Salivary gland tumors

Diagnosis

Salivary gland tumor diagnosis often begins with a physical exam of the area by a healthcare professional. Imaging tests and a biopsy may be used to find the location of the tumor and determine what type of cells are involved.

Physical exam

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

Imaging tests

Imaging tests make pictures of the body. They can show the location and size of a salivary gland tumor. Tests might include MRI, CT and positron emission tomography, which is also called a PET scan.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. To collect a sample of tissue, a fine-needle aspiration or a core needle biopsy may be used. During the biopsy, a thin needle is inserted into the salivary gland to draw out a sample of suspicious cells. The sample is sent to a lab for testing. Tests can show 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, you may have other tests to see if the cancer has spread. These tests help your healthcare team find out the extent of your cancer, also called the stage. Cancer staging tests often involve imaging tests. The tests might look for signs of cancer in your lymph nodes or in other parts of your body. Your healthcare team uses the cancer staging test results to help create your treatment plan.

Imaging tests may include CT, MRI and PET scan. Not every test is right for every person. Talk with your healthcare professional about which procedures will work for you.

The stages of salivary gland cancer range from 0 to 4. A stage 0 salivary gland cancer is small and only in the gland. As the cancer gets larger and grows deeper into the gland and surrounding areas, such as the facial nerve, the stages get higher. A stage 4 salivary gland cancer has grown beyond the gland or has spread to the lymph nodes in the neck or to distant parts of the body.

Treatment

Treatment for salivary gland tumors usually involves surgery to remove the tumor. People with salivary gland cancers may need additional treatments. These additional treatments can include radiation therapy, chemotherapy, targeted therapy or immunotherapy.

Surgery

Surgery for salivary gland tumors may include:

• Removing part 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 around it.
• Removing the entire salivary gland. If you have a larger tumor, your surgeon may recommend removing the entire salivary gland. If your tumor extends into nearby structures, they also may be removed. Nearby structures may include the facial nerves, the ducts that connect the salivary glands, facial bones and skin.
• Removing lymph nodes in your neck. If your salivary gland tumor is cancerous, there may be a risk that the cancer has spread to the lymph nodes. Your surgeon may recommend removing some lymph nodes from your neck and testing them for cancer.

• Reconstructive surgery. After the tumor is removed, your surgeon 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 using 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 working around and underneath the facial nerves. 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 with other techniques.

Radiation therapy

If you're diagnosed with salivary gland cancer, your healthcare team may recommend radiation therapy. Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. For salivary gland cancer, radiation therapy is most often done with a procedure called external beam radiation. During this treatment, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.

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 healthcare professional may recommend radiation alone or in combination with chemotherapy.

Chemotherapy

Chemotherapy treats cancer with strong medicines. 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 combined with radiation therapy.

Targeted therapy

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

For salivary gland cancer, targeted therapy may be used when the cancer can't be removed with surgery. It also may be used for advanced cancers that spread to other parts of the body or cancer that comes back after treatment.

Some targeted therapies only work in people whose cancer cells have certain DNA changes. Your cancer cells may be tested in a lab to see if these medicines might help you.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

For salivary gland cancer, immunotherapy may be used on cancer that can't be removed with surgery. It also may be used for advanced cancers that have spread to other parts of the body or cancer that has come back after treatment.

Palliative care

Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A healthcare team that may include doctors, nurses and other specially trained health professionals provides palliative care. The care team's goal is to improve quality of life for you and your family.

Palliative care specialists work with you, your family and your care team. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time you're getting strong cancer treatments, such as surgery, chemotherapy or radiation therapy.

The use of palliative care with other proper treatments can help people with cancer feel better and live longer.

Lifestyle and home remedies

Coping with dry mouth

People with salivary gland tumors that are cancerous may need to have radiation therapy. One side effect of radiation therapy to the head and neck area is having a very dry mouth, called xerostomia. Having a dry mouth can cause discomfort. It can lead to frequent infections in your mouth, cavities and problems with your teeth. Dry mouth also can make eating, swallowing and speaking difficult.

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

• Avoid acidic or spicy foods and drinks. Choose foods and drinks that won't irritate your mouth. Avoid caffeinated and alcoholic beverages.
• Brush your teeth several times each day. Use a soft-bristled toothbrush and gently brush your teeth several times each day. Tell your healthcare professional if your mouth becomes too sensitive to tolerate gentle brushing.
• Choose moist foods. Avoid dry foods. Moisten dry food with sauce, gravy, broth, butter or milk.
• 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.
• 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.

Tell your healthcare professional if you have dry mouth. Treatments may help you cope with more-severe symptoms of dry mouth. You also may be referred to a dietitian who can help you find foods that are easier to eat if you're experiencing dry mouth.

Alternative medicine

Complementary or alternative medicine treatments can't cure salivary gland tumors. But complementary and alternative treatments can be combined with your healthcare team's care to help relieve fatigue, pain and other symptoms.

Options may include:

• Acupuncture.
• Exercise.
• Guided imagery.
• Hypnosis.
• Massage.
• Relaxation techniques.

Ask your healthcare team whether these options are safe for you.

Coping and support

With time, you'll find what helps you cope with the worries that may come with a salivary gland tumor diagnosis. Until then, you may find it helps to:

Learn enough about salivary gland tumors to make decisions about your care

Ask your healthcare team about your tumor, including the type, stage and treatment options. As you learn more about your tumor, you may become more confident in making treatment decisions.

Keep friends and family close

Keeping your close relationships strong can help you cope during treatment. Friends and family 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 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 salivary gland tumor, you may be referred to a doctor who specializes in diseases that affect the ears, nose and throat. This doctor is called an ENT specialist or otolaryngologist.

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 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 symptoms you're experiencing, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down key 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 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?

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?