Salivary Gland Tumors
Salivary gland tumors are rare types of tumors that begin in the salivary glands.
Salivary gland tumors can begin in any of the salivary glands in your mouth, neck or throat. Salivary glands make saliva, which aids in digestion, keeps your mouth moist and supports healthy teeth.
You have three pairs of major salivary glands under and behind your jaw — parotid, sublingual and submandibular. Many other tiny salivary glands are in your lips, inside your cheeks, and throughout your mouth and throat.
Salivary gland tumors most commonly occur in the parotid gland, accounting for nearly 85 percent of all salivary gland tumors. Approximately 25 percent of parotid tumors are cancerous (malignant).
Treatment for salivary gland tumors often involves surgery. Treatments for salivary gland tumors may also include radiation therapy and chemotherapy.
Signs and symptoms of a salivary gland tumor may include:
- A lump or swelling on or near your jaw or in your neck or mouth
- Numbness in part of your face
- Muscle weakness on one side of your face
- Persistent pain in the area of a salivary gland
- Difficulty swallowing
- Trouble opening your mouth widely
Salivary gland tumors are rare, accounting for less than 10 percent of all head and neck tumors. It’s not clear what causes salivary gland tumors.
Doctors know salivary gland cancer occurs when some cells in a salivary gland develop mutations in their DNA. The mutations allow the cells to grow and divide rapidly. The mutated cells continue living when other cells would die. The accumulating cells form a tumor that can invade nearby tissue. Cancerous cells can break off and spread (metastasize) to distant areas of the body.
Parotid And Submaxillary
Parotid tumors are the most common type of salivary gland tumors, accounting for 80 to 85 percent of all salivary gland tumors. While most parotid tumors are noncancerous (benign), the parotid glands are where nearly 25 percent of cancerous (malignant) salivary gland tumors develop.
The parotid glands, located just in front of the ears on each side of the face, are the largest of the three sets of major salivary glands. They are responsible for producing saliva to aid in chewing and digesting food.
Parotid tumors may present a variety of characteristics. If you have a parotid tumor, you may notice a mass or swelling in your jaw area that may or may not be painful. If the tumor is malignant, it may also affect facial nerves, causing pain, numbness, a burning or prickling sensation, or loss of movement in the face.
In most cases, surgery to remove all or a part of the parotid gland (parotidectomy) is the preferred treatment for parotid tumors. Special care must be taken to avoid damaging the facial nerve that runs through the parotid gland. The facial nerve is responsible for controlling facial expressions and movement.
For malignant parotid tumors, your doctor may also recommend radiation therapy. To date, chemotherapy has proved to be ineffective for this type of cancer.
Laryngeal cancer occurs in the larynx, or voice box.
The larynx is a short, triangular passageway just below the pharynx in the neck. It is about 2 inches wide.
The larynx has three main parts:
- the glottis is the middle part of the larynx that contains the vocal cords
- the supraglottis is the tissue above the glottis
- the subglottis is the tissue below the glottis that connects to the trachea, which takes air to the lungs
Cancer can develop in any part of the larynx but usually begins in the glottis. Most laryngeal cancers start in the flat, scale-like squamous cells that line the inner walls of the larynx.
If laryngeal cancer spreads, it often reaches nearby lymph nodes in the neck. The cells can also spread to the back of the tongue, other sections of the throat and neck, the lungs, and other parts of the body.
When this happens, and a tumor forms at the new site, it will contain the same kind of abnormal cells as the original tumor in the larynx. A doctor would diagnose this as metastatic laryngeal cancer.
The symptoms of laryngeal cancer include:
- a persistent cough
- a sore throat
- an abnormal lump in the throat or neck
- difficulty or pain when swallowing
- frequently choking on food
- difficult or noisy breathing
- persistent ear pain or an unusual sensation in and around the skin of the ear
- unplanned, significant weight loss
- persistent bad breath
Nasal and Sinus Tumors
Nasal and Sinus tumors often present unique treatment challenges related to the complex and important anatomic structures surrounding the sinus cavities. State of the art technology and instruments are utilized by the Finger Lakes ENT to decrease post-operative healing times, improve functional outcomes and decrease complications.
Computerized surgical navigation, specialized endoscopes and a new generation of sinus instruments are utilized. For patients with nasal or sinus cancer, we often work closely with our colleagues in oncology, neurosurgery, head and neck cancer surgery and prosthodontics to provide outstanding multi-disciplinary care. Finger Lakes ENT has experience treating the following nasal, sinus and anterior skull base tumors: inverting papilloma (Schneiderian papilloma), juvenile nasopharyngeal angiofibroma, hemangiopericytoma, ossifying fibroma, osteoma, fibrous dysplasia, hemangioma, schwannoma, meningioma, pleomorphic adenoma, pituitary adenoma, lymphoma, esthesioneuroblastoma (olfactory neuroblastoma), adenocarcinoma, squamous cell carcinoma and melanoma.
