Salivary Gland Cancer?

SALIVARY-GLAND-CANCER

What Is Salivary Gland Cancer?

The salivary glands are responsible for the production of saliva in our mouth. Saliva contains many digested enzymes that help us break down the food we eat. They also protect our throat from certain pathogens. The enzymes can kill certain pathogens.

Cancer that occurs in the salivary gland is called salivary gland cancer. It is rare cancer that forms in the salivary gland tissues. Salivary gland cancers are malignant, they invade other healthy cells.

These tumours are a rare group of complex and heterogenous histologies that are located in the parotid gland, submandibular gland, sublingual gland and minor salivary glands of the upper aerodigestive tract. The diverse group of tumours has a wide range of pathogenesis.

Three major salivary glands that help in the production of saliva are listed below.

Parotid glands

The parotid glands are the largest and are located in front of the ears. The saliva produced from the gland is secreted to the mouth from a duct near the upper second molar.

The salivary gland tumours start from this gland. The surgery to treat the parotid gland tumour is called parotidectomy.

Sublingual glands

Sublingual glands are the smallest and have an almond-shaped structure. They are located under the mouth, below either side of the tongue.

Submandibular glands

The submandibular glands are found below the jaw and the size of the gland will be about a walnut.

Who is likely to have salivary gland cancer?

Men are more prone to salivary gland cancer and people aged  55 and above also have high chances of getting salivary gland cancer.

Salivary gland cancer is not common in children and when they occur, it is mostly malignant and low-grade mucoepidermoid carcinoma.

The risk factor of salivary gland cancer increases when exposed to radiation, according to NBK538340.

Types

Cancer is a result of the abnormal proliferation of different kinds of cells in the body. The pathology of cancer is further differentiated into a benign and malignant tumour.

Tumour is an abnormal proliferation of cells and the tumours may be benign or malignant. A benign tumour is confined to its original place and they do not invade or spread to other healthy cells. A skin wart is an example of a benign tumour.

A malignant tumour is capable of metastasis i.e., it can invade and spread to other healthy cells, through the circulatory system or lymphatic system.

Malignant tumours are considered as cancers and they are considered dangerous as they can invade and spread to other healthy cells.

The benign tumours can easily be removed by surgical methods and they are not dangerous in most cases.

The malignant and benign tumours are further classified into three types such as carcinomas, sarcomas, and leukaemias or lymphomas.

Carcinomas are malignancies of epithelial cells and most human cancers fall under this category.

Sarcomas are rare in humans and are solid tumours that occur in connective tissues like muscle, cartilage, bone and fibrous tissue.

 Leukaemias or lymphomas account for 8% of human malignancies. The lymphomas are mostly associated with blood-forming cells and immune cells.

Types of noncancerous

Pleomorphic adenoma

Pleomorphic adenoma  is the most common salivary gland tumour. It is also called as benign mixed tumours (BMT). The adenoma is said to have a dual origin from epithelial and myoepithelial elements.

According to NBK430829, the oncogenic simian virus (SV40) plays a vital part in the onset or the progression of the adenoma.  Another risk factor of pleomorphic adenoma is head and neck irradiation.

Basal cell adenoma

Basal cell adenoma is a rare epithelial tumour. It is a benign salivary gland tumour. The adenoma is not common in young people, but women above the age of 50 are affected in the range of 1-3%, according to PMC4451648. 

Canalicular adenoma

A canalicular adenoma is not a common tumour but it is a benign neoplasm that occurs in the oral cavity. The adenoma is considered to be more common in women than in men. The ratio of females and males getting affected by this adenoma are 1.7:1, according to PMC4424207.

The tumour is not common in children but researchers suggest that they can be asymptomatic and is present as a non-ulcerated mass with an average of 3 years duration.

The tumour occurs exclusively in the oral labia, buccal mucosa and palate. It more specifically grows in the upper lip and only 5 cases are reported for the growth in the lower lip, according to PMC4424207.

Warthin tumour

It is a benign tumour that occurs in the salivary gland and its occurrence is relatively frequent. The symptoms are usually painless during the early stage.

There is a development of a slow-growing bump in front of the ear, bottom of the mouth or under the chin. The cause of the warthin tumour is still unknown, but smoking is considered to increase the risk factor of the tumour.

 It is characterised by the presence of a dense lymphoid stroma and a double layer of oncocytic epithelium with a papillary and cystic architectural pattern.

