Salivary gland neoplasms

Salivary gland tumors . They are abnormal cells that proliferate in the ducts that drain the salivary glands.

Summary

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  • 1 Alternative names
  • 2 Features
  • 3 Causes, incidence and risk factors
  • 4 Symptoms
  • 5 Signs and tests
  • 6 Treatment
  • 7 Expectations (prognosis)
  • 8 Complications
  • 9 Situations requiring medical assistance
  • 10 Classification of the salivary glands
    • 1 Classification (according to WHO)
  • 11 Benign Tumors
  • 12 Malignant tumors
  • 13 Tumors of the minor salivary glands
  • 14 Treatment
  • 15 Stages of Salivary Gland Cancer
  • 16 Overview of Treatment Options
  • 17 Staged treatment
    • 1 Stage I
    • 2 Stage II
    • 3 Stage III
    • 4 Cancer of the Salivary Glands – Stage IV
  • 18 Recurring
  • 19 Sources
  • 20 Category

Alternative names

Tumor in the salivary duct: Salivary gland tumors constitute around 5% of head and neck neoplasms, the average age of patients with malignant neoplasms is approximately 55 years and 40 years for benign tumors. 25% of parotid tumors and 50% of tumors of the submandibular glands can be malignant.

Tumors of the minor salivary glands are rare and constitute 2 to 3% of malignant tumors of the upper airway and upper digestive tract, rare under the age of 20 and rare under the age of 10; Its most frequent location is in the hard palate, nasal cavity and paranasal sinuses. The smaller a salivary gland, the more likely a tumor in it will be malignant.

features

Salivary gland cancer is a disease in which cancer (malignant) cells are found in the tissues of the salivary glands . These glands make saliva, the liquid that is poured into the mouth to keep it moist and help dissolve food. The main groups of salivary glands are located under the tongue, on the sides of the face, just in front of the ears, and below the jaw. There are other smaller groups of salivary glands in other parts of the upper digestive system ; the smallest glands are called the minor salivary glands.

Many growths in the salivary glands do not spread to other tissues and are not cancer. These tumors are called “benign” tumors and are generally not treated the same as cancer.

A doctor should be consulted when there is swelling under the chin or around the jaw, if the face is numb, if the muscles in the face cannot move , or if there is pain that does not go away on the face, chin, or neck . When there are symptoms, the doctor examines the throat and neck using a mirror and lights. The doctor may order a special x-ray called a CT scan, or CT, in which a computer is used to make an image of the inside of the body parts. Another special scintillation called magnetic resonance imaging or MRI can also be done , using magnetic waves.to make a picture of the head. If tissue that is not normal is found, the doctor has to cut a small piece and look at it through the microscope to determine if there are cancer cells .

This procedure is known as a biopsy. The chances of recovery (prognosis) depend on the location of the cancer in the salivary glands, whether the cancer is only in the area where it started, or whether it has spread to other tissues (stage), how cancer cells look in the microscope (the degree) and the general health of the patient.

Causes, incidence and risk factors

The salivary glands are located around the mouth and produce saliva that moistens food to help with chewing and swallowing. Saliva contains enzymes that start the digestion process and help cleanse the mouth, removing bacteria and food particles. By keeping your mouth moist, saliva helps keep dentures, retainers, or other orthodontic appliances in place.

There are three main pairs of salivary glands:

  • The largest are the parotids, located one on each cheek above the jaw, in front of the ears.
  • Two submandibular glandsare located at the back of the mouth on either side of the jaw, and two sublingual glands are below the floor of the mouth. There are also thousands of minor salivary glands around the rest of the mouth.

All salivary glands empty saliva into the mouth through ducts that lead to different places in it. Salivary duct tumors are rare, especially in children. The inflammation of the salivary glands is mainly due to:

  • Abdominal surgery
  • Hepatic cirrhosis
  • Infections
  • Other cancers
  • Sialolithsin the salivary ducts
  • Salivary gland infections
  • Sarcoidosis
  • Siögren’s syndrome

The most common type of salivary duct tumor is a non-cancerous (benign), slow-growing parotid gland that gradually increases the size of the parotid gland. However, some of these tumors can be cancerous (malignant). Malignant tumors of the salivary glands are usually carcinomas.

symptom

A firm and usually painless swelling in one of the salivary glands (in front of the ears, under the chin, or on the floor of the mouth) that gradually increases in size. Difficulty moving one side of the face, known as paralysis of the facial nerve.

Signs and tests

An examination by a doctor or dentist shows a larger than normal salivary gland, usually one of the parotid glands .

Exams may include:

  • X-ray of the salivary glands (called a sialogram or sialography) to look for a tumor.
  • CT scan or an MRIto confirm if there is a mass and to see if the cancer has spread to the lymph nodes in the neck.
  • Salivary gland biopsyor fine needle biopsy to determine if the tumor is malignant or benign .

