Aim:This study aimed to assess trends in the incidence, clinical stage, and risk factors associated with tongue cancer in young patients (aged <50 years) over a ten-year period at a tertiary head and neck referral centre. Methodology:A retrospective cohort study was conducted using data from the Head and Neck Departmental database, to identify tongue squamous cell carcinoma (SCC) diagnoses in patients under 50 years of age. Patients were divided into two periods: 2015–2019 and 2020–2025. Patient demographics and risk factors, clinical stage, subsite, and recurrence rates were analysed. Results: A total of 300 tongue SCC cases were identified, of which 39 occurred in patients <50 years. Tongue cancer incidence increased significantly year-on-year over the study period (Z = 2.47, p = 0.014), while the proportion of patients <50 years remained stable (OR 0.93, 95% CI 0.84–1.04). Median age was similar between cohorts (39.5 vs 37.4 years) and there were no significant differences in gender distribution, alcohol use or smoking status (all p > 0.05). Although the proportion of advanced-stage tumours (Stage III–IV) increased from 45.5% to 67.9%, this difference did not reach statistical significance (p = 0.20). Tumour subsite analysis showed a significant rise in posterior tongue cancers from 9% to 39% between periods (RR 0.23, 95% CI 0.04–1.18; p = 0.03). Trends toward higher nodal positivity (4/11 vs 20/28, p = 0.06) were observed, while locoregional recurrence rates remained similar (p = 0.60). Conclusion: This ten-year review demonstrates a significant rise in tongue cancer incidence at our institution in recent years, accompanied by a concerning shift toward more advanced stage at diagnosis. Despite this increase, the proportion of affected patients under 50 years has remained stable. These findings underscore the need for improved early detection strategies and further research into the underlying drivers of rising tongue cancer incidence.