Types of cancerous

Acinic cell carcinoma

Acinic cell carcinoma (ACC) is a low-grade salivary neoplasm that is malignant. It constitutes 17% of primary salivary gland cancers.

Acinic cell carcinoma is more frequently diagnosed in women than men and the parotid gland is the site of origin.

Exposure to radiation and familial predisposition are the risk factors associated with acinic cell carcinoma. Surgical excision is the recommended treatment of malignant neoplasm.

Adenocarcinoma

Adenocarcinoma is a malignant neoplasm that arises from epithelial cells. Adenocarcinoma arises from multiple sites of the body and some common sites are the lungs, breasts, prostate and the gastrointestinal tract like the colon, rectum and pancreas.

The origin of cancer is unknown 70% when it is adenocarcinoma, according to NBK562137. the risk factor of adenocarcinoma include environmental and lifestyle, however, tobacco smoking is considered to play a major role in adenocarcinoma.

Adenoid cystic carcinoma

Adenoid cystic carcinoma is a common malignant salivary gland tumour and it can arise from any salivary tissue.

The incidence of carcinoma is gender-equal and mostly seen in people age 60.

The tumour is usually a slow-growing mass and then spreads to nerve sheaths. The patients often complain of facial pain and may present with facial paresis and the incidence of lymph node metastases is low.

Malignant mixed tumour

The malignant tumours that occur in the salivary gland are of high-grade malignancy and they can be distinguished from the other carcinoma like ex pleomorphic adenoma.

The malignant mixed tumour has an origin from the frequently occurring benign pleomorphic adenoma. It is an aggressive form of tumour and it is a rapidly growing lethal neoplasm.

Mucoepidermoid carcinoma

Mucoepidermoid carcinoma is malignant and a locally invasive tumour that occurs in the salivary glands. The occurrence of the malignancy is estimated to be 35% of major and minor salivary glands.

The occurrence is reported in the submandibular, minor salivary gland and also in the parotid gland.

When the carcinoma occurs in the minor salivary gland, it can be found in the palate, retromolar area, in the floor of the mouth, buccal mucosa, lips and tongue.

The occurrence is mostly reported in the age of 48 years and the peaks are reported in the age of fifties and sixties.

The carcinoma contributes to more than 50% of malignant lesions of the salivary gland.

Oncocytic carcinoma

Oncocytic carcinoma is a malignant carcinoma and is also called malignant oncocytoma. The carcinoma can occur in any organ including the pancreas and the breast. The occurrence of the carcinoma is more frequently reported in the thyroid.

According to PMC1564019, carcinoma is reported to be an extremely rare neoplasm that occurs in the salivary gland.

The carcinoma accounts for 11% of all oncocytic salivary gland neoplasm and 0.5% of epithelial salivary gland malignancy and 0.18% of all epithelial salivary gland tumours as reported by PMC1564019.

The oncocytic carcinoma is differentiated from acinic cell adenocarcinoma with the presence of cytoplasmic granules which will be amphophilic or basophilic.

Polymorphous low-grade adenocarcinoma

Polymorphous adenocarcinoma is a rare tumour and is low-grade adenocarcinoma. The carcinoma is commonly found in the minor salivary glands.

The polymorphous low-grade adenocarcinoma is found near the salivary gland as a mass lump and a lingering pain can be seen in the affected area.

Patients with the polymorphous low-grade adenocarcinoma also experience sudden bleeding in the mouth and numbness on parts of your face.

Salivary duct carcinoma

The salivary duct carcinoma is a malignant tumour that is similar to the ductal carcinoma of the breast.

The majority of patients affected by the salivary duct carcinoma were male and 65 years and above. The tumour is frequently located in the parotid gland.

Squamous cell carcinoma

Squamous cells are found on the surface of the skin. These cells are thin and flat that look like fish scales.

Cancer that occurs on the squamous cell is called squamous cell carcinoma. The carcinoma is not fatal like melanoma.

Other rare salivary gland cancers

Non-Hodgkin lymphoma

Non-Hodgkin lymphoma is cancer that occurs in the lymph system. The lymph system acts as a protection against pathogens.

The non-Hodgkin lymphoma can be aggressive and grows at a faster rate. The lymphoma is both indolent and aggressive.

The indolent lymphoma grows and spreads slows whereas the aggressive lymphoma grows and spreads quickly.