Treatment

The generally recommended treatment is surgery to remove the affected salivary gland. If the tumor is benign, no other treatment is usually needed. Radiation therapy or extensive surgery may be needed if the tumor is cancerous. Chemotherapy is sometimes used in patients considered high risk or when the disease has spread beyond the salivary glands.

Expectations (prognosis)

Most salivary gland tumors are noncancerous and slow growing. The condition is usually cured by surgical removal of the tumor. In rare cases, the tumor is cancerous and additional treatment is necessary.

Complications

Cancerous tumors can cause major complications, including spread to other organs (metastases). Rarely, surgery to remove the tumor can damage the nerve that controls movement of the face.

Situations requiring medical assistance

Call your health care provider if: You experience pain when eating or chewing.

Notice a lump in the mouth, under the jaw, or in the neck that does not go away in 2 to 3 weeks or is getting larger.

Classification of the salivary glands

  1. Major: Parotid glands, submandibular glands, sublingual glands
  2. Minors: Salivary glands that are located throughout the submucosa of the upper respiratory and digestive tract, from the lips to the bronchial tree and esophagus.

There is a wide range of benign and malignant salivary gland tumors, and change in diagnosis of freeze biopsy (rapid biopsy) is not uncommon with definitive reporting.

Classification (according to WHO)

  • Benign:
  1. Mixed tumor (pleoform adenoma)
  2. Warthin’s tumor (lymphomatous papillary cystadenoma).
  3. Benign lymphoepithelial lesion.
  4. Monomorphic adenoma.
  • Malignant:
  1. Malignant mixed tumor
  2. Adenoid cystic carcinoma.
  3. Adenocarcinoma.
  4. Mucoepidermoid carcinoma.
  5. Acinic cell carcinoma.
  6. Squamous cell carcinoma.

Benign Tumors

The benign mixed tumor or pleomorphic adenoma, appears between 20 and 40 years old, is slow growing and has a pseudocapsule that can be crossed by extensions of the tumor, hence its resection by enucleation or with narrow margins can mean a recurrence. Warthin’s tumor or lymphomatous papillary cystadenoma, a benign tumor, probably originated from lymphatic elements, has a complete capsule and is found in patients older than 60 years, it can be bilateral in 10% of cases and sometimes multiple.

Benign lymphoepithelial lesion has also been called Godwin’s tumor and constitutes about 5% of benign lesions. It can be bilateral and would be more common in women. It has a high frequency of post-treatment recurrence. Its primary description was associated with Siögren and Mikulicz syndrome. There appears to be an increase in its incidence in patients with infection with the acquired immunodeficiency virus (HIV). Numerous reports of parotid tumors include non-Hodgkin lymphoma, Kaposi’s sarcoma, and adenoid cystic carcinoma, some of which may originate from benign lymphoepithelial lesions.

Its treatment is controversial, parotidectomy may be justified by its association with malignant tumors; others recommend low-dose radiation therapy. The most rational therapy should be evaluated individually, depending on the clinical picture and diagnostic suspicion of malignancy, asymptomatic HIV status, and the discussed risk-benefit ratio between patient and surgeon. Oncocytoma is a benign, slow-growing tumor found in older age groups, is encapsulated, and has a dark appearance similar to melanoma.

Monomorphic adenoma includes a group of benign lesions that can have a variety of presentation, the most common being basal cell adenoma and oxyphilic adenoma (oncocytoma). Other forms are sebaceous lymphoadenoma and sebaceous adenoma, these lesions can occur in the parotid, they must be distinguished from basal cell cancer of the skin with metastatic parotid lymph nodes.

Malignant tumors

Mucoepidermoid carcinoma is the most common tumor of the major salivary glands. It can be confused on histology with hematoxylin and eosin staining with squamous or squamous cell carcinoma. It has a wide spectrum of aggressiveness. The possibility of metastasizing and causing death depends on the degree of malignancy. Low-grade mucoepidermoid cancer grows primarily locally and slowly. Local resection can be curative. As the degree of malignancy increases, regional lymph node metastases and invasion of vessels and nerves are more frequent. Due to these characteristics, aggressive surgery with cervical lymph node dissection and postoperative radiation therapy should be considered.

Acinic cell carcinoma is rare. It probably reaches 10% of salivary gland cancers. It is more frequent in the parotid. It is a low-grade tumor and rarely invades the facial nerve. Distant metastases are late and have a poor prognosis. Due to its slow growth, survival is good, performing radical surgery. Adenocarcinoma constitutes approximately 16% of the malignant tumors of the parotid gland and 9% of those of the submandibular gland. It is more frequent in the minor salivary glands of the nose and paranasal sinuses. High-grade malignancies have a poor prognosis, and failure of treatment usually results in distant metastases. The loco-regional treatment must be aggressive.

