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Salivary Gland Cancer

Salivary Gland Cancer
City of Hope offers a truly comprehensive treatment approach to salivary gland cancer. We employ the latest chemotherapy protocols and develop promising experimental therapies through our drug development research programs. These combined attributes allow us to provide powerful therapeutic options to patients fighting salivary gland cancer.

Salivary gland cancer patients at City of Hope receive treatment from a coordinated, multidisciplinary team of surgeons, oncologists, endocrinologists, radiation oncologists, nurses, supportive care specialists and others, ensuring the highest possible standard of care.
 
About Salivary Gland Cancer
 
The term “salivary gland cancer” represents a diverse group of malignant tumors. These tumors may occur in different types of salivary glands and originate from a variety of cell types. These characteristics impact prognosis and treatment options.

Types of Salivary Glands

Salivary glands are classified as major or minor. The major salivary glands come in pairs, and are much larger than the minor salivary glands. The major salivary glands are:

  • Parotid glands - the largest of the salivary glands, located immediately in front of and below each ear
  • Sublingual glands –these glands are located under the tongue
  • Submandibular glands – these glands are located beneath the mandible, or jawbone.
 
The minor salivary glands are very small, and are located in the mucosa (mucous membranes) of the lips and cheeks, hard and soft palate, uvula, the floor of the mouth, the back of the tongue, and the area near the tonsils, among other areas of the mouth and throat. Most tumors of the minor salivary glands are located in the hard palate, which has the greatest concentration of minor salivary glands in the mouth.
 
Salivary Gland Cancer Risk Factors
 
  • Age: Most patients are diagnosed in their 50s and 60s
  • External radiation exposure, especially to the head and neck; this includes radiation therapy used in previous cancer treatment
  • Tobacco use – both smoking and chewing tobacco may increase the risk of squamous cell salivary cancers
  • Occupational exposure – workers exposed to silica dust, nickel-containing dust, asbestos, as well as those engaged in rubber products manufacturing, plumbing and some types of woodworking may be more likely to develop salivary cancer
  • Family history of salivary gland cancer
  • Diet – some studies suggest a diet high in animal fats and low in vegetables may increase the risk of salivary gland cancer
 
Salivary Gland Cancer Symptoms
 
Salivary gland cancer may not cause any symptoms. It is sometimes found during a regular dental check-up or physical exam. Symptoms caused by salivary gland cancer also may be caused by other conditions.

Symptoms specific or more common to a particular type of salivary gland cancer are mentioned in the descriptions of each type of cancer, listed above. A doctor should be consulted if any of the following problems occur:
 
  • A lump (usually painless) in the area of the ear, cheek, jaw, lip or inside the mouth
  • Fluid draining from the ear
  • Trouble swallowing or opening the mouth widely
  • Numbness or weakness in the face
  • Pain in the face that does not go away

Salivary Gland Cancer Staging

Staging is the process of finding out if and how far a cancer has spread. The stage of a cancer is one of the most important factors in choosing treatment options and predicting your chance for cure and long-term survival.

Staging is based on the results of the physical exam, biopsy, the physician’s impression during or after surgery to remove the tumor (presence or absence of invasion of the tumor to other organs) and imaging tests (ultrasound, computed tomography scan, magnetic resonance imaging, positron emission tomography scan or endoscopy).

Stage I
In stage I, the tumor is in the salivary gland only and is 2 centimeters or smaller.

Stage II
In stage II, the tumor is in the salivary gland only and is larger than 2 centimeters but not larger than 4 centimeters.

Stage III
In stage III, one of the following is true:

The tumor is not larger than 4 centimeters and has spread to a single lymph node on the same side as the tumor and the lymph node is 3 centimeters or smaller.

The tumor is larger than 4 centimeters and/or has spread to soft tissue around the affected gland. Cancer may have spread to a single lymph node on the same side as the tumor and the lymph node is 3 centimeters or smaller.

Stage IV
Stage IV is divided into stages IVA, IVB and IVC as follows:

Stage IVA:
The tumor may be any size and may have spread to soft tissue around the affected gland. Cancer has spread to one or more lymph nodes on either or both sides of the body and the lymph nodes are not larger than 6 centimeters; or

Cancer has spread to the skin, jawbone, ear canal and/or facial nerve, and may have spread to one or more lymph nodes on either or both sides of the body. The lymph nodes are not larger than 6 centimeters.

Stage IVB:
The tumor may be any size and may have spread to soft tissue around the affected gland. Cancer has spread to a lymph node larger than 6 centimeters; or

Cancer has spread to the base of the skull and/or the carotid artery, and may have spread to one or more lymph nodes of any size on either or both sides of the body.

