salivary gland cancer
Surgical removal of the tumor is almost always the first treatment of salivary gland cancer.

Cancer of the salivary glands is uncommon and can be treated surgically. Doctors may remove the entire salivary gland or its portion to treat the tumor.

Doctors may recommend a suitable treatment for people to manage their salivary gland cancer after determining a diagnosis and completing a thorough pretreatment evaluation.

In general, there are three treatment options for salivary gland cancer, which can be used alone or in combination.

Surgery

  • Surgical removal of the tumor is almost always the first treatment of salivary gland cancer unless a doctor determines that surgery is not possible or safe.
  • People and their care teams should talk about the types of surgeries that may be needed to treat their cancer.
  • If necessary, a surgeon may perform a neck dissection during or shortly after the surgery, which involves removing some of the lymph nodes from the neck and examining them for cancer.
  • The pathologic diagnosis and grade of the tumor, as well as whether the surgeon believes cancer has the potential to spread to the lymph nodes in the neck, will be used to make this decision.

The 4 types of salivary gland cancer surgery include:

  1. Parotid gland surgery:
    • If cancer begins on the outside of the gland, the surgeon uses a superficial parotidectomy to remove only this section. The facial nerve is usually not damaged during this procedure.
    • If cancer has spread to deeper tissues, the surgeon will entirely remove the gland. This is known as a total parotidectomy.
    • If cancer has spread to the facial nerve, the surgeon will remove it.
  2. Submandibular or sublingual gland surgery:
    • The surgeon removes the entire gland, as well as some surrounding tissue or bone, during this procedure.
    • In some cases, the surgeon may need to remove nerves that run through or near these glands, which control the movement of the tongue and lower half of the face. These nerves play a role in sensation and taste.
  3. Minor salivary gland surgery:
    • The surgeon will remove the tumor and some surrounding tissue. The specifics of the surgery are determined by the location and size of the tumor.
  4. Reconstructive surgery:
    • Following tumor removal surgery, your doctor may recommend reconstructive surgery to repair the area.
    • If you have bone, skin, or nerves removed during your surgery, they may need to be repaired or replaced with reconstructive surgery.
    • The surgeon works to repair your ability to chew, swallow, speak, breathe and move your face during reconstructive surgery.
    • Transfers of skin, tissue, bone, or nerves from other parts of your body may be required to rebuild areas in your mouth, face, throat, or jaws.

Side effects of surgical removal of salivary gland cancer include:

  • Numbness in the ear
  • Weakness when raising the arm above the head
  • Weakness of the lower lip
  • Facial droop
  • Frey syndrome (a flushing or sweating over parts of your face while chewing certain foods)
  • Difficulties with speech, swallowing, or tongue movement
  • Cosmetic concerns

Radiation

Adjuvant radiation: Radiation given after surgery to reduce the chances of the tumor returning is the most common use of radiation for the treatment of salivary gland cancer.

In a few cases, the doctor may recommend post-surgical radiation if:

  • The tumor was not completely removed.
  • The type of cancer was determined to be aggressive or of a high grade or stage.
  • Cancer had spread to lymph nodes or other structures.

In some cases, complete surgical removal of salivary gland cancer may be impossible or dangerous, and radiation therapy may be recommended as the primary treatment.

  • Different types of radiation therapy have been used to treat salivary gland cancer, and they appear to have a high success rate.
  • An external beam of radiation is directed at the tumor to destroy the rapidly dividing cancer cells in this type of treatment.
  • To treat large, slow-growing tumors, radiation therapy uses high-energy neutron beams. This type of treatment may be considered for certain types of unresectable salivary gland cancer.

Chemotherapy

  • Chemotherapy is usually ineffective to treat salivary gland cancer, but it may be used in rare cases if cancer has spread to other parts of the body other than the head and neck.
  • In some cases, chemotherapy may be used in conjunction with radiation therapy.

Salivary gland cancer can be cured surgically, but there is a risk of recurrence. Doctors usually advise people to have regular screenings for at least five years.

