Overview of Salivary Gland Cancer

Symptoms, Diagnosis, & Treatment of Salivary Gland Cancer

Salivary Gland Cancer

Medically reviewed by Dr. C.H. Weaver M.D. Medical Editor 8/2018

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.

Treatment of Salivary Gland Cancer

Early stage cancer of the salivary gland is treated with surgery or radiation. More advanced stages and recurrent cancers often require a combination of surgery, radiation and systemic treatment with chemotherapy or precision cancer medicines.

Patients with cancer of a salivary gland should be evaluated in a medical center that treats many patients with these cancers because effective treatment typically require a multidisciplinary team approach comprised of a head and neck surgeon, a radiation oncologist, a medical oncologist, a pathologist, a dentist, and social services personnel. Evaluation and treatment by an experienced team is essential for optimal treatment and support.

Early Stage I- III Salivary Gland Cancer

Early stage salivary gland cancers are small, localized, and highly curable when treated with surgery and/or radiation therapy. Early stage disease includes stage I, II, and most stage III cancers. Stage III cancer can be considered “early” if it is small and involves only a single lymph node, which can be surgically removed.

Patients with salivary gland cancers should consider being evaluated in a medical center that treats many patients with these cancers because salivary gland cancer may require a multidisciplinary team approach comprised of a head and neck surgeon, a radiation oncologist, a medical oncologist, a plastic surgeon, a dentist, and social services personnel. Evaluation and treatment by an experienced team is essential for determining optimal treatment and support.

Surgery: Patients with low-grade stage I- III cancer of the salivary gland may be cured with surgery alone.(1,2,3) The minimum therapy for low-grade malignancies of the superficial portion of the parotid gland is a superficial parotidectomy. For all other lesions, a total parotidectomy is indicated. The facial nerve or its branches should be resected if involved by tumor; repair can be done simultaneously.

Radiation therapy: Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation therapy works by damaging the DNA in the cancer cell, thereby disabling the cancer cells from reproducing and growing. The National Cancer Institute recommends that patients undergoing radiation therapy be seen by a radiation oncologist experienced in managing salivary gland cancer. Treatment is individualized for each patient and will take advantage of the latest advances in the delivery of radiation therapy.(4)

Radiation therapy as primary treatment for salivary gland cancer is not often required but may be used when surgical resection involves a significant cosmetic or functional deficit, or in addition to surgery when evidence of the cancer remains in the margins following surgical removal of the cancer.(4)

Neutron-beam radiation therapy improves survival and delays the time to cancer recurrence in patients with slavery gland cancers that cannot be removed surgically.(5,6,7,8) Cancer treatment centers with fast neutron-beam radiation therapy are of limited availability in the United States. Accelerated hyperfractionated photon-beam radiation therapy has also resulted in high rates of long-term control of salivary gland cancers.(9,10)

Patients with high-grade stage III salivary gland tumors that are confined to the gland in which they arise may be cured by surgery alone, and postoperative radiation therapy may be used, especially if positive margins are present to decrease the risk of local cancer recurrence. Fast neutron beam radiation therapy has been reported to improve disease-free survival and overall survival in this clinical situation.(5,6,7) Patients with tumors that have spread to regional lymph nodes should have a regional lymphadenectomy as part of the initial surgical procedure.

Treatment of Advanced Salivary Gland Cancer

Advanced salivary gland cancers are those that are too large to be effectively cured with surgery and or have already spread or metastasized to other locations in the body. Treatment with surgery and/or radiation therapy can help with local control of the cancer but is not typically curative.

Patients with advanced or recurrent salivary gland cancers should consider being evaluated in a medical center that treats many patients with these cancers because salivary gland cancer may require a multidisciplinary team approach comprised of a head and neck surgeon, a radiation oncologist, a medical oncologist, a plastic surgeon, a dentist, and social services personnel. Evaluation and treatment by an experienced team is essential for determining optimal treatment and support.

Patients with advanced salivary gland cancer should strongly consider participation in clinical trials. Their cancer may be responsive to aggressive combinations of chemotherapy and radiation. Chemotherapy using doxorubicin, cisplatin, cyclophosphamide, and fluorouracil as single agents or in various combinations is associated with modest response rates.(1,2,3,4) Newer precision medicines are ongoing evaluation in clinical trials.

