction techniques and accelerated radiation protocols are improving treatment regimens, the prognosis for this disease remains poor.