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Salivary Gland 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. You have major salivary glands under and behind your jaw and hundreds of other tiny salivary glands in your lips, inside your cheeks and throughout your mouth and 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. As with other head and neck cancers, men and people older than 50 are more likely to develop salivary gland cancer.

Because predicting who will get salivary gland cancer can be difficult, be sure to pay attention to possible signs and symptoms. The first sign of salivary gland cancer often is a painless lump that forms near a saliva gland. If you develop a lump or mass on or near your jaw or in your neck or mouth, see your doctor.

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.

When cells are healthy, they grow and divide in an orderly way. This process is controlled by DNA — the genetic material that contains the instructions for every chemical process in your body. When DNA is damaged, changes occur in these instructions. One result is that cells may begin to grow out of control and eventually form a mass of cancer cells.

Just what causes this process to start in salivary gland cells is not known. It's also unclear why some salivary gland tumors are benign and others are cancerous. Like many other head and neck cancers, however, using tobacco can increase your risk of salivary gland cancer. Most head and neck cancers are associated with tobacco use. Exposure to radiation and heredity also may play a role in the development of salivary gland cancer.


Risk Factor :
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 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 have not 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.

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

Symptoms:
Salivary gland cancer is often painless in its early stages. The most 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).

If you have a lump or experience swelling on or near your jaw or in your neck or mouth, or if you develop any of the other signs or symptoms below, see your doctor :

  • Numbness in part of your face
  • Muscle weakness on one side of your face
  • Persistent pain in the area of a salivary gland

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.

  • Cellular classification. Salivary gland cancer can begin in many different kinds of cells. With more than 40 types of known tumors, salivary gland cancer has one of the body's most diverse tumor groups, which can sometimes make cellular classification of the disease complicated.
  • Grading. The grade of salivary gland cancer depends on how the cancerous cells look under a microscope. Low-grade cancer cells look more like normal cells than high-grade cells, which appear much more abnormal. The grade of cancer is a factor your doctor will use to determine how quickly the tumor may grow or spread.
  • Staging. This defines the extent or spread of the cancer. The stage of salivary gland cancer is based on tumor size, spread of the cancer outside of the salivary glands and lymph node involvement. Additional MRI or CT scans may be necessary to determine the cancer's stage.
Treatment:
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 surgeons, 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 (the VII cranial nerve) 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 will 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 uses X-rays to kill cancer cells. 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 may include changes in skin color and texture (similar to a suntan or sunburn), a dry mouth or thickened saliva, redness, irritation and sores in the mouth, sore throat, hoarseness, problems swallowing, a stiff jaw, loss of or changes in taste, earaches, bone pain, nausea, or fatigue.

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

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

  • Avoid tobacco use.
  • Avoid or limit exposure to radiation, when possible.
  • 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 just because it is painless and doesn't hurt if you touch 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.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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