Salivary Gland Cancer

What is Salivary Gland Cancer?

Salivary glands make saliva, the fluid that moistens the mouth and throat. There are major and minor salivary glands.

  • The parotid glands are the largest salivary glands. They are located just in front of the ears. The majority of salivary gland tumors start here. Most of these tumors are not cancerous. However most cancerous (malignant) salivary gland tumors start in the parotid glands.
  • The submandibular glands are smaller and are below the jaw. About 10% to 20% of salivary gland tumors start in these glands, and about half of these tumors are cancerous.
  • The sublingual glands are located under the floor of the mouth and below either side of the tongue. It is rare for tumors to start in these glands.

There are several hundred minor salivary glands. They are located under the lining of the lips and tongue; in the roof of the mouth; and inside the cheeks, nose, sinuses, and larynx (voice box). Tumors in minor salivary glands are uncommon, but when they do occur they are more likely to be cancerous. Minor salivary gland tumors most often start in the roof of the mouth.

Types of Salivary Gland Cancer

This is the most common type of salivary gland cancer. Most start in the parotid glands. They usually grow slowly and often have a good outcome.

This salivary gland cancer is usually slow growing. It can be difficult to remove completely because it tends to spread along nerves. The cancer often returns after treatment, sometimes many years later.

There are many kinds of salivary gland adenocarcinomas. They include:

  • Acinic cell carcinoma: Most of these cancers start in the parotid gland. They tend to grow slowly.
  • Polymorphous low-grade adenocarcinoma (PLGA): These tumors usually start in the minor salivary glands. They often grow slowly and most can be cured.
  • Adenocarcinoma, not otherwise specified (NOS): These cancers are most common in the parotid glands and the minor salivary glands. They can be slow- or fast-growing.

These cancers occur mainly in the major salivary glands.

Melanoma or other types of skin cancer can spread to the salivary glands or to the nearby lymph nodes inside and surrounding the parotid gland and next to the submandibular gland.

Other types of salivary cancers include acinic cell cancer, salivary duct cancer and squamous cell carcinoma. Non-Hodgkin lymphoma can also affect the salivary glands.

Risk Factors

Risk factors for salivary gland cancer include:

  • Radiation exposure
  • Older age
  • Being exposed to certain substances at work

Signs of salivary gland cancer include:

  • Lump near ear, cheek, jaw, lip or inside the mouth
  • Fluid draining from ear
  • Trouble swallowing or opening the mouth widely
  • Numbness or weakness in the face
  • Pain in the face that doesn’t go away

Diagnosis and Staging

Your doctor will do a physical exam and ask you many questions. It is important to describe how you have been feeling and any changes you have noticed, such as pain, difficulty swallowing, mouth or throat sores, or changes in your voice.

Testing

Your doctor may order some of these tests: 

  • Endoscopy - A thin, lighted tube is inserted through the nose to look at the back of your nose and throat. This may be done at the doctor’s office, often after using numbing spray.
  • Biopsy - A sample of tissue is removed to check for cancer.
  • Fine needle aspiration - This is a type of biopsy done with a small needle to see if you have cancer. It is often used to assess lumps in the neck.
  • Fiberoptic endoscopic evaluation of swallowing test (FEES) - A thin, lighted tube is inserted through your nose and down your throat so that the health care provider can watch how you swallow from inside.
  • Biomarker testing/Molecular testing of the tumor - Your doctor may want to test your tumor for P16 or HPV. In certain kinds of head and neck cancer (oropharyngeal squamous cell carcinomas), knowing this test result will help your doctor decide on the treatment that is best for you. The tumor may also be assessed for the Epstein-Barr Virus (EBV). This can cause cancers in the nasopharynx (upper part of the throat behind the nose).
Imaging

Your doctor may also use the following diagnostic tests:

  • Ultrasound
  • CT Scan
  • MRI
  • PET or PET-CT Scan
  • Modified barium swallow studies (a series of x-rays taken after you swallow a barium drink) 
Staging

If you are diagnosed with salivary gland cancer, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.

The following stages are used for salivary gland cancers that affect the parotid, submandibular, and sublingual glands:

Stage 0 (carcinoma in situ)

In stage 0, abnormal cells are found in the lining of the salivary ducts or the small sacs that make up the salivary gland. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. The tumor is in the salivary gland only and is 2 centimeters or smaller.

Stage II

In stage II, the tumor is in the salivary gland only and is larger than 2 centimeters but not larger than 4 centimeters.