Adenoid-cystic carcinoma constitutes almost 25% of salivary gland cancers. In the parotid, between 10 and 15% appear, this cancer is proportionally more frequent in the minor salivary glands, it can have a prolonged evolution of 10 to 20 years without metastasis and when they occur, with more frequent lung death occurs in a relatively short time. This carcinoma has the ability to invade nervous tissue, compromising local control and survival. Treatment consists of extensive surgery followed by radiation therapy.

Minor salivary gland tumors

They can appear at any age without distinction of sex and anywhere in the head and neck, but mainly in the upper digestive tract and within it, preferably on the palate, tongue, paranasal sinuses and oral mucosa.

Between 65 and 88% of tumors of the minor salivary glands are malignant and histologically adenoid cystic carcinoma is the most frequent (55%). It generally presents as a painless submucosal mass, unchanged for years and its growth should make the malignancy suspect. These tumors are spread by local invasion to neighboring tissues, in addition to bone and nerve; the adenoid cystic carcinoma has a particular tendency to grow by perineural space and can spread to places far from the primary, it is important to note resection. Thus, for example, the palate tumor can infiltrate branches of the palatine nerve and extend to the Gasserian ganglion.in the cranial fossa, for this reason it must be included in the resection; It can also spread through the bone channels, a situation that must be considered in surgical treatment.

Treatment

The initial treatment in benign and malignant tumors in major or minor salivary glands is “almost” always surgical and, if possible, parotid, submandibular or sublingual resection should be performed, preferring an excisional action better than the incisional one. Biopsy and definitive surgical treatment are often the same procedure. In deep parotid lobe tumors or tumors involving both lobes, it is best to perform a total parotidectomy.

Incisional or excisional biopsy increases the risk of contamination of the tumor bed and therefore the recurrence and damage of the facial nerve with the definitive surgical procedure that must remove the biopsy site. The presence of cervical metastases in salivary gland tumorsit has a poor prognosis and modified radical dissection is indicated followed by radiation therapy. Non-palpable metastases (hidden metastases) are present in a high percentage ranging from 20 to 50% in relation to the size of the primary and the degree of malignancy, however, currently there is no information that justifies elective neck dissection when clinically negative. The indication for post-surgery radiotherapy arises when there are positive surgical margins, advanced primary tumor and high degree of malignancy, involvement of the facial nerve or deep lobe in the parotid, positive lymph nodes and when tumor “seeding” occurs in the operation due to rupture of the its capsule.

In minor salivary gland tumors, resection in healthy tissue should be the primary intention, whether benign or malignant; tumor enucleation is inadequate and there is a recurrence of over 90%. In tumors of the palate or paranasal sinuses, the surgeon must be prepared to perform bone resection of either the palate or the maxilla to have tumor-free margins; This situation must be presented to the patient and accepted by him or her, and even by their closest family environment. The surgeon must clearly explain the sequelae and inconveniences secondary to the surgery and must also be prepared to carry out functional and cosmetic rehabilitation.

The presence of a tumor in the deep lobe of the parotid is benign or malignant, often cannot be addressed by the usual pre-atrial route and some type of mandibulotomy must be used, which gives good exposure. These tumors can manifest with bulging of the palate, since they are tumors that occupy the maxillary pituitary or the parapharyngeal space. In these cases, axial tomography or nuclear magnetic resonance is essential, providing an objective appreciation of the location and extent.

Stages of cancer of the salivary glands

Once cancer of the salivary glands is found, more tests are done to find out if cancer cells have spread to other parts of the body. This process is called staging. The doctor needs to know the stage of the disease to plan the appropriate treatment. Salivary gland cancer is also classified by “degrees.” The grade indicates how fast cancer cells grow, which is determined by how the cells look under a microscope. Low-grade cancer grows more slowly than high-grade cancer.

These stages are used to classify salivary gland cancer:

  • Stage I

Cancer is no more than 4 centimeters in diameter (about 1 1/2 inches) and has not spread to surrounding tissue or to lymph nodes in the area (lymph nodes are small, bean-like structures that spread found throughout the body and whose function is to produce and store cells that fight infection).

  • Stage II

One of these two circumstances occurs. Cancer is no more than 4 centimeters in diameter and has spread to the skin, soft tissue, bone, or nerve around the gland. It has not spread to the lymph nodes in the area. The cancer is 4 to 6 centimeters (just over 2 inches) and has not spread to surrounding tissue or lymph nodes in the area.

  • Stage III

The cancer is no more than 4 centimeters in diameter and has not spread to the skin, soft tissue, bone, or nerve around the gland, but it has spread to only one of the lymph nodes in that area.

