Salivary gland tumors

Overview

Salivary gland tumors are growths of abnormal cells (tumors) that begin in the salivary glands. Salivary gland tumors are rare.

Salivary glands make saliva, which aids in digestion, keeps your mouth moist and supports healthy teeth. You have three pairs of major salivary glands under and behind your jaw — parotid, sublingual and submandibular. Many other tiny salivary glands are in your lips, inside your cheeks, and throughout your mouth and throat.

Salivary gland tumors can begin in any of your salivary glands. Most are noncancerous (benign), but sometimes they can be cancerous. Most salivary gland tumors occur in the parotid glands.

Treatment for salivary gland tumors is usually with surgery to remove the tumor. People with salivary gland cancers may need additional treatments.

Symptoms

Signs and symptoms of a salivary gland tumor may include:

• 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

When to see a doctor

Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.

Having a lump or an area of swelling near your salivary gland is the most common sign of a salivary gland tumor, but it doesn't mean you have cancer. Most salivary gland tumors are noncancerous (benign). Many other noncancerous conditions may lead to a swollen salivary gland, including an infection or a stone in a salivary gland duct.

Causes

Salivary gland tumors are rare. Their cause isn't clear.

Salivary gland tumors begin when some cells in a salivary gland develop changes (mutations) in their DNA. A cell's DNA contains the instructions that tell a cell what to do.

The changes tell the cells to grow and divide rapidly. The abnormal cells go on living when healthy cells would die. The accumulating cells form a tumor.

If additional changes happen in the DNA, the abnormal cells may become cancerous. Cancer cells can invade and destroy nearby tissue. They can also break away from the tumor and spread (metastasize) to distant areas of the body.

Types of salivary gland tumors

Many different types of salivary gland tumors exist. Doctors classify salivary gland tumors based on the type of cells involved in the tumors. Knowing the type of salivary gland tumor you have helps your doctor determine which treatment options are best for you.

Types of noncancerous (benign) salivary gland tumors include:

• Pleomorphic adenoma
• Basal cell adenoma
• Canalicular adenoma
• Oncocytoma
• Warthin tumor

Types of cancerous (malignant) salivary gland tumors include:

1. Acinic cell carcinoma
2. Adenocarcinoma
3. Adenoid cystic carcinoma
4. Clear cell carcinoma
5. Malignant mixed tumor
6. Mucoepidermoid carcinoma
7. Oncocytic carcinoma
8. Polymorphous low-grade adenocarcinoma
9. Salivary duct carcinoma
10. Squamous cell carcinoma

Risk factors

Factors that may increase your risk of salivary gland tumors include:

• Older age. Though salivary gland tumors can occur at any age, they most commonly occur in older adults.
• Radiation exposure. Radiation treatments for cancer, such as radiation used to treat head and neck cancers, may increase the risk of salivary gland tumors.
• Workplace exposure to certain substances. People who work with certain substances may have an increased risk of salivary gland tumors. Jobs associated with salivary gland tumors include those involved in rubber manufacturing, asbestos mining and plumbing.

Diagnosis

Tests and procedures used to diagnose salivary gland tumors include:

• Physical exam. Your doctor will feel your jaw, neck and throat for lumps or swelling.
• Imaging tests. Imaging tests, such as magnetic resonance imaging (MRI), computerized tomography (CT), positron emission tomography (PET), ultrasound or X-ray, may help your doctor determine the size and location of your salivary gland tumor.
• Collecting of a sample of tissue for testing (biopsy). To collect a sample of tissue, your doctor may recommend a fine-needle aspiration or a core needle biopsy. During the biopsy, the doctor inserts a thin needle into the salivary gland to draw out a sample of suspicious cells. Doctors in a lab analyze the sample to determine what types of cells are involved and whether the cells are cancerous.

Determining the extent of salivary gland cancer

If you're diagnosed with salivary gland cancer, your doctor will determine the extent (stage) of your cancer. Your cancer's stage determines your treatment options and gives your doctor an idea of your prognosis.

Cancer stages are identified by Roman numerals, with stage I indicating a small, localized tumor and stage IV indicating an advanced cancer that has spread to the lymph nodes in the neck or to distant parts of the body.

Treatment

Treatment for salivary gland tumors is usually with surgery to remove the tumor. People with salivary gland cancers may need additional treatments, such as with radiation therapy and chemotherapy.

Surgery

Surgery for salivary gland tumors may include:

• Removing a portion of the affected salivary gland. If your tumor is small and located in an easy-to-access spot, your surgeon may remove the tumor and a small portion of healthy tissue that surrounds it.
• Removing the entire salivary gland. If you have a larger tumor, your doctor may recommend removing the entire salivary gland. If your tumor extends into nearby structures — such as the facial nerves, the ducts that connect your salivary glands, facial bones and skin — these also may be removed.
• Removing lymph nodes in your neck. Your surgeon may recommend removing some lymph nodes from your neck if your salivary gland tumor is cancerous and there's a risk that the cancer has spread to the lymph nodes. The surgeon removes the lymph nodes that are most likely to contain cancerous cells.

• Reconstructive surgery. After surgery to remove the tumor, your doctor may recommend reconstructive surgery to repair the area. If bone, skin or nerves are removed during your surgery, these may need to be repaired or replaced with reconstructive surgery.

  During reconstructive surgery, the surgeon works to make repairs that improve your ability to chew, swallow, speak, breathe and move your face. You may need transfers of skin, tissue, bone or nerves from other parts of your body to rebuild areas in your mouth, face, throat or jaws.

Salivary gland surgery can be difficult because several important nerves are located in and around the glands. For example, a nerve in the face that controls facial movement runs through the parotid gland.

