How Are Parotid Tumors Diagnosed
Parotid tumors can involve the superficial lobe or deep lobe of the parotid gland. If your doctor suspects a tumor in this area, he or she is likely to recommend several steps to diagnose and evaluate it.
First, you will undergo imaging studies, or scans. Imaging allows your surgeon to better visualize the extent of the tumor. MRI of the head and neck is the preferred method, but in some cases a CT scan or other imaging studies are used.
Another step in evaluating the mass is taking a sample of tissue from it a biopsy which can be examined under a microscope by a pathologist.
The most common type of biopsy used for parotid masses is a fine needle aspiration biopsy. In this procedure, the doctor gives you numbing medication and then collects a very small amount of tissue from the tumor with a needle under ultrasound guidance. This is a reliable way to help your head and neck surgeon determine characteristics of the tumor.
If you have already had these tests done at one medical institution and choose another for surgery, your surgeon may request that his or her colleagues in radiology and pathology review your imaging studies and biopsy slides so they can double-check the interpretation of these tests.
New Types Of Treatment Are Being Tested In Clinical Trials
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.
Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.
Salivary Gland Cancer Is A Rare Disease In Which Malignant Cells Form In The Tissues Of The Salivary Glands
The salivary glands make saliva and release it into the mouth. Saliva has enzymes that help digest food and antibodies that help protect against infections of the mouth and throat. There are 3 pairs of major salivary glands:
- Parotid glands: These are the largest salivary glands and are found in front of and just below each ear. Most major salivary gland tumors begin in this gland.
- Sublingual glands: These glands are found under the tongue in the floor of the mouth.
- Submandibular glands: These glands are found below the jawbone.
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Being Exposed To Certain Types Of Radiation May Increase The Risk Of Salivary Cancer
Anything that increases the chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesnt mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Although the cause of most salivary gland cancers is not known, risk factors include the following:
- Treatment with radiation therapy to the head and neck.
- Being exposed to certain substances at work.
Deterrence And Patient Education
Because of the possibility of recurrence and distant metastasis, patients with a history of salivary gland, cancer must be monitored throughout their lifetime. During the follow-up care, the otolaryngologist can give patients personalized information about the risk of recurrence. Patients may have blood tests or imaging tests as part of regular follow-up care. However, testing recommendations depend on the type and stage of cancer originally diagnosed and the types of treatment given.
Who Is Likely To Have Salivary Gland Cancer
Anyone can develop salivary gland cancer, but men and people assigned male at birth are more likely to have malignant salivary gland tumors. Youre also more likely to develop cancer in a salivary gland if you:
- Are 55 or older.
- Smoke or use alcohol frequently.
- Have received radiation therapy to your head or neck.
- Work in certain occupations, including plumbing, rubber products manufacturing, asbestos mining and leatherwork.
Studies have shown that some rare types of salivary gland cancer may occur more commonly in people with certain viral infections, like Epstein-Barr virus and human papillomavirus . Still, these infections dont cause salivary gland cancer. More research is needed to understand the connection.
Cancer May Spread From Where It Began To Other Parts Of The Body
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if salivary gland cancer spreads to the lung, the cancer cells in the lung are actually salivary gland cancer cells. The disease is metastatic salivary gland cancer, not lung cancer.
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About Salivary Gland Cancer
Salivary gland cancer is 1 of the 5 main types of cancer in the head and neck region, a grouping called head and neck cancer. Cancer begins when healthy cells change and grow out of control, forming a mass of tissue called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.
Both benign and cancerous tumors can begin in any of the major or minor salivary glands. Most of the tumors that develop in the parotid gland, and about half of the tumors in the submandibular gland, are benign. Sublingual gland tumors are frequently cancerous. Most cancerous tumors of this type begin in the parotid gland or in the submandibular glands.
There are many subtypes of salivary gland tumors. The classification of subtype depends on the type of cell where the tumor started and an evaluation of tumor cells under a microscope .
Thenext section in this guide is Statistics. It helps explain how many people are diagnosed with salivary gland cancer and general survival rates. Use the menu to choose a different section to read in this guide.
Three Types Of Standard Treatment Are Used:
After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be givenradiation therapy after surgery to kill any cancercells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is calledadjuvant therapy.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body .
