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Salivary Gland Cancer

Saliva, an important fluid for our body, plays a significant role in speech, taste, and nutrition. However, both benign and malignant masses can develop in the salivary glands responsible for producing saliva. Salivary gland cancer, which is more commonly observed in individuals aged 60-70, is more frequently seen in men. The success of treatment for malignant salivary gland cancers that have a malignant course can be improved by early diagnosis and prompt initiation of treatment. The treatment plan for the disease is determined based on the stage of cancer. Uniqacare Ear, Nose, and Throat Department provides information about salivary gland cancer.

What is saliva and salivary gland?


"Saliva" is a type of fluid crucial for our bodies, produced in the mouth and containing various important substances such as water, sodium, chloride, calcium, potassium, bicarbonate, immunoglobulin A, albumin, ptyalin, and mucin. Saliva serves vital functions within our bodies. It continuously keeps the inside of the mouth moist, allowing food inside the mouth to become lubricated and certain molecules within the food to dissolve, aiding them in reaching taste receptors. Saliva facilitates the process of swallowing, frees up the movements of the tongue and lips, making speaking easier, and helps keep teeth and the inside of the mouth clean through continuous washing.


Saliva secretion is carried out by the salivary glands. Apart from the 400-600 minor salivary glands found in the oral cavity, nose, sinuses, pharynx, larynx, trachea, and bronchial mucosa, there are also large salivary glands that connect to the oral cavity through small ducts located on each side of our face. These include one in front of each ear (the Parotis gland), one under each jaw (the Submandibular gland), and one under each tongue (the Sublingual gland), totaling six major salivary glands.


What is the function of salivary gland?


The salivary glands produce saliva. It is known that a healthy person produces around 1000-1500 cc of saliva daily. Salivary glands play a crucial role in maintaining oral cleanliness, regulating acidity, and facilitating the passage of food into the stomach. Saliva has many functions, ranging from combating bad breath to aiding in digestion, making it of great importance for overall health.


What is salivary gland cancer?


Salivary gland cancer is a condition that occurs when one of the salivary glands in our mouth, which produce saliva and include both major (three pairs) and minor (nearly a thousand) glands, develops cancer.


What are the types of salivary gland tumors?


Tumors are divided into benign and malignant categories. Benign tumors grow more slowly and do not metastasize (spread) to nearby or distant organs. Malignant tumors, on the other hand, grow more rapidly and have the potential to metastasize (spread) to regional lymph nodes and distant organs such as the lungs, liver, brain, bones, and others.


What are the symptoms of salivary gland cancer?


Benign tumors, which grow more slowly, are often surrounded by a thin, membranous capsule and do not invade the surrounding tissues. They typically grow by pushing aside the adjacent tissues, and this growth process can take months or even years. Benign tumors do not typically cause pain, and patients rarely complain of pain. When pain does occur, it is generally related to indirect factors rather than the tumor itself.


Malignant tumors, on the other hand, grow more rapidly and have the potential to metastasize (spread) to regional lymph nodes and distant organs such as the lungs, liver, brain, and bones. They exhibit invasion into surrounding tissues, disrupting their functions. For example, when they reach adjacent nerves, they disrupt their functions. Additionally, malignant tumors can start causing pain once they reach a certain size. This pain can result from the tumor invading structures like bones or the jaw joint, or it can occur directly in the head and facial region or affect the nerves responsible for pain sensation.


What are the causes of salivary gland cancer?


While the exact causes of salivary gland cancers are not known, certain factors are believed to increase the risk. One of the primary factors is the presence of benign tumors within the salivary gland for an extended period. Therefore, even if the tumor is benign, it is preferred to be removed from the salivary gland. Radiation exposure is also a factor that can increase the risk of salivary gland cancer. Smoking, which is known to increase the risk of many cancers, is also thought to raise the likelihood of salivary gland cancer.


How is salivary gland cancer diagnosed?


The early diagnosis of salivary gland cancers is typically based on the symptoms they cause in the patient. When a person presents with complaints such as swelling or pain in the head and neck region, a detailed examination can lead to the diagnosis of the disease.


After taking a detailed medical history, the patient undergoes a physical examination. During the physical examination, the doctor checks for swelling or enlargement of the salivary glands and assesses the size and boundaries of any swelling if present. Comparative bilateral examination is important during these evaluations.


Imaging techniques are also used in the diagnosis of salivary gland cancers. Particularly, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are used to examine tumor tissue and surrounding structures. For a definitive diagnosis of salivary gland cancers, histopathological examination is performed. This involves taking a biopsy, obtaining a tissue sample for examination. After the diagnosis of salivary gland cancer is confirmed, MRI can also be useful in staging the cancer.


What is the treatment method for salivary gland cancer?


