Salivary Gland Cancer

Cancer of the salivary glands is one of many head and neck cancers. There are three main pairs of salivary glands in and around the mouth and throat that produce and release saliva into your mouth.  The parotid glands which release saliva through tubes called salivary ducts are located near your upper teeth, the submandibular glands are under your tongue, and the sublingual glands are located in the floor of your mouth.  There are also many tiny glands called minor salivary glands located in your lips, inner cheek area, and extensively in other linings of your mouth and throat. Salivary glands produce the saliva necessary to moisten your mouth, facilitate digestion, and help protect your teeth from decay.

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Salivary gland cancers are rare and occur mainly in the sixth or seventh decade of life.1,2,3 The cause of most salivary gland cancers is unknown and approximately 70% to 80% of all salivary gland cancers originate in the parotid glands.1,4,5  Early-stage salivary gland cancers are usually curable by adequate surgical resection alone. Unresectable or recurrent cancers may respond to chemotherapy.6,7

It is highly recommended that patients be carefully evaluated in medical centers that treat many patients with cancers of the head and neck. Patients with salivary gland cancer require a multidisciplinary team approach that is often only available at specialty medical centers. A multidisciplinary team may be comprised of a head and neck surgeon, a radiation oncologist, a medical oncologist, a pathologist, a dentist, and social services personnel. Evaluation by an experienced team is essential for determining optimal treatment.

Staging

Staging is the process of identifying how extensive the cancer is. Accurately identifying the stage of a cancer helps determine what treatments will be most effective. Staging is particularly important for determining whether a cancer has spread from its original site to other parts of the body. The four general cancer stages are early, locally advanced, metastatic, and recurrent.

Cancers of the salivary glands are staged according to size, lymph node involvement (in parotid tumors, whether or not the facial nerve is involved), and presence of metastases.1,2,3,4 Magnetic resonance imaging (MRI) offers advantages over computed tomographic scanning in the detection and localization of head and neck cancer and is preferred for evaluation of suspected neoplasms of the salivary glands.7

Early Stage Cancer

Stage I, II, and some stage III cancers are referred to as early stage. At these stages, the cancer is small, localized and can typically be treated with surgery or radiation therapy.

Stage I The cancer is no more than 2 centimeters (about 1 inch) and has not spread to lymph nodes in the area.

Stage II The cancer is more than 2 centimeters, but less than 4 centimeters (less than 2 inches) and has not spread to lymph nodes in the area.

Stage III The cancer is less than 4 centimeters and involves 1 lymph node less than 3 centimeters in size on the same side of the face as the primary cancer, or the cancer is more than 4 centimeters.

Stage IVA The cancer has spread and invades the skin, mandible (jaw bone), ear canal, and or facial nerve or other structures and or has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck or to any lymph node that measures more than 6 centimeters (over 2 inches). The cancer has not spread to distant sites.

Stage IVB The cancer is any size and has spread into the base of the skull or other regional bones or it surrounds the carotid artery. The cancer may or may not have spread to lymph nodes and has not spread to distant sites.

Stage IVC The cancer is any size, may or may not have spread to nearby tissues, bones, or lymph nodes. The cancer has spread to distant sites (metastatic).

Recurrent cancer has failed to respond completely to primary treatment or has recurred after a complete response.

References

1 Speight PM, Barrett AW: Salivary gland tumours. Oral Dis 8 (5): 229-40, 2002.

2 Ellis GL, Auclair PL: Tumors of the Salivary Glands. Washington, DC : Armed Forces Institute of Pathology, 1996. Atlas of Tumor Pathology, 3.

3 Wahlberg P, Anderson H, Biörklund A, et al.: Carcinoma of the parotid and submandibular glands–a study of survival in 2465 patients. Oral Oncol 38 (7): 706-13, 2002.

4 Mendenhall WM, Werning JW, Pfister DG: Treatment of head and neck cancer. In: DeVita VT Jr, Lawrence TS, Rosenberg SA: Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2011, pp 729-80.

5 Gooden E, Witterick IJ, Hacker D, et al.: Parotid gland tumours in 255 consecutive patients: Mount Sinai Hospital’s quality assurance review. J Otolaryngol 31 (6): 351-4, 2002.

6 Wang CC, Goodman M: Photon irradiation of unresectable carcinomas of salivary glands. Int J Radiat Oncol Biol Phys 21 (3): 569-76, 1991.

7 Buchholz TA, Laramore GE, Griffin BR, et al.: The role of fast neutron radiation therapy in the management of advanced salivary gland malignant neoplasms. Cancer 69 (11): 2779-88, 1992.