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Signs of the disease often include: Constitutional symptoms: fatigue, lethargy, loss of appetite, and weight loss Neurological changes: headaches, confusion, difficulty focusing, memory loss, cognitive decline, numbness, and balance issues Psychiatric effects: emotional instability, depression, personality changes, psychosis Otolaryngologic symptoms: loss or change in the sense of taste, inflammation of the tongue Cardiopulmonary indications: palpitations, difficulty breathing Gastrointestinal problems: indigestion, diarrhea, reduced appetite Patients with advanced pernicious anemia may also have noticeable physical characteristics such as pale or yellowing skin, dry skin, tender tongue, and rapid heart rate

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Surgeons should attempt to achieve complete, en bloc , surgical tumour resection with at least 3 cm (preferably 5 cm) margins (Phelps et al., 2011) and the removal of one fascial plane underlying the tumour, because incomplete resection can result in recurrence as early as two weeks after surgery (Lester et al., 1996

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