5 stages of salivary gland cancer

Salivary gland cancer of the parotid, submandibular and sublingual glands is classified into the following stages:

  1. Stage 0 (carcinoma in situ):
    • Abnormal cells are discovered in the lining of the salivary ducts or small sacs that comprise the salivary gland.
    • These abnormal cells have the potential to develop into cancer and spread to nearby normal tissue.
  2. Stage I:
    • Cancer is confirmed in stage I.
    • The tumor is only in the salivary gland and is ≤ 2 cm in size.
  3. Stage II:
    • The tumor in stage II is only in the salivary gland but is larger than 2 cm and not larger than 4 cm.
  4. Stage III: In stage III, one of the following is true:
    • The tumor is larger than 4 cm, and/or cancer has spread to soft tissue around the salivary gland.
    • 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 cm or smaller, and cancer has not grown outside the lymph node.
  5. Stage IV: Stage IV is divided into stages IVA, IVB, and IVC as follows
    • Stage IVA:
      • The tumor can be any size and has the potential to spread to the soft tissue surrounding the affected gland.
      • Cancer has spread to a single lymph node on the same side as the tumor, and the lymph node is larger than 3 cm but not larger than 6 cm.
      • Cancer has spread to more than one lymph node on either or both sides of the body, and the lymph nodes are not larger than 6 cm.
      • Cancer has spread to the skin, jawbone, ear canal, and/or facial nerve, and it may have spread to one or more lymph nodes on one or both sides of the body. The lymph nodes are no more than 6 cm in size.
    • Stage IVB:
      • The tumor can be any size and has the potential to spread to the soft tissue surrounding the affected gland.
      • Cancer has spread to a lymph node, measuring more than 6 cm in diameter.
      • Cancer has spread to the base of the skull and/or carotid artery, and it may have spread to one or more lymph nodes of any size on either or both sides of the body.
    • Stage IVC:
      • The tumor could be any size and could have spread to the soft tissue surrounding the affected gland, skin, jawbone, ear canal, facial nerve, the base of the skull or carotid artery, or one or more lymph nodes on either or both sides of the body.
      • Cancer has spread to other parts of the body.

A scan and/or biopsy is usually used to diagnose the growth.

The best treatment plan will then be determined by a doctor. The most common treatment option for both benign and malignant salivary gland tumors is surgical removal, which may be combined with other forms of therapy.

  • Stages I and II (early stage):
    • For tumors with high-grade (aggressive) pathology, surgery to remove the tumor is combined with lymph node removal.
    • Depending on the surgical pathology, radiation with or without chemotherapy may be administered following surgery.
    • Cancer that can be completely removed with clear margins, no lymph node or nerve spread, and a low pathology grade is frequently treated solely with surgery.
    • For people who are unable to undergo surgery, radiation therapy with or without chemotherapy may be considered.
  • Stages III, IVA, and IVB (advanced stage):
    • Tumor removal surgery is combined with neck dissection to remove lymph nodes. Following surgery, radiation therapy may be combined with chemotherapy.
    • For people who are unable to undergo surgery, radiation therapy with or without chemotherapy may be considered.
  • Stage IVC (metastatic spread):
    • Surgery may be considered in some cases to alleviate symptoms.
    • Radiation therapy and chemotherapy may be considered in some cases to help with symptoms.

What is the outcome of people with salivary gland cancer?

Salivary gland cancer has a good prognosis if detected and treated early. Salivary gland tumors are rare and, for the most part, benign (noncancerous).

According to the American Cancer Society, salivary gland tumors occur at a rate of approximately 1 case per 100,000 people in the United States each year. The vast majority of salivary gland tumors are harmless (not cancer). These are rarely fatal and are unlikely to spread. Benign tumors can remain unchanged for years.

The majority of people will survive cancer if it is detected at an early stage. Get plenty of rest and eat a healthy diet while you're recovering. Clinical trials are underway for new treatment options.

Survival rates for salivary gland cancer are affected by various factors, the most important of which are tumor stage and tumor type.

Five-year survival rates are as follows depending on the extent of spread of cancer:

  • Local (within the saliva gland): 94 percent
  • Local + Regional (spread to the neck lymph nodes): 66 percent
  • Distant (spread to other parts of the body): 36 percent
  • All stages: 72 percent

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Medically Reviewed on 1/21/2022
References
Image Source: iStock Images

Surgery for Salivary Gland Cancer: https://www.cancer.org/cancer/salivary-gland-cancer/treating/surgery.html

Salivary Gland Surgery: https://www.mskcc.org/cancer-care/types/salivary-gland/salivary-gland-cancer-treatment/salivary-gland-surgery

Surgical Procedures: Surgery and Staging for Salivary Cancer: https://www.oncolink.org/cancers/head-and-neck/treatments/surgical-treatments/surgery-for-salivary-cancer

Surgery for salivary gland cancer: https://cancer.ca/en/cancer-information/cancer-types/salivary-gland/treatment/surgery

Salivary Gland Cancer Treatment (Adult): https://www.vicc.org/cancer-info/adult-salivary-gland-cancer-treatment-adult