Types of Cancer : Salivary Glands Cancer

Definition

Salivary gland cancer is a rare form of cancer that occurs in one of the salivary glands in your mouth, neck or throat.

The cause of salivary gland cancer is not clear, although exposure to radiation, use of tobacco and a family history of salivary gland cancer may increase your risk.

Because predicting who will get salivary gland cancer can be difficult, be sure to pay attention to possible signs and symptoms, such as a painless lump. If you develop a lump or mass on or near your jaw or in your neck or mouth, see your doctor.

Symptoms

Salivary gland cancer is often painless in its early stages. A common sign is a lump, mass or swelling in the area of a salivary gland. Just because you have a lump in the area of a salivary gland, however, doesn't necessarily mean you have cancer. More than half the tumors found in the salivary glands are noncancerous (benign).

Signs and symptoms that may indicate salivary gland cancer and a need to see your doctor include the following:

• A lump or swelling on or near your jaw or in your neck or mouth
• Numbness in part of your face
• Muscle weakness on one side of your face
• Persistent pain in the area of a salivary gland
• Difficulty swallowing
• Trouble opening your mouth widely
• A newly developed, noticeable difference in size between the right and left side of your face

Causes

Salivary glands are located in and around your mouth and throat. Salivary glands make saliva, which aids in digestion, helps prevent tooth decay and keeps your mouth moist.

You have three pairs of major salivary glands under and behind your jaw — parotid, sublingual and submandibular. The parotid gland, which is just in front of your ear, is the most common site of salivary gland cancer. Many other tiny salivary glands are in your lips, inside your cheeks and throughout your mouth and throat.

The exact cause of salivary gland cancer isn't known. In some cases, cancer may develop due to DNA damage, as can occur after years of tobacco use or exposure to radiation. Heredity also may play a role in the development of salivary gland cancer.

Risk factors

In general, these factors may increase the likelihood that you'll develop salivary gland cancer:

• Tobacco use. Smoking or using chewing tobacco can increase your risk of some types of salivary gland cancer.
• Radiation exposure. Because radiation has the potential to damage DNA, if you've had radiation treatment to your head or neck, or if you're exposed to radioactive materials in your work, you may be more likely to develop some types of cancer, including salivary gland cancer, than may people who haven't been exposed to radiation.
• Family history. If members of your family have had salivary gland cancer, you may be at a higher risk of getting the disease.
• Diet. Eating large amounts of animal fats and low quantities of vegetables may increase the risk of salivary gland cancer.
• Age. Additionally, people older than 60 are more likely to develop salivary gland cancer.

When to seek medical advice

See your doctor if you develop any of the following signs or symptoms:

• A lump or swelling in your face, neck or mouth
• Numbness in part of your face
• Muscle weakness on one side of your face
• Persistent pain in the area of a salivary gland

Tests and diagnosis

If your doctor suspects you might have salivary gland cancer, he or she will first do a physical exam, feeling for lumps in your jaw, neck and throat, feeling inside your mouth and inspecting your mouth with a small mirror and lights.

In order to detect abnormal tissue, your doctor may have you undergo imaging tests:

• Computerized tomography (CT) scan. A CT scan allows your doctor to see your organs in two-dimensional slices. Split-second computer processing creates these images as a series of very thin X-ray beams are passed through your body.
• Magnetic resonance imaging (MRI) scan. An MRI scanner uses no X-rays. Instead, a computer creates tissue-slice images from data generated by a powerful magnetic field and radio waves. These images can be viewed from any direction or plane.

CT and MRI scans can help your doctor determine if you have a tumor, how large it is, and if it has spread outside of the salivary gland. If test results show an abnormality, your doctor will need to take a small tissue sample (biopsy) that will be examined in the laboratory. Results of the biopsy will show if the abnormal tissue is cancerous.

Further identification of your cancer
If the biopsy reveals salivary gland cancer, your doctor will then determine the type of cell in which the cancer began, as well as the disease's grade and stage, in order to recommend the most appropriate treatment. The grade of cancer is a factor your doctor will use to determine how quickly the tumor may grow or spread, and the stage defines the extent or spread of the cancer. Additional MRI or CT scans may be necessary to determine the cancer's stage.

Treatments and drugs

Treatment for salivary gland cancer usually involves surgery, with or without radiation therapy. Your treatment plan should be tailored specifically for you by a team of doctors including head and neck surgeons (otolaryngologists), cancer specialists (oncologists) and doctors who specialize in treating cancer with radiation (radiation oncologists).

Surgery
If the cancer hasn't spread outside the salivary gland, and if the tumor is small and low grade, surgery alone may be all you need to remove the cancer.

Removing a tumor from the salivary glands can be complicated because several important nerves are located in and around these glands. For example, a nerve that controls facial movement runs through the parotid gland. Complications of removing a tumor from the parotid gland may include nerve damage, which can affect movement in your face. Nerves near the submandibular and sublingual glands include those that control tongue movement, feeling and taste. If the cancer has spread outside the salivary gland, some of those nerves may need to be removed.

Your surgeon may need to remove lymph nodes in your neck (neck dissection) to see if the cancer has spread. In addition to removing the lymph nodes, neck dissection may involve removal of other muscles and nerves in your neck, as well. Complications from neck dissection may include ear numbness, weakness in your lower lip and weakness in raising your arm above your head.

Physical therapy
You may need physical therapy to help you overcome complications from surgery, such as difficulty speaking, chewing or swallowing. A dietitian can help you choose foods that are suitable for you if you've lost some of your ability to chew and swallow. You'll also receive instructions on how to learn to swallow again.

Reconstructive therapy
If a large amount of bone or tissue is taken during surgery, you may need reconstructive surgery. The goal of reconstructive surgery is to improve your appearance and to help you adjust to difficulties you may have with chewing, swallowing, speaking or breathing. You may need grafts of skin or tissue from other parts of your body to rebuild areas in your mouth, throat or jaw. You may also need to have a dental prosthesis implanted to replace a part of your jaw removed during surgery.

Radiation therapy
Radiation therapy destroys cancer cells using high-energy radiation. Radiation for salivary gland cancer usually comes from a machine outside the body (external radiation therapy).

If the tumor is large or high grade, if the cancer has spread outside the salivary glands or if your doctor is concerned that other areas may be affected, radiation after surgery may be part of your treatment. If a tumor cannot be removed by surgery, radiation alone may be used to treat salivary gland cancer.

Side effects from radiation to the head and neck are usually temporary and may include changes in skin color and texture (similar to a suntan or sunburn), dry mouth, sore throat, hoarseness, problems swallowing, loss of or changes in taste, or fatigue.

Chemotherapy
Chemotherapy is not used as a standard treatment for salivary gland cancer, although researchers are investigating its effectiveness in treating this condition.

Prevention

Take these steps to help prevent salivary gland cancer or its progression:

• Avoid or limit exposure to radiation, when possible.
• Avoid using tobacco and other known cancer-causing substances (carcinogens)
• Eat a nutrient-rich diet that includes more than five servings of fruits and vegetables daily, and limit your intake of animal fat.
• Check your mouth and jaw periodically for lumps or bumps.
• Have your doctor or dentist check your salivary glands during routine checkups.

If you notice a lump, don't ignore it. See your doctor or dentist. It's often difficult to tell if a lump is benign or cancerous without imaging tests or a biopsy.