Removing tumors that involve important nerves may require stretching or cutting the nerves. This can cause partial or complete paralysis of your face (facial droop) that can be temporary or, in some situations, permanent. Surgeons take care to preserve these nerves whenever possible. Sometimes severed nerves can be repaired with nerves taken from other areas of your body or with processed nerve grafts from donors.

Radiation therapy

If you're diagnosed with salivary gland cancer, your doctor may recommend radiation therapy. Radiation therapy uses high-powered energy beams, such as X-rays and protons, to kill cancer cells. During radiation therapy, you lie on a table while a machine moves around you, directing high-powered beams at specific points on your body.

A newer type of radiation therapy that uses particles called neutrons may be more effective in treating certain salivary gland cancers. More study is needed to understand the benefits and risks of this treatment. Neutron radiation therapy isn't widely available in the United States.

Radiation therapy can be used after surgery to kill any cancer cells that might remain. If surgery isn't possible because a tumor is very large or is located in a place that makes removal too risky, your doctor may recommend radiation alone or in combination with chemotherapy.

Chemotherapy

Chemotherapy is a drug treatment that uses medications to kill cancer cells. Chemotherapy isn't currently used as a standard treatment for salivary gland cancer, but researchers are studying its use.

Chemotherapy may be an option for people with advanced salivary gland cancer. It's sometimes used in combination with radiation therapy.

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

Lifestyle and home remedies

Coping with dry mouth

People who undergo radiation therapy to the head and neck area often experience very dry mouth (xerostomia). Having a dry mouth can be uncomfortable. It can also lead to frequent infections in your mouth, cavities and problems with your teeth, and difficulty eating, swallowing and speaking.

You may find some relief from dry mouth and its complications if you:

• Brush your teeth several times each day. Use a soft-bristled toothbrush and gently brush your teeth several times each day. Tell your doctor if your mouth becomes too sensitive to tolerate gentle brushing.
• Rinse your mouth with warm salt water after meals. Make a mild solution of warm water and salt. Rinse your mouth with this solution after each meal.
• Keep your mouth moistened with water or sugarless candies. Drink water throughout the day to keep your mouth moistened. Also try sugarless gum or sugarless candies to stimulate your mouth to produce saliva.
• Choose moist foods. Avoid dry foods. Moisten dry food with sauce, gravy, broth, butter or milk.
• Avoid acidic or spicy foods and drinks. Choose foods and drinks that won't irritate your mouth. Avoid caffeinated and alcoholic beverages.

Tell your doctor if you have dry mouth. Treatments may help you cope with more-severe signs and symptoms of dry mouth. Your doctor may also refer you to a dietitian who can help you find foods that are easier to eat if you're experiencing dry mouth.

Alternative medicine

No complementary or alternative medicine treatments can cure salivary gland tumors. If you're diagnosed with salivary gland cancer, complementary and alternative medicine treatments may help you cope with the side effects of cancer treatment.

Complementary treatments for fatigue

Many people undergoing radiation therapy for cancer experience fatigue. Your doctor can treat underlying causes of fatigue, but the feeling of being utterly worn out may persist despite treatments.

Complementary therapies can help you cope with fatigue. Ask your doctor about trying:

• Exercise. Try gentle exercise for 30 minutes on most days of the week. Moderate exercise, such as brisk walking, during and after cancer treatment reduces fatigue. Talk to your doctor before you begin exercising, to make sure it's safe for you.
• Massage therapy. During a massage, a massage therapist uses his or her hands to apply pressure to your skin and muscles. Some massage therapists are specially trained to work with people who have cancer. Ask your doctor for names of massage therapists in your community.
• Relaxation. Activities that help you feel relaxed may help you cope. Try listening to music or writing in a journal.

Coping and support

Learning you have a salivary gland tumor can be frightening. Each person deals with this diagnosis in his or her own way. With time you'll discover ways of coping that work for you. Until then, you might find some comfort if you:

• Learn enough to feel comfortable making treatment decisions. Ask your doctor for details about your tumor — the type, stage and treatment options. The more you know, the more comfortable you may feel when making treatment decisions.
• Ask friends and family to be your support system. Your close friends and family can provide a support system that can help you cope during treatment. They can help you with the small tasks you may not have the energy for during treatment. And they can be there to listen when you need to talk.
• Connect with others. Other people who've had salivary gland tumors can offer unique support and insight because they understand what you're experiencing. Connect with others through support groups in your community and online.
• Take care of yourself during treatment. Get enough rest each night so that you wake feeling rested. Try to exercise when you feel up to it. Choose a healthy diet full of fruits and vegetables.

Preparing for an appointment

If you have any signs or symptoms that worry you, make an appointment with your family doctor or dentist.

If your doctor or dentist suspects you may have a salivary gland tumor, you may be referred to a doctor who specializes in diseases of the face, mouth, teeth, jaws, salivary glands and neck (oral and maxillofacial surgeon) or to a doctor who specializes in diseases that affect the ears, nose and throat (ENT specialist).

Because appointments can be brief, and because there's often a lot of information to consider, it's a good idea to be well prepared. Here's some information to help you get ready, and know what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you're taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For salivary gland tumors, some basic questions to ask include:

• Where is my salivary gland tumor located?
• How large is my salivary gland tumor?
• Is my salivary gland tumor cancerous?
• If the tumor is cancerous, what type of salivary gland cancer do I have?
• Has my cancer spread beyond the salivary gland?
• Will I need more tests?
• What are my treatment options?
• Can my salivary gland tumor be cured?
• What are the potential side effects of each treatment option?
• Will treatment make it difficult for me to eat or speak?
• Will treatment affect my appearance?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow time later to cover other points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?