Parotid tumors

Diagnosis

Tests and procedures used to diagnose a parotid tumor may include:

• A physical exam. A healthcare professional feels the jaw, neck and throat for lumps or swelling.

• Collecting a sample of tissue for testing. A biopsy is a procedure to collect a sample of tissue for testing. It typically involves using a needle to collect fluid or tissue from the parotid gland. The needle may be inserted through the skin on the face and into the parotid gland.

  In the lab, tests can show what types of cells are involved and tell if they're cancerous. This information helps your healthcare team understand your prognosis and which treatments are best for you.

  Results from a needle biopsy aren't always correct. Sometimes the results say a tumor isn't cancerous when it is. For this reason, some healthcare professionals don't do a biopsy before surgery. Instead, they may take a sample of tissue for testing during surgery.

• Imaging tests. Imaging tests help your healthcare team understand the size and location of your tumor. If your parotid tumor is cancerous, imaging tests help look for signs that the cancer has spread. Tests may include ultrasound, MRI and CT.

Treatment

Parotid tumor treatment often involves surgery to remove the tumor. If the tumor is cancerous, you might need more treatment. This could be with radiation therapy and chemotherapy.

Surgery

Operations used to remove parotid tumors include:

• Removing part of the parotid gland. For most parotid tumors, surgeons may cut away the tumor and some of the healthy parotid gland tissue around it. The part of the parotid gland that's left continues working as before.
• Removing all of the parotid gland. Surgery to remove all of the parotid gland is called parotidectomy. It might be needed for larger tumors, tumors that are cancerous and those that affect the deeper parts of the parotid gland.
• Removing more tissue to get all of the cancer. If parotid gland cancer has grown into nearby bone and muscles, some of these may be taken out with the parotid gland. Surgeons try to remove all of the cancer and a small amount of the healthy tissue that surrounds it. Then they work to repair the area so that you can continue to chew, swallow, speak, breathe and move your face. This may involve moving skin, tissue, bone or nerves from other parts of your body to make repairs. This type of surgery isn't needed for parotid tumors that aren't cancerous.

To get to the parotid gland, surgeons make a cut in the skin near the ear. The cut is often hidden in a crease of skin or behind the ear.

Sometimes a sample of tumor tissue is tested during surgery to see if it's cancer. A doctor who uses blood and body tissue to diagnose diseases, who is called a pathologist, looks at the sample right away. The pathologist tells the surgeon if the tumor is cancerous. This helps the surgeon decide how much of the parotid gland to remove. The pathologist also might test nearby lymph nodes and other tissue for signs of cancer.

The parotid gland surrounds the nerve that moves the muscles of the face. This nerve is called the facial nerve. Surgeons take special care to avoid hurting it. They might use electrical devices to check on the nerve and make sure it works as expected after surgery.

Sometimes the facial nerve gets stretched during surgery. This can cause loss of movement in the face muscles. Muscle movement often gets better over time. Rarely, the facial nerve must be cut in order to get all of the tumor. Surgeons can repair the facial nerve using nerves from other areas of the body or from artificial nerves.

Parotid tumor surgery can be complex. It requires well-trained surgeons and specialists for the best outcome. If you're facing surgery for a parotid tumor, meet with your surgeon before your operation to ask questions. Learning more about the procedure can help you feel more comfortable about your treatment plan. You might consider asking:

• Where will you cut into the skin to reach the parotid gland? Will I have a scar?
• How much of the parotid gland do you plan to remove?
• How likely is it that the facial nerve will be hurt? How will you manage this?
• How will you be sure that you've removed all of the tumor?
• Will you remove any lymph nodes?
• Will I need reconstructive surgery? What will that involve?
• What should I expect during recovery? How long will it take to heal?

Radiation therapy

Radiation therapy uses powerful energy beams to kill cancer cells. The energy can come from sources such as X-rays and protons.

Radiation therapy is used to treat parotid gland cancers. Radiation therapy might be recommended after surgery. The radiation can kill any cancer cells that remain. If surgery isn't possible, radiation therapy might be the first treatment for parotid cancers.

Chemotherapy

Chemotherapy uses strong medicines to kill cancer cells. Chemotherapy is sometimes used to treat parotid gland cancers. It might be needed if there's a risk that the cancer might spread or if surgery isn't an option. In these situations, chemotherapy might be done at the same time as radiation therapy.

Chemotherapy is sometimes used on its own for advanced cancer, such as cancer that has spread to other parts of the body. Chemotherapy may help relieve pain and other symptoms caused by the cancer.

Targeted therapy

Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Targeted therapy might be an option for treating parotid gland cancers when other treatments haven't helped.

Preparing for your appointment

Make an appointment with a doctor or other healthcare professional if you have any symptoms that worry you.

If your healthcare professional thinks that you might have a parotid tumor, you may be referred to a doctor who specializes in diseases of the ears, nose and throat. This doctor is called an ENT specialist or an otolaryngologist. If a cancer diagnosis is made, you also may be referred to a doctor who specializes in treating cancer, called an oncologist.

Because appointments can be brief, it's a good idea to be prepared. Here's some information to help you get ready.

What you can do

• Be aware of anything you need to do ahead of time. 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 symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down important personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements you're taking and the doses.
• Take a family member or friend along. Sometimes it can be very hard to remember all the information provided during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

Your time with your healthcare team 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 parotid tumors, some basic questions to ask include:

• Do I have a parotid tumor?
• Is my parotid tumor cancerous?
• What is the stage of my parotid tumor?
• Has my parotid tumor spread to other parts of my body?
• Will I need more tests?
• What are the treatment options?
• How much does each treatment increase my chances of a cure or prolong my life?
• What are the potential side effects of each treatment?
• How will each treatment affect my daily life?
• Is there one treatment option you believe is the best?
• What would you recommend to a friend or family member in my situation?
• Should I see a specialist?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

Don't hesitate to ask other questions.

What to expect from your doctor

Be prepared to answer questions, such as:

• When did your symptoms begin?
• 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?