Endoscopic resection of skull base cancers must be carefully considered in the setting of a multidisciplinary tumor board or team (medical oncologist, radiation oncologist, head and neck surgeon, endoscopic skull base surgeon, neurosurgeon). Generous tumor margins are generally not obtained with the endoscopic technique and this must be accounted for in the overall management of the patient’s disease. Furthermore, the endoscopic approach to anterior skull base tumors is a newer technique compared to the external craniofacial resection. This limits the longitudinal data we have allowing us to predict the prognosis of a patient undergoing endoscopic resection of a malignant tumor.
Radical Neck Dissection
A neck dissection is a systematic approach to removing entire groups of lymph nodes from the neck. This is very different than plucking out a few nodes from the neck (which should only be done in rare cases when all other modalities have failed to reach a diagnosis or to get more tissue to help with treatment decisions in diseases such as lymphoma). Removing lymph nodes from the neck does not alter your body’s ability to fight infection—so the patient should not be worried about that.
A neck dissection can be done as an elective neck dissection, which is the removal of the lymph nodes without any evidence that there is obvious cancer in the neck, or as a therapeutic neck dissection, which is the removal of lymph nodes in the neck with known cancerous lymph nodes in the region based on a biopsy or a high level of suspicion based on their appearance on imaging studies. An elective neck dissection will be considered if there is a high risk that there is microscopic (hidden or not clinically apparent) cancer in the lymph nodes (more than 20%).
The different lymph node groups of the neck are shown in the image.
The extent on the neck dissection will depend on a number of factors. Perhaps most important is the site of the primary cancer. Interestingly, there is a pattern to which level certain cancers spread when they enter the lymphatic system. For example, cancers of the oral cavity are known to spread to Levels I, II and III; therefore, an elective neck dissection for a cancer of the oral cavity should include these lymph node groups on the side of the primary cancer. The general patterns include:
- Level I, II, III: oral cavity
- Level II, III, IV: oropharynx, hypopharynx, larynx
- Level V: scalp, facial skin
- Level VI: thyroid, larynx
- Level VII: thyroid
Another important factor contributing to the extent of the neck dissection required is whether there is clinical evidence of spread into the lymph nodes. If there is clinical evidence of cancer in the neck, your surgeon will probably be more comprehensive in cleaning out more of the neck.
Surgeons use different terms to describe neck dissections. You need not be concerned with the exact name given to different types of neck dissection, but you might be interested to know some nomenclature:
- Radical neck dissection: This refers to the removal of lymph node groups I to V, as well as the sternocleidomastoid muscle, internal jugular vein and spinal accessory nerve. This used to be the standard neck dissection years ago but has been replaced with neck dissections that spare some or all of these structures. An extended radical neck dissection includes all of these, plus removal of additional lymph node groups or non-lymphatic structures not accounted for in the radical neck dissection definition.
- Modified radical neck dissection: This is the removal of lymph node groups I to V, while sparing one or more of the three structures taken in the radical neck dissection (sternocleidomastoid muscle, internal jugular vein and spinal accessory nerve). In old nomenclature, depending on what structure was removed, surgeons would call them Type I, Type II or Type III modified radical neck dissections. These days, they should be described as a modified radical neck dissection with sacrifice of the internal jugular vein and sternocleidomastoid muscle (this implies that the spinal accessory nerve was preserved). A modified radical neck dissection that preserves all three structures is also called a comprehensive neck dissection, indicative of the removal of lymph nodes from Levels 1 though 5.
- Selective neck dissection: This is the removal of a select group of lymph nodes in the neck, with or without sacrifice of additional non-lymphatic structures. Most neck dissections in current times are really selective neck dissections. Some common selective neck dissections are given names such as the following:
- Supraomohyoid neck dissection: This is the removal of lymph node Groups I, II and III.
- Lateral neck dissection: This is the removal of lymph node Groups II, III and IV.
- Posterolateral neck dissection: This is the removal of lymph node Groups II, III, IV and V.
What Are the Symptoms of Oral Cancer?
The most common symptoms of oral cancer include:
- Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums, or other areas inside the mouth
- The development of velvety white, red, or speckled (white and red) patches in the mouth
- Unexplained bleeding in the mouth
- Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck
- Persistent sores on the face, neck, or mouth that bleed easily and do not heal within 2 weeks
- A soreness or feeling that something is caught in the back of the throat
- Difficulty chewing or swallowing, speaking, or moving the jaw or tongue
- Hoarseness, chronic sore throat, or change in voice
- Ear pain
- A change in the way your teeth or dentures fit together
- Dramatic weight loss
Most early stages are cured with a simple incision. More advanced stages can require surgery, radiation therapy or chemotherapy.