See Drugs Approved for Head and Neck Cancer for more information.
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Infiltration And Metastases To Cranial Nerves
Cranial nerves have a cerebral, parenchymal, and intracavitary skull portion. Once they exit from the skull, they have an extracranial segment. Neoplastic lesions of the cranial nerves can result from leptomeningeal carcinomatosis, metastasis to the skull base, rarely from direct infiltration such as in leukemia and melanoma, or compression from local tumors. Local metastases go to the cavernous sinus, clivus, orbital fissure, Meckel cave, and to other cranial nerve exit points from the skull.
Malignant cells may invade cranial nerves by epineurial, perineural, or endoneural spread and intravascular spread may occur in lymphoma . Squamous cell carcinoma and parotid tumors can infiltrate the cranial nerves directly , whereas intraneural metastases are very rare . Skull base metastasis occurs in only 4% of cancer patients and often presents with a combination of cranial neuropathies and pain . Though skull base metastasis is usually a late event for cancer patients, in nearly one-third it may be the first sign of cancer .
Tumors that commonly metastasize to the skull base and result in cranial neuropathies include breast, lung, and prostate cancer with breast cancer accounting for the majority in a large series of 175 patients . Hematogenous spread likely accounts for the greater part of skull base tumors, especially true for lung metastases. Retrograde seeding, such as in the case of prostate cancer, through Batson valveless venous plexus may also account for metastasis .
How Is Salivary Gland Cancer Staged
Your healthcare provider will stage your cancer as part of your diagnosis. Cancer staging provides information about your tumor that can help guide treatment.
The staging system used for tumors that form in your parotid glands, submandibular glands and sublingual glands follows the TLM system:
- T: Tumor size and location.
- L: Whether the cancer has spread to your lymph nodes.
- M: Whether the cancer has metastasized, or spread to organs.
A different system is used to stage cancers that form in minor salivary glands.
Understanding your cancer stage is important to understanding both your treatment options and likely outcomes. Ask your provider to explain your cancer stage and what this means for your diagnosis.
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What Is The Treatment Of Salivary Gland Cancer
Management of salivary gland cancers is complex. Optimal treatment and follow-up requires a multidisciplinary team with the full range of specialists and support services with expertise in management of these neoplasms. Surgery is the primary treatment for salivary gland cancers, with complete surgical resection of the primary tumor as the goal. A comprehensive neck dissection is indicated for clinically detected metastases to the neck lymph nodes. Reconstructive surgery may be performed during the primary surgery, depending on what structures are resected to ensure complete removal of the cancer for example, the facial nerve, skin, soft tissues and bone. This ensures the best cosmetic and functional results.
Adjuvant radiation therapy is indicated for select patients with advanced stage and high grade cancers. In select patients with minor salivary gland cancer, primary radiation therapy is sometimes recommended if surgical resection is considered to be too morbid. Long-term clinical follow-up is important for patients who need to be treated for salivary gland cancers, as salvage surgery is feasible for select patients. All decisions are made with a multidisciplinary team.
Risk Factors For Parotid Tumors
Factors that could increase your chances of developing salivary gland tumors include:
Exposure to substances in the workplace: Individuals who work with certain substances in the workplace could have a higher risk of salivary gland tumors. Jobs such as plumbing, asbestos mining and rubber manufacturing are linked with salivary gland tumors.
Older age: While salivary gland tumors can develop at any age, they often develop in older adults.
Radiation exposure: Radiation, like that used for treating neck and head cancers, increases your risk of parotid tumors.
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What You Need To Know
- A painless swelling on one side of your face may indicate a mass or tumor on your parotid gland.
- Most parotid tumors are benign . The most common type, pleomorphic adenoma, is slow-growing and has a low chance of becoming malignant.
- Cancer in the parotid gland can arise either from the parotid gland itself or spread to the gland from another place, such as the skin.
- Treatment usually involves surgery to remove the tumor completely.
Adenocarcinoma Not Otherwise Specified
When seen in the lab, these cancers have enough features to show that they are adenocarcinomas, but not enough detail to classify them further. They are most commonly found in the parotid glands and the minor salivary glands. These tumors can be any grade. They are often seen in people older than 60 years of age.