In treatment, a treatment plan is developed based on the stage of the disease. Factors that affect the staging of the disease include the size of the tumor, whether it has invaded surrounding tissues, lymph node involvement, and the histological type of the tumor. The staging determined as a result of these factors guides the treatment plan. Treatment options for salivary gland cancer include surgery, radiation therapy, and chemotherapy. In most cases, a combination of these treatment methods is used.


FREQUENTLY ASKED QUESTIONS ABOUT SALIVARY GLAND CANCER

Is salivary gland cancer dangerous?


Salivary gland tumors are generally benign. Among salivary gland tumors, parotid gland tumors are the most common. These tumors are usually benign. They do not have an aggressive course, and spreading to other areas is rare. In benign tumors, although the chance of turning into malignancy or cancer is very low in untreated cases, it is important to evaluate salivary gland tumor formations and initiate appropriate treatment options. Early diagnosis and early treatment greatly increase the success of treatment, especially in malignant salivary gland cancers. Therefore, early hospitalization is very important in cases with complaints such as swelling in the front of the ear, under the jaw, difficulty swallowing, numbness in the face, and tingling.


Does salivary gland cancer kill?


Salivary gland tumors are generally benign. The survival rate after the treatment of these tumors is around 95%. In cases of malignant salivary gland tumors that are poorly managed, treated late, or left untreated, the success rate is around 50%.


Which salivary glands are most commonly affected?


The most common benign tumor of major and minor salivary glands is pleomorphic adenoma, which makes up 50% of all salivary gland tumors and 65% of all parotid tumors. The most common malignant tumor of major and minor salivary glands is mucoepidermoid carcinoma, which constitutes 10% of all salivary gland tumors and 35% of all malignant salivary gland tumors. This tumor is most commonly found in the parotid gland.


Is every tumor in the salivary glands cancer?


Not every tumor in the salivary gland is cancer. Not all lumps are malignant. A significant portion of these, especially those in the parotid glands in front of the ear, are benign lumps. Therefore, the crucial point to emphasize is whether the lumps are benign or malignant.


What are the risk factors for salivary gland cancer?


Exposure to ionizing radiation is the most blamed etiological factor in salivary gland cancers. Secondary risk due to exposure is higher in rubber industry workers, miners exposed to asbestos, plumbers, and lumber industry workers.


What does benign salivary gland tumor mean?


Salivary gland-related tumors generally appear as slowly growing masses in people aged 50-70. In addition to physical examination and radiological examinations, fine needle biopsy is important. Distinguishing whether the tumor is benign or malignant is done by needle biopsy, and the treatment plan is shaped accordingly.


The majority of benign salivary gland tumors are mixed tumors or pleomorphic adenomas, more commonly seen in women between the ages of 30-60. Generally, all benign tumors are treated with surgery. During this surgery, the salivary gland where the tumor is located is completely removed. In the case of benign parotid tumors, if there is no involvement of the deep lobe, only the superficial lobe is removed during surgery.


What does malignant salivary gland tumor mean?


Malignant tumors are classified as low, moderate, and high grade based on the clinical behavior of the tumor, the rate of spread, and the degree of structural changes. High-grade tumors are more aggressive, tend to spread to surrounding tissues, have a high risk of distant metastasis (spreading to the lungs, liver, brain, bones, etc.). Surgery is the first choice in the treatment of malignant salivary gland tumors. During surgery, the tumor should be removed widely, including the surrounding normal tissue, as long as there is no involvement of the tumor. Important nerves such as the facial nerve, which passes through the surgical area, and the nerve that carries sensation in the tongue should be preserved unless they are involved in the tumor. In cases where tumor metastasis to the neck lymph nodes is detected and there is no clear involvement, neighboring lymph nodes are also removed during surgery (neck dissection surgery). Radiation therapy can rarely be chosen as the primary treatment for small tumors. In the case of large tumors with a high risk of spreading, postoperative radiation therapy is given to prevent tumor recurrence in the same area.


In patients who are not suitable for surgery due to other health problems and in patients with advanced regional spread and/or distant metastasis of the tumor, drug treatment (chemotherapy) may be preferred.


How common is salivary gland cancer?


Malignant salivary gland tumors make up 3-4% of malignant tumors in the head and neck region. Malignant salivary gland tumors are most common in the parotid gland, accounting for 75-80%, followed by the submandibular gland at 20%, and rarely in the sublingual or minor glands. The majority of patients with malignant salivary gland tumors are between the ages of 60-70, and it is more common in men.


Does salivary gland cancer cause facial paralysis?


The facial nerve, which controls the muscles of our face, runs inside our major salivary gland, the parotid gland. If the malignant tumors of the parotid gland spread towards the deep lobe and involve the facial nerve, facial paralysis can occur.


Which doctor should you see if you suspect salivary gland cancer?


You should consult an ear, nose, and throat specialist.


How is a biopsy done for salivary gland cancer?