Radiation therapy: Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. Radiation therapy works by damaging the DNA in the cancer cell, thereby disabling the cancer cells from reproducing and growing. The National Cancer Institute recommends that patients undergoing radiation therapy be seen by a radiation oncologist experienced in managing salivary gland cancer. Treatment is individualized for each patient and will take advantage of the latest advances in the delivery of radiation therapy.

Fast neutron-beam radiation therapy or accelerated hyperfractionated photon-beam schedules have been reported to be more effective than conventional x-ray therapy in the treatment of patients with advanced salivary gland cancers.(5,6,7,8)

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.
  8. Byers RM, Jesse RH, Guillamondegui OM, et al.: Malignant tumors of the submaxillary gland. Am J Surg 126 (4): 458-63, 1973.
  9. Woods JE, Chong GC, Beahrs OH: Experience with 1,360 primary parotid tumors. Am J Surg 130 (4): 460-2, 1975.
  10. Guillamondegui OM, Byers RM, Luna MA, et al.: Aggressive surgery in treatment for parotid cancer: the role of adjunctive postoperative radiotherapy. Am J Roentgenol Radium Ther Nucl Med 123 (1): 49-54, 1975.
  11. 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.
  12. Krüll A, Schwarz R, Engenhart R, et al.: European results in neutron therapy of malignant salivary gland tumors. Bull Cancer Radiother 83 (Suppl): 125-9s, 1996.
  13. Douglas JG, Lee S, Laramore GE, et al.: Neutron radiotherapy for the treatment of locally advanced major salivary gland tumors. Head Neck 21 (3): 255-63, 1999.
  14. Douglas JG, Laramore GE, Austin-Seymour M, et al.: Treatment of locally advanced adenoid cystic carcinoma of the head and neck with neutron radiotherapy. Int J Radiat Oncol Biol Phys 46 (3): 551-7, 2000.
  15. Wang CC, Goodman M: Photon irradiation of unresectable carcinomas of salivary glands. Int J Radiat Oncol Biol Phys 21 (3): 569-76, 1991.
  16. Douglas JG, Koh WJ, Austin-Seymour M, et al.: Treatment of salivary gland neoplasms with fast neutron radiotherapy. Arch Otolaryngol Head Neck Surg 129 (9): 944-8, 2003.
  17. Venook AP, Tseng A Jr, Meyers FJ, et al.: Cisplatin, doxorubicin, and 5-fluorouracil chemotherapy for salivary gland malignancies: a pilot study of the Northern California Oncology Group. J Clin Oncol 5 (6): 951-5, 1987.
  18. Posner MR, Ervin TJ, Weichselbaum RR, et al.: Chemotherapy of advanced salivary gland neoplasms. Cancer 50 (11): 2261-4, 1988.
  19. Suen JY, Johns ME: Chemotherapy for salivary gland cancer. Laryngoscope 92 (3): 235-9, 1982.
  20. Licitra L, Cavina R, Grandi C, et al.: Cisplatin, doxorubicin and cyclophosphamide in advanced salivary gland carcinoma. A phase II trial of 22 patients. Ann Oncol 7 (6): 640-2, 1996.
  21. Wang CC, Goodman M: Photon irradiation of unresectable carcinomas of salivary glands. Int J Radiat Oncol Biol Phys 21 (3): 569-76, 1991.
  22. Laramore GE, Krall JM, Griffin TW, et al.: Neutron versus photon irradiation for unresectable salivary gland tumors: final report of an RTOG-MRC randomized clinical trial. Radiation Therapy Oncology Group. Medical Research Council. Int J Radiat Oncol Biol Phys 27 (2): 235-40, 1993.
  23. Krüll A, Schwarz R, Engenhart R, et al.: European results in neutron therapy of malignant salivary gland tumors. Bull Cancer Radiother 83 (Suppl): 125-9s, 1996.
  24. Douglas JG, Lee S, Laramore GE, et al.: Neutron radiotherapy for the treatment of locally advanced major salivary gland tumors. Head Neck 21 (3): 255-63, 1999.
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