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Parotid Gland Tumor Treatment Options
The doctor will perform a physical exam, order a CT scan or MRI and get a biopsy to see if your tumor is benign.
If it turns out its cancerous, they’ll stage it based on its location and size.
The stages are:
- Stage I: Tumors are very small and don’t spread to other areas of your body.
- Stage II: Tumors are a little bigger but remain in the original gland.
- Stage III: Tumors have spread from the gland, possibly to your lymph nodes located in your neck on the same side.
- Stage IV: Tumors have definitely spread to your lymph nodes and possibly to other areas of your body.
Physicians will also give salivary gland tumors a certain grade of one to three which measures the rate of speed in which the cancer cells grow.
- Grade 1: This is a low-grade cancer and still has a good chance of being cured. It’s slow growing and doesn’t look that different than your normal cells.
- Grade 2: Cancer is growing moderately fast.
- Grade 3: Cancer is growing quickly.
Common Symptoms Of Parotid Gland Cancer
Common symptoms of parotid gland cancer include:
Changes in the symmetry of the face
Difficulty eating or swallowing
Fluid draining from the ear
Pain, numbness or weakness of the face
Swelling or lump in the cheek, jaw, mouth or neck
Parotid gland cancer is a serious condition. Seek prompt medical care if you, or someone you are with, have any of these symptoms:
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Where Do These Survival Numbers Come From
The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for salivary gland cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:
- Localized: There is no sign that the cancer has spread outside of the salivary gland.
- Regional: The cancer is very large or has spread outside the salivary gland to nearby structures or lymph nodes.
- Distant: The cancer has spread to distant parts of the body such as the lungs.
Signs Of Parotid Cancer
The parotid glands are responsible for producing the saliva thats needed to properly chew and digest food. If a tumor grows within these tissues, it may cause problems with saliva production that could result in difficulty chewing food. Patients sometimes have trouble opening their jaw, or pain may be triggered when chewing. A parotid tumor thats malignant may affect facial nerves and produce additional symptoms that include:
- Muscle weakness on one side of the face
- Burning or prickling sensations
- Loss of movement in parts of the face
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Cancers Of The Head And Neck
Carotid Risk and RT
Carotid artery disease is well established as causative factor in ischemic stroke with almost 140,000 carotid endarterectomies performed each year in the United States . Patients diagnosed with head and neck cancers have an increased risk of developing a carotid-related stroke due to both their primary disease causing procoagulation changes systemically and for radiation-induced accelerated atherosclerotic plaque development in the carotid arteries.
Trends in Head and Neck Cancer
Treatment Recommendations for Vascular Complications Following Irradiation of the Head and Neck
Given the elevated risks seen in patients who have been treated with RT for head and neck malignancies, patients who have undergone RT of the head and neck should be evaluated with ultrasonography of the carotid arteries at regular intervals starting 25 years after treatment in order to assess patients for risk and need for intervention. Furthermore, additional cardioprotective treatments should be implemented given the accelerated nature of radiation-induced atherosclerotic disease. This would include annual lipid monitoring and management, blood pressure control, smoking cessation, weight loss, and regular physical activity.
Kelly G. Gwathmey, in, 2018
Primary Neuroendocrine Small Cell Carcinoma Of The Parotid Gland: A Case Report And Review Of The Literature
This article is mentioned in:
A mass of 1.7×2.4×1.4 cm3 in size wasresected to obtain an intraoperative frozen section. The margins ofthe mass were well defined, the texture of the section was solidand the coloration was pink and white. The intraoperative frozensection revealed that the mass was an epithelial malignant tumor.Such a result indicated that the tumor should be evaluated byimmunohistochemistry. The results of the immunohistochemicalanalysis indicated that the tumor was a neuroendocrine SCC.
Under a light microscope, the tumor cells stainedwith hematoxylin and eosin were shown to be arranged into irregularnests. Tumor cells were observed palisading around the cell nestwith a moderate amount of fibrous mesenchyme. The tumor cells weresmall with poorly-defined borders, bare nuclei and sparsecytoplasm. The nuclei were round, oval or partially fusiform. Thechromatin was fine and granular and the nucleoli were not evident.A section of the nuclei was twisted and fragmental necrosis wasvisible .
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