Tumors That Begin in One of the Salivary Glands
Your salivary glands make saliva, which is the lubricating fluid inside your mouth and throat. Saliva moistens food to help with chewing and swallowing and contains enzymes that help digest food. It also contains antibodies that help prevent infections in your mouth and throat and protect your teeth from decay.
Salivary gland tumors, called neoplasms, are rare, and most are noncancerous (benign). American Cancer Society statistics show they occur at a rate of about one case per 100,000 people per year in the U.S. When benign or cancerous (malignant) tumors occur, they are usually found in the three major pairs of salivary glands:
- Parotid: the largest salivary glands, located in each cheek in front of your ears. Most salivary gland tumors originate in the parotid gland, and most of them are benign.
- Submandibular: located under the floor of your mouth, under both sides of your jaw. According to the American Cancer Society, about one to two out of 10 salivary gland tumors originate in the submandibular gland and about half of these are malignant.
- Sublingual: located under the floor of your mouth. Tumors in these glands are rare.
You also have hundreds of minor salivary glands lining the rest of your mouth. While it is uncommon to find tumors in these glands, when they do occur, they are often cancerous and occur in the roof of the mouth.
The most common benign tumor is called a pleomorphic adenoma. The most common malignant tumor is a mucoepidermoid carcinoma.
The risk for salivary gland cancer is higher in men and increases with age. Other risk factors include:
- Radiation exposure, including low-dose treatment to the head and neck areas and radioactive substances in the workplace
- Family history of salivary gland cancer, although rare
- Tobacco use (there is not a strong connection to salivary gland cancer, but tobacco use has been linked to many cancers and should be avoided)
Symptoms, Diagnosis & Outlook
Symptoms of salivary gland tumors can include:
- Firm, usually painless swelling in one of the salivary glands (in front of the ears, under the chin or on the floor of the mouth). The swelling gradually increases.
- Pain in your mouth, cheek, jaw, neck or ear that doesn’t go away.
- Facial numbness.
- A noticeable difference between the right and left sides of your face or neck.
- Trouble swallowing or opening your mouth widely.
- Difficulty moving one side of the face, known as facial nerve palsy.
- Fluid draining from either ear.
Many of these symptoms can be caused by benign salivary gland tumors or issues unrelated to the salivary glands. However, if you experience any symptoms or are concerned about your health, schedule an appointment with your primary care provider. Your provider will conduct a complete physical exam and check for signs of salivary gland tumors. After your exam, your provider may refer you to a head and neck surgery specialist, called an otolaryngologist.
At that appointment, you will answer in-depth questions about your personal and family medical history and describe the severity of your symptoms, including how long you have been experiencing them. Your doctor may also perform a flexible scope exam during your visit, using local anesthesia to examine and check the extent of any abnormalities.
Your doctor may also order tests to determine if you have salivary gland cancer, as well as the extent of the cancer and whether it has spread to the lymph nodes or other organs. These tests include:
- Computed tomography (CT or CAT) scan: takes detailed images of internal organs, bones, soft tissue and blood vessels. Your physician is able to use the images to confirm the presence, size and location of a tumor.
- Ultrasound (US) scan: takes detailed images of the soft tissues, salivary glands and lymph nodes.
- Magnetic resonance imaging (MRI) scan: takes detailed pictures to help diagnose cancer and to monitor the effectiveness of treatments.
- Positron emission tomography (PET) scan: generally used in later-stage cancers to determine if cancer has spread to other organs. PET scans are sometimes combined with CT scans to provide a more precise and accurate diagnosis.
- Fine needle aspiration biopsy (FNA): cells are sampled with a needle from a mass in the salivary gland under ultrasound guidance.
- Open biopsy: a small tissue sample is taken from the area to confirm the diagnosis and check for the extent of the cancer. If the tumor is in a minor salivary gland, biopsies can be performed in the office, but your specialist may want a more thorough evaluation by performing a biopsy in the operating room under general anesthesia.
When tumors are malignant, the cancer’s stage is used to determine treatment options. Stages describe the severity of cancer and help your doctor determine the best treatment plan. A lower stage, such as stage I, indicates a smaller cancer confined to one area. The highest stage of salivary gland cancer, IVC, indicates advanced cancer that has spread to other areas of the body.
Most salivary gland tumors are treated with surgery to remove the affected salivary gland. Benign tumors require no further treatment. Patients with advanced stage salivary gland cancers will usually need radiation and sometimes chemotherapy following surgery.
Your Penn State Health head and neck surgeon will discuss the best way to treat your cancer, depending on its type and stage. Our multidisciplinary team also includes radiation and medical oncologists from Penn State Cancer Institute, as well as pathologists who review all cases.
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