Salivary Gland Cancer Treatment in Northern Illinois

Benign Salivary Gland Tumors

Most salivary gland tumors are benign and slow growing. Here is a breakdown of the incidence of salivary gland tumors.

As noted,

• Most benign salivary gland tumors are found in the parotid gland (70-80%)
• 10%-15% of benign tumors start in the submandibular salivary gland
• Sublingual gland tumors are less common but can occur and may be more likely to be malignant.

As a tumor grows, it can lead to symptoms. The tumor can increase in size but usually doesn’t metastasize. These benign tumors are identified by the type of cells or the characteristics that make up the tumor cells. Let’s look at the benign salivary gland tumors.

Pleomorphic Adenoma

These rare and benign tumors are the most common type of salivary gland tumors. It primarily affects the parotid gland. It appears as a single, movable mass which is painless and slow growing. It could feel soft or firm. Symptoms depend on the size and location.

• Parotid gland – may see lump in front of the ear
• Submandibular gland – may see lump under the jaw
• Sublingual gland or minor glands – may see lump on hard or soft palate

• Sublingual glands – or minor glands-may see lump on hard or soft palate.

These tumors also have a small risk of transforming into malignancy. When the tumor gets too large, there could be facial nerve involvement.Rapid growth or facial nerve symptoms should raise concern about a change into a malignancy.

When this type of tumor is in the deep lobe of the parotid gland, it can be seen in the oral cavity. Patients can have difficulty chewing or swallowing, hoarseness, or shortness of breath. Surgery is recommended before the tumor enlarges. Once this tumor is removed, it rarely comes back.

Other Adenomas

• Monomorphic Adenomas – benign and slow growing tumor made up of a single cell type.
• Canalicular Adenomas – benign and slow growing tumor. Diagnosed through biopsy exam showing a distinct appearance.
• Sebaceous Adenomas – usually benign and appear as small bumps usually on face or head. Diagnosed with biopsy.

Surgical removal is recommended for all these types of adenomas.

Oncocytoma

Rare and benign, usually found in the parotid gland.
Oncocyte cells are diagnosed with scans and biopsy exams.

Myoepithelioma

Benign tumor that can be found in major or minor salivary glands.
Diagnosed through biopsy examination. This type of tumor can also be found in the breast, prostate, and sweat and lacrimal glands.
Recurrence is rare after surgical excision.

Ductal Papillomas

Rare and benign tumors can be found in the minor glands in the lip, palate and cheek areas.
They can also be found in the parotid gland.
They have finger-like projections (papillary) that form within the ducts.
Surgical removal is recommended.

Facial Nerve Neuroma

Neuromas are benign tissues that grow along the nerve.
Schwannomas, named for Schwann cells which surround nerve fibers, are benign tumors.
They form along a nerve in the parotid or submandibular glands.
They appear as a lump near the ear or under the jaw and can be mistaken for other types of tumors.

Because of how close they are to the nerve, careful consideration is needed to confirm diagnosis.
CT or MRI and fine needle aspiration may be needed.
Facial nerve preservation during surgery is imperative.

Warthin’s Tumor

This is the second most common benign salivary gland tumor, usually occurring in the parotid gland.
It is also associated with smoking.

The tumor appears rounded and is painless and slow growing.
The lumps are usually soft and movable.

As it grows, it can push against other structures in the area, but it doesn’t invade these structures.
If the tumor becomes too large, it can increase the risk of nerve damage.
The best treatment for a Warthin’s tumor is surgical removal.
These tumors rarely come back, giving patients a favorable prognosis.

Treatment and Next Steps

Generally, benign salivary gland tumors are not dangerous but left untreated, they can cause symptoms including facial disfigurement and nerve injury.

The doctors at Oral Cancer Institute will diagnose benign salivary tumors by doing a physical examination and will also order other tests, such as a CT scan or MRI. A needle biopsy may also be needed to examine the cells from the tumor under a microscope.

Early diagnosis and treatment with experienced head and neck surgeons is paramount. If you notice any swelling or lumps at the side of your face or under your jawline or any other changes please contact us to arrange a consultation.

Risk Factors

anyone can develop a salivary gland tumor, but you are more likely to if you:

• Are over 55-although salivary gland tumors can occur at any age.
• Use tobacco (smoking and other tobacco products).
• Drink alcohol.
• Have had viral exposure-people with Epstein-Barr, HIV/AIDS, and HPV have a higher incidence of salivary gland tumors.
• Have received radiation therapy to the head or neck.
• Have had chemical exposure to asbestos, rubber, plumbing or other chemicals.

Diagnosis

Your doctor will order diagnostic testing to learn more about the tumor. Expect to have at least one of the following tests.

• CT scan
• MRI scan
• Fine needle aspiration (FNA) and other biopsies

Treatment for Benign Salivary Gland Tumors

The most common treatment for salivary gland tumors is surgery for removal of part or all the affected glands. The size and scope of the tumor will determine the extent of surgery. If the tumor has spread into other tissues or any bone is removed, reconstruction may be necessary. Surgeons at the Oral Cancer Institute are experts in this aspect of head and neck oncology and microvascular reconstruction surgery. 