The indolent lymphoma has few signs that are not painful, whereas the aggressive lymphoma can have symptoms that can be painful.

Sarcoma

Sarcoma is a type of cancer that affects the bones and the soft tissues in the body like cartilage, fat, muscles and fibrous tissues.

Osteosarcoma forms in the bone and liposarcoma are formed in the fat cells. The treatment of sarcoma depends on the grade of cancer and how fast the cancer is growing. Sarcoma can be seen in adults and children.

Sarcoma can be seen in parts of the body like arms, legs, head, trunk and neck region. Sarcoma is an uncommon tumour.

Epithelial-myoepithelial carcinoma

Epithelial-myoepithelial carcinoma is a biphasic tumour, which is a rare form of the salivary gland. The tumour is commonly seen in the parotid gland and the submandibular gland.

It is a low-grade malignant tumour and the tumour is reported to grow after a local resection in 25-30%, according to PMC4073474.

The carcinoma is common in women and its occurrence is mostly at the age of 70.

Anaplastic small cell carcinoma

Anaplastic small cell carcinoma is commonly seen at the age of sixty and is reported to be aggressive. One of the common symptoms of anaplastic small cell carcinoma is hoarseness.

The tumour is reported to derive from Kulchitsky cells and the treatment involves radiation therapy.

Undifferentiated carcinomas

Undifferentiated carcinoma is a rare carcinoma that occurs in the salivary glands. The undifferentiated carcinoma is reported to be closely associated with Epstein- Barr virus (EBV) infection.

The survival rate of carcinoma is reported to be 79.8%. These are high-grade cancers that often spread.

What causes salivary gland cancer?

The exact reason for the cause of salivary gland cancer is unknown to researchers. But the doctors and scientists predict that smoking can cause salivary gland cancer and exposure can aggravate the chances of getting cancer.

According to PMC3658557, HIV infection increases the risk of salivary gland cancer. Some studies support the fact of consuming vitamin C-rich and low cholesterol foods may be effective in preventing salivary gland cancer.

The risk factor increases with age and exposure to radiation. And the commonly affected salivary glands are

  • Parotid glands (inside each cheek)
  • Submandibular glands (on the floor of the mouth)
  • Sublingual glands (below the tongue)

What are the symptoms of salivary gland cancer?

Salivary gland cancer may not show any symptoms in the early stage. They can be diagnosed during a dental check-up or physical examination.

There can be a slow-growing mass, that is painless in the early stage. Then there can be seen some symptoms like rapid growth, pain, ulceration of the skin and facial nerve palsy.

Some of the common symptoms of salivary gland cancer are listed below.

Weakness or numbness in the face, neck, jaw or mouth

Swelling or lumps near your facial region like the neck or mouth can cause numbness in part of your face.

  • Persistent pain in the face, neck, jaw or mouth
  • Difficulty opening your mouth fully or moving your facial muscles
  • Trouble swallowing
  • Bleeding from the mouth

Exams and Tests for Salivary Gland Tumours

If you find any unusual lump or growth near your mouth and facial region consult your doctor. The doctor after examining your physical mass lump might suggest any of the below-mentioned diagnosing methods.

Imaging tests

The doctor will decide on the diagnosing methods. The imaging test includes ultrasound, magnetic resonance imaging and tomography.

Ultrasound is considered to be the fast and non-invasive method of testing. Ultrasound imaging is conclusive in most cases as it provides with real-time and multiplanar scanning results. Ultrasound also gives precision and high resolution and it is conclusive in most cases.

For accuracy and to find the nature of the tumour, cross-sectional imaging techniques like CT scan or MRI are recommended. CT scan is a choice when an inflammatory disease is suspected.

Nasopharyngolaryngoscopy

Nasopharyngolaryngoscopy is an imaging technique to view the flexible fibre optic inside the nasal passage. The sinus openings, larynx and the vocal cords can be viewed with this diagnosis.

Biopsy

For the diagnosis of salivary gland cancer, a needle biopsy is recommended. The skin is sanitised with rubbing alcohol and then a localised pain killer is administered.

A needle is inserted into the gland and a piece of tissue or cell is removed. The removed cell or tissue is placed on the slide and then the sample will be examined.

The biopsy is used to determine the type of the tumour. It also helps to determine whether the gland and the tumour are to be removed.