  • Stage IV

Either of these circumstances occurs. The cancer is larger than 6 centimeters in diameter and has spread to the skin, soft tissue , bone, or nerve around the gland. It may or may not have spread to the lymph nodes. Cancer is any size and has spread to more than one lymph node on the same side of the neck as cancer, to lymph nodes on one or both sides of the neck, or to any lymph node, and is more than 6 centimeters in diameter.

Overview of treatment options

Salivary Gland Cancer Treatment There are treatments for all patients with salivary gland cancer. Three kinds of treatment are used:

  1. Surgery (removal of cancer): Surgery is frequently used to remove cancers of the salivary glands. Depending on where the cancer is located and how far it has spread, the doctor may have to cut and remove some tissues around the cancer. If the cancer has spread to the lymph nodes in the neck, the lymph nodes may need to be removed (lymph node dissection).
  2. Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells): Radiation therapy is also a common treatment for cancer of the salivary glands. Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation can come from a machine outside the body (external radiation therapy) or from materials that produce radiation (radioisotopes)and they are placed through thin plastic tubes in the area where the cancer cells are (internal radiation therapy). A special type of radiation therapy using tiny particles called neutrons has been proven effective in treating some cancers of the salivary glands. The use of medications in conjunction with radiation therapy to increase the sensitivity of cancer cells to radiation (sensitizing rays) is being evaluated in clinical trials.
  3. Chemotherapy (use of drugs to kill cancer cells): Chemotherapy is the use of drugs to kill cancer cells. It can be taken in pill form, or it can be put into the body through a needle inserted into a vein or muscle. Chemotherapy is said to be a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy is still being evaluated in clinical trials as a treatment for cancer of the salivary glands.

Since the salivary glands help digest food and are close to the jaw, the patient may need special help to adjust to the side effects of cancer and its treatment. The doctor consults with other specialists who can help determine the optimal treatment for the patient. In addition, trained medical personnel can help the patient recover from treatment. If a large amount of tissue or bone is removed from around the salivary glands, plastic surgery may be necessary.

Staged treatment

Treatment for salivary gland cancer depends on the location of the cancer, the stage of the disease, the age of the patient, and their general health. You can consider a standard treatment based on how effective it has been in other patients in previous trials, or you can choose to participate in a clinical trial. Not all patients are cured with standard therapy; some standard treatments may have too many side effects. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the latest information. There are ongoing clinical trials in some regions of the country for patients with cancer of the salivary glands.

Stage I

Treatment depends on the grade of the cancer: whether it is low-grade (slow-growing) or high-grade (fast-growing). If the patient has low-grade cancer, the treatment will likely consist of surgery. If the patient has high-grade cancer, treatment may be one of the following:

 

  1. Surgery, followed by radiation therapy.
  2. Participation in a clinical trial with new chemotherapeutic drugs.

Stage II

Treatment depends on the grade of the cancer: whether it is low-grade (slow-growing) or high-grade (fast-growing). If the cancer is low-grade, treatment may be one of the following:

  1. Surgery, possibly followed by radiation therapy.
  2. Chemotherapy (if surgery or radiation is refused or if cancer does not

responds to surgery or radiation therapy).

If the cancer is high-grade, treatment may be one of the following:

  1. Surgery followed by radiation therapy.
  2. Participation in a clinical trial of radio sensitizing drugs (drugs given with radiation to increase the sensitivity of cancer cells to radiation) or of new chemotherapeutic drugs.

Stage III

Treatment depends on the grade of the cancer: whether it is low-grade (slow-growing) or high-grade (fast-growing). If the cancer is low-grade, treatment may be one of the following:

  • Surgery, possibly followed by radiation therapy.
  • Chemotherapy (if surgery or radiation is refused or if cancer does not

responds to surgery or radiation therapy).

  • Participation in a clinical trial of new or specialized radiotherapy

chemotherapeutic drugs. If the cancer is high-grade, treatment may be one of the following:

  1. Surgery followed by radiation therapy.
  2. Participation in a clinical trial of radio sensitizing drugs (drugs given with radiation to increase the sensitivity of cancer cells to radiation) given with radiation therapy or chemotherapy.

Salivary Gland Cancer – Stage IV

The treatment may be one of the following:

  • Participation in a clinical trial of chemotherapy, with or without radiation therapy

she.

Recurrent

The disease is said to be recurrent when the cancer has come back (recurred) after it has been treated. It may reappear in the salivary glands or in another part of the body.

Treatment depends on the type of cancer of the salivary glands that the patient has, the place where the cancer reappeared, the treatment that has been received previously and the general state of health of the patient. Radiation therapy may be given, or the patient may choose to participate in a clinical trial of new treatments.

 

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