Stage IVC:
The tumor may be any size and may have spread to soft tissue around the affected gland, to the skin, jawbone, ear canal, facial nerve, base of the skull or carotid artery, or to one or more lymph nodes on either or both sides of the body. Cancer has spread to distant parts of the body.

Salivary gland cancers are also grouped by grade. The grade of a tumor describes how fast the cancer cells are growing based on how the cells look under a microscope. Low-grade cancers grow more slowly than high-grade cancers.

Minor salivary gland cancers are staged according to where they were first found in the body.

Diagnosing Salivary Gland Cancer

A variety of methods is used to diagnose salivary gland cancer. They include:
 

  • Physical exam and history
After a physical exam that reveals cause for suspicion of salivary gland cancer, imaging tests may be ordered to determine the extent of spread of the tumor, if any. Standard imaging tests include:
 

 

  • Magnetic resonance imaging (MRI): A procedure that uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear MRI , or NMRI.
  • CT (computed tomography) scan: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computerized tomography or computerized axial tomography.
  • Positron emission tomography (PET) scan: A procedure to find malignant tumor cells in the body. A small amount of a radioactive glucose derivative (fluorodeoxyglucose) is injected into a vein. The PET scanner rotates around the body and generates a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. For salivary gland cancer, an endoscope is inserted into the mouth to look at the mouth, throat and larynx. An endoscope is a thin, tube-like instrument with a light and a lens for viewing.


After identifying the primary site or sites of the tumor, a biopsy may be ordered, as detailed below:
 

  • Fine needle aspiration biopsy: The removal of tissue or fluid using a thin needle. A pathologist views the tissue or fluid under a microscope to look for cancer cells. This test is necessary to establish three things: 1) whether the tumor is benign or malignant, 2) what type of cell the tumor originated from and 3) what grade, or level of differentiation, the tumor cells display.
 

Salivary Gland Cancer Treatment Options

Department of Surgery
First-line treatment for salivary gland cancer is surgery.  The surgeon will remove the affected salivary gland and possibly some surrounding tissue.  If nearby lymph nodes are thought to be involved, they will also be removed, and a neck dissection will be performed.
 
Radiation Therapy
In cases of higher-grade or larger tumors, unclean surgical margins or evidence of lymph node metastasis, postoperative radiation therapy is recommended to improve clinical outcomes. It may be used by itself in cases where the tumor may be too large to be removed surgically, where surgery would be disfiguring, or if the tumor is inoperable for other reasons. It is useful for reducing symptoms such as pain and difficulty in swallowing.
 
City of Hope’s Radiation Oncology was the first in the western United States to offer the helical TomoTherapy Hi-Art System, one of the first radiation therapy systems of its kind to incorporate not only radiation therapy, but also tumor imaging capabilities comparable to a diagnostic computed tomography (CT) scan.
 
Radiation therapy is a localized treatment, which means it provides benefits — and side effects — in the exact area where it’s delivered.  By reducing the radiation dose to an area of normal, healthy tissue, a patient will experience potentially fewer side effects than they would in a more conventional treatment setting. This is especially important in the treatment of cancers of the head and neck region.  If the radiation dose can be spared to any portion of the oral cavity (mouth) or throat, the patient will experience significant fewer problems in making their way through the course of treatment. This advanced technique makes it possible to reduce the dose to the parotid gland, hence – saliva is preserved – lessening a patient’s possibility of having a dry mouth.  In addition, TomoTherapy can assist in reducing dose to the normal swallowing muscles.  This can improve a patient’s ability to continue eating – directly impacting a patient’s quality of life.
 
Chemotherapy
Chemotherapy is sometimes used with radiation in cases of salivary gland cancer where the disease is metastatic, unresectable and/or recurrent.  It may also be employed postsurgically (along with radiation) in late-stage or aggressive cancers. Chemotherapy regimens vary depending on the particular cell type in question.
 
Clinical Trials
City of Hope has several clinical trials involving experimental therapies for advanced solid tumors of the head and neck. Some of these may apply to salivary cancer.  One clinical trial includes the use of cetuximab (Erbitux), a monoclonal antibody that inhibits EGFR (epidermal growth factor receptor), impairing the growth of cancer cells. Sometimes, this is combined with radiation and chemotherapy.  Click here for more information.
 
Follow-up
Because salivary gland cancer can recur, patients should be followed closely for any signs of recurrence or metastasis. This is accomplished by regular physical exams that include thorough head and neck palpation as well as multiple imaging modalities, e.g., ultrasound, CT, magnetic resonance imaging and positron emission tomography scans.
 

Salivary Gland Cancer Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Kimberly Wah
Director
Phone: 213-241-7275
Email: kwah@coh.org

 
 
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