Stage III

In stage III, one of the following is true:

  • The tumor is larger than 4 centimeters and/or cancer has spread to soft tissue around the salivary gland; 
  • OR the tumor is any size and cancer may have spread to soft tissue around the salivary gland. Cancer has spread to one lymph node on the same side of the head or neck as the tumor. The lymph node is 3 centimeters or smaller and cancer has not grown outside the lymph node.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC as follows:

  • Stage IVA:
    • Cancer has spread to the skin, jawbone, ear canal, and/or facial nerve. Cancer may have spread to one lymph node on the same side of the head or neck as the tumor. The lymph node is 3 centimeters or smaller and cancer has not grown outside the lymph node; or
    • The tumor is any size and cancer may have spread to soft tissue around the salivary gland or to the skin, jawbone, ear canal, and/or facial nerve. Cancer has spread:
      • to one lymph node on the same side of the head or neck as the tumor; the lymph node is 3 centimeters or smaller and cancer has grown outside the lymph node; or
      • to one lymph node on the same side of the head or neck as the tumor; the lymph node is larger than 3 centimeters but not larger than 6 centimeters and cancer has not grown outside the lymph node; or
      • to more than one lymph node on the same side of the head or neck as the tumor; the lymph nodes are 6 centimeters or smaller and cancer has not grown outside the lymph nodes; or
      • to lymph nodes on both sides of the head or neck or on the side opposite the primary tumor; the lymph nodes are 6 centimeters or smaller and cancer has not grown outside the lymph nodes.
  • Stage IVB:
    • The tumor is any size and cancer may have spread to soft tissue around the salivary gland or to the skin, jawbone, ear canal, and/or facial nerve. Cancer has spread:
      • to one lymph node larger than 6 centimeters and cancer has not grown outside the lymph node; or
      • to one lymph node on the same side of the head or neck as the tumor; the lymph node is larger than 3 centimeters and cancer has grown outside the lymph node; or
      • to more than one lymph node on the same side of the head or neck as the tumor, on the side opposite the primary tumor, or on both sides of the head or neck; cancer has grown outside any of the lymph nodes; or
      • to one lymph node of any size on the side of the head or neck opposite the primary tumor; cancer has grown outside the lymph node;
        • Or cancer has spread to the bottom of the skull and/or surrounds the carotid artery. Cancer may have spread to one or more lymph nodes of any size on either or both sides of the head or neck and may have grown outside the lymph nodes.
  • Stage IVC:
    • Cancer has spread to other parts of the body, such as the lungs

 

Treatment and Side Effects Management

Surgery

Salivary gland cancer is often treated with surgery. Whether the doctor can remove the cancer completely largely depends on how far it has spread. The surgery will remove the cancer and some or all of the surrounding salivary gland. If the cancer is more likely to grow and spread quickly, or if it already spread to nearby lymph nodes, the doctor will perform a neck dissection. This is removal of lymph nodes and other tissues in the neck.

Types of salivary gland cancer surgery include:

A cut is made in the skin in front of the ear and may extend down to the neck. If the cancer starts in the outside part of the gland, it can be treated by removing only this section with a superficial parotidectomy. This surgery usually leaves the facial nerve intact. If the cancer has spread into deeper tissues, the entire gland will be removed. This is called a total parotidectomy. If the cancer has spread into the facial nerve, that will have to be removed, too.

In this procedure, the surgeon removes the entire gland, and may also remove some surrounding tissue or bone. In some cases, the surgeon may need to remove some nerves that pass through or near these glands that control movement of the tongue and lower half of the face. They also are involved in sensation and taste.

The surgeon will remove the cancer and some surrounding tissue. The details of the surgery depend on the location and size of the cancer.

Side Effects

The most common side effects of any neck dissection are numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip. These side effects are caused by injury during the operation to certain nerves that supply these areas.

If the facial nerve is damaged during surgery, the side of the face where the surgery is done may droop. In some cases, the damage may eventually heal. If nerves cut during surgery grow back abnormally and become connected to the sweat glands in the face, you may have flushing or sweating over parts of your face when you chew. This is called Frey syndrome. It can be treated with medicines or more surgery.

Salivary gland cancer surgery may damage other nerves in the face or mouth. This could cause problems with speech, swallowing or tongue movement.

Some types of salivary gland cancer surgery can change your appearance. Talk with your doctor about what can be done to correct changes caused by the surgery. Options may include skin grafts, nerve grafts, and reconstructive surgery.

Frankly Speaking About Cancer Eating Well with Head and Neck Cancer 20180628 2201 1
Play video