Prognosis of Benign Salivary Gland Tumors

A benign parotid tumor has an excellent prognosis and can be considered a cure, but there are some variabilities. The size and type of benign tumor will determine the chance of recurrence. Pleomorphic Adenoma (most common benign parotid tumor) does have a 1% chance of transforming into a malignancy, whereas Warthin’s Tumor rarely recurs. Regardless of the type of parotid tumor, it is paramount to continue follow-up care with your doctor. 

Malignant Parotid Gland Tumors

Salivary gland cancer is rare. Most salivary gland tumors start in the parotid glands. You may notice a lump in your cheek or in areas around the face and neck. Left untreated, a tumor can spread to nearby lymph nodes and other organs. It is rare, but tumors can form in the minor salivary glands. These glands are inside the mouth, cheek, tongue and lip areas. Most of these tumors are malignant and can spread (metastasize) to other organs or through the bloodstream.

Anyone can develop salivary gland tumors, but you are more likely to if you:

• Are over 55
• Use tobacco, smoke or use alcohol
• Have received radiation therapy to your head or neck
• Have occupational exposure to asbestos, rubber and chemicals

Symptoms of Salivary Gland Cancer

In most cases, there could be very minimal symptoms other than a painless lump in the area of your salivary glands. With a malignant tumor, you may also have other symptoms like:

• Ongoing pain in your face, neck, jaw or mouth
• Difficulty moving your mouth or facial muscles
• Numbness or weakness in your face, neck, jaw or mouth
• Trouble swallowing
• Bleeding from the mouth

Please call Oral Cancer Institute for an evaluation of any symptoms that you are experiencing.

Let’s review the types of malignant parotid gland tumors.

Mucoepidermoid carcinoma (MEC) 

MEC is the most frequently diagnosed malignant salivary tumor. Swelling or a painless lump in the jaw, mouth or neck are common symptoms although these can vary depending on the size and location of the tumor. 

• Low grade MEC is slow growing and has a good prognosis with surgery and possibly radiation.
• High grade MEC is a more rare but aggressive type of cancer. It can spread to nearby lymph nodes, neck or to other parts of the body. Treatment can include surgery to remove the salivary gland and neck dissection. Other treatments, such as radiation and chemotherapy may be needed for a more advanced stage.

Adenoid Cystic Carcinoma (ACC) 

This uncommon type of cancer usually develops in the salivary glands or other areas of the head or neck. Most people with ACC are between the ages of 40 and 60. It is slightly more prevalent in females. The cause is unknown. Because ACC is slow-growing, it doesn’t always cause symptoms.

Symptoms can vary, depending on the size and location of the tumor. Some symptoms might be:

• A painless lump
• Difficulty breathing
• Difficulty swallowing
• Hoarseness
• Nosebleeds or nasal congestion
• Pain
• Vision changes
• Jaw spasms

Metastatic ACC does not often spread to nearby lymph nodes, but most commonly does metastasize to the lungs. There are two ways that ACC can spread.

• Perineural invasion-This is when the cancer cells reach into the nerve fibers around the tumor. This condition is hard to detect even on scans and will require radiation therapy.
• Circulation-Cancer cells break off from the tumor and travel to other parts of the body via the bloodstream. This condition also can require radiation therapy, chemotherapy or immunotherapy.

ACC tumors are slow-growing, but they can be aggressive. That means even when this type of tumor is surgically removed, it can come back. Most people with ACC will have a recurrence within 5-10 years and even 20 years later. Follow up care, including checkups and scans will be important for your doctor to closely monitor your condition.

Acinic Cell Carcinoma

While still rare, this is the second most common malignant salivary gland tumor, primarily found in the parotid gland. It is slow-growing. Metastasis can occur years after treatment. Surgical removal is the recommended treatment.

Polymorphous low-grade adenocarcinoma (PLGA)

PLGA is a rare, painless, slow growing salivary gland cancer. It is usually found in the smaller, minor salivary glands but may also occur in the oral cavity or parotid gland. The tumor can break down and enter adjacent bony areas. There can also be perineural invasion, where the cancer cells reach into nearby nerve fibers. There is a low incidence of metastasis. Surgery is the primary treatment with excellent prognosis. Radiation therapy may also be needed.

Diagnosis of Malignant Salivary Gland

Testing will be similar to initially diagnosing a salivary gland tumor. Once a malignancy is discovered, additional tests will be needed. These tests can determine if cancer cells have spread to lymph nodes or other parts of the body. It is also important to stage the tumor, which will help clarify the treatment plan.

• CT scan
• MRI
• PET scan
• Endoscopy-a tube is inserted into the mouth and advanced to look at throat and larynx.
• Biopsies
  • Fine Needle Aspiration (FNA)-commonly used for initial diagnosis
  • Incisional-a piece of tumor removed surgically
  • Surgical-any tumor removed will always be sent to pathology

Staging of Salivary Gland Cancer

Salivary gland tumors are staged between 0 through IV. 

The American Joint Committee on Cancer (AJCC) TNM system uses various tests to determine staging for different types of cancer. It is based on the tumor location, size, lymph node involvement and if there is any spread (metastasis). T describes the tumor. N describes if there is any lymph node involvement. M describes if there is any metastasis. Once the scores are established and added up, a stage of 0-IV is given. Lower stages are less severe cancers, while higher stages are more extensive.