This procedure can be performed with open biopsy, fine needle aspiration biopsy (FNAB), core biopsy, and frozen section biopsy. FNAB is the most commonly used biopsy method for masses in the parotid and submandibular glands today. Open biopsy (incisional) with forceps is more commonly preferred for minor salivary glands.


Does fine needle aspiration biopsy for salivary gland cancer cause the tumor to spread?


Needle biopsy has been applied to millions of patients worldwide for many years and there has been no scientific evidence that it causes tumor spread. Therefore, it is safely applied by doctors.


Can salivary gland cancer be prevented?


Unfortunately, the causes of salivary gland cancer are not yet known. Therefore, nothing can be said about how it can be prevented. Just as there is a cause-and-effect relationship between smoking and laryngeal or lung cancer, and preventive measures can be taken, there is no such relationship for salivary gland cancer. The only preventive measure that can be taken for salivary gland cancers is the timely removal of the tumor within the salivary gland.


Can salivary gland cancer be detected early?


When a patient notices a lump or mass in the ear, under the jaw, or in the mouth, throat, or other areas and seeks medical attention, the diagnostic process begins. The doctor, suspecting a salivary gland tumor through examination, generally resorts to radiological imaging tools such as ultrasound, MRI (magnetic resonance imaging), or CT scan. This will be the second step after the examination to strengthen the diagnosis of the tumor. Then, sometimes, taking a cell or tissue sample from the mass with a needle biopsy will be necessary to confirm the diagnosis and make the most accurate pre-treatment plans.


Does salivary gland cancer metastasize?


Malignant tumors (cancerous, malignant) grow faster, have the potential to metastasize (spread) to regional lymph nodes and distant organs (lungs, liver, brain, bones, etc.). They invade surrounding tissues and disrupt their functions.


Does salivary gland cancer leave a scar after surgery?


In parotid gland surgeries, an incision is made that starts from in front of the ear and extends from behind the ear to under the jaw. At the end of the surgery, this incision is closed with subcutaneous stitches referred to as cosmetic stitches, resulting in minimal scarring. By aligning this incision with the back of the ear, the likelihood of scarring is greatly reduced. Similarly, in submandibular gland surgeries, an incision of about 3 cm is made under the jaw and closed with subcutaneous stitches. After healing, the remaining scar is so minimal that it is not of concern.


What are the consequences of removing the salivary glands after salivary gland cancer surgery?


Unilateral removal of the parotid and submandibular glands does not lead to problems such as salivary insufficiency and dry mouth. The remaining glands on the other side of the face and microscopic salivary glands compensate for the missing gland's function. Postoperative salivary gland surgeries do not affect functions such as nutrition and speech.


How long does salivary gland cancer surgery take?


When approaching salivary gland cancer and tumors, first, the location of the cancerous tissue is determined. Secondly, it is tried to distinguish whether this tumor is benign or malignant. After these stages, treatment options are discussed, and the most suitable treatment method for the patient, which will cause the least organ loss, loss of labor, and discomfort, in short, minimize the impact on the quality of life, should be determined.


In the processes taken into consideration later, it is tried to determine how much the tumor has spread in the area where the tumor is located, whether it has spread to the surrounding area, especially neck lymph nodes, and whether it has spread to any other part of the body. With this information, considering the general condition of the patient, a treatment plan is created.


How long is the hospitalization after salivary gland cancer surgery?


Depending on the nature of the surgery, the average length of hospitalization is usually 2-4 days.


What should be taken care of after surgery?


After surgery, a drain, a small tube, is placed to remove accumulated blood and fluid from the surgical area. The drain is usually removed between 24 and 48 hours. However, a bandaged dressing will remain in place for 3-4 more days to prevent accumulation in the field. If there are stitches in the skin, they will be removed on the 5th to 7th days, depending on the doctor's preference.


During this period, 3 or 4 dressings are usually sufficient. If the skin incision is closed with special self-absorbing threads and hidden, there will be no need to remove the stitches. Typically, the patient can take a shower comfortably within a week of the operation. Antibiotics may be prescribed for 3-4 days to prevent infection.


After waking up from surgery, the patient is not given food or liquid by mouth for about 3-4 hours until the effects of anesthesia wear off. In the later hours of the operation day, the patient usually starts with soft, liquid foods and can generally transition to normal foods from the next day. However, especially in cases of extensive surgery due to malignant tumors, it may take longer for the patient to recover and return to their normal eating habits.


In general, in surgeries performed in the face and neck region, the planning and closure of the incision are done with special care considering cosmetic concerns. In contrast, to avoid late formation of scar tissue, patients are advised not to expose the incision area to the sun for about a year. When they go outside in open air, they are recommended to protect themselves with high SPF creams or accessories such as scarves or shawls. Additionally, some cream and gel medications may be able to make the scar tissue less prominent.

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