What are the stages of salivary gland cancer?

After the diagnosis of salivary gland cancer, there are few tests carried out to find out whether cancer will spread within the salivary gland or to other parts of the body.

There are stages to determine the tumour spread. There are four stages of cancer.

Stage I of salivary gland cancer

Stage I is considered as the first and early stage of cancer. In this stage, the cancer is not more than 2 centimetres. During this stage the has not yet, reached the lymph nodes.

Stage II of salivary gland cancer

In stage II, the cancer is grown and it becomes more than 2 centimetre but less than 4 centimetres. In stage II, also the cancer will not reach the lymph node.

Stage III of salivary gland cancer

In stage III, the cancer is grown more than 4 centimetres and the spread can be noted in the lymph node.

Stage IV of salivary gland cancer

Stage IV of salivary gland cancer is the most advanced stage. In this stage, cancer would have spread to nearby soft tissue. In stage IV, cancer can be of any size.

Grades are also assigned in addition to stages

Grades of cancers tell how fast the tumour is growing. The grade helps in the diagnosis and treatment.

Salivary gland cancers are of two grades. Low-grade and high-grade cancers. Low-grade cancers grow slowly and high-grade cancer grows faster. High-grade cancers may require immediate and aggressive treatment.

How is salivary gland cancer treated?

Salivary gland cancer treatment depends on various factors like the type and grade of cancer. The stage of cancer also determines the treatment. The possibility of treating cancer depends on the personal choice.

Surgery

Surgery is the most recommended for salivary gland cancer and the doctors will suggest surgery if cancer can be removed completely.

According to the American Cancer Society, people with head and neck cancer treated with surgery tend to live longer.

Side effects

The side effects of surgery are numbness and weakness around the earlobe and skin around the wound. Difficulty in moving your lips, numbness in tongue, pain and weakness.

Radiation therapy

Radiation therapy is used when cancer cannot be removed by surgery. It depends on the location and the size of the tumour.

Radiation is also used after surgery to kill the cancer cells that cannot be removed by surgery. This treatment is called adjuvant radiation.

Side effects

Radiation treatment can cause side effects like

  • Skin changes or tan in the treated area,
  • Loss of taste,
  • Dry mouth,
  • Trouble swallowing,
  • Feeling tired,
  • Hoarseness and
  • Open sores.

Chemotherapy

Chemotherapy is given along with anti-cancer drugs that are administered through the vein or by mouth. Chemotherapy is usually not used for salivary gland cancer as it does not work well for these types of cancers.

Chemotherapy is used when cancer has spread to other organs and when cancer cannot be controlled by surgery and radiation.

Chemotherapy shrinks the tumour but they do not fully cure it. Chemotherapy is used when the cancer cell is very small and cannot be seen by naked eyes.

Side effects

The side effects caused by chemotherapy are listed below.

Prevention and Lifestyle

The cause of salivary gland cancer is not fully known, so the prevention is uncertain. Salivary gland cancer is linked with  Epstein-Barr virus (EBV), human immunodeficiency virus (HIV) and human papillomavirus (HPV). They are said to increase the risk of salivary gland cancer. So, avoiding exposure to the virus can decrease the risk of salivary gland cancer.

However, there is more research required to support the link between the virus and salivary gland cancer.

Smoking tobacco increases the risk of salivary gland cancer. Avoid smoking and drinking to avoid any kind of disease.

Conclusion

The occurrence of cancer is still not known and researchers are working closely on it. Avoid smoking and alcohol. Avoid exposure to infections like HIV. Practice hygiene in your daily life to avoid diseases. Consult your doctor, if you have any unusual mass lump near your facial area.

FAQ

1.What are the signs of salivary gland cancer?

The common signs of salivary gland cancer are
1. Lump swelling near your jaw or neck.
2. Numbness
3. Pain in the salivary gland
4. Facing difficulty while swallowing
5. Trouble opening mouth.

2.What is the survival rate of salivary gland cancer?

The survival rate for salivary gland cancer is about  years and it depends on the type and stage of the salivary gland cancer.

3.How serious is a salivary gland tumour?

Most salivary gland cancers are benign and not life-threatening.

4.Is salivary gland cancer curable?

Salivary gland cancer can be cured if they are diagnosed early.

5.What causes salivary cancer?

 The exact reason for salivary gland cancer is not known but an infection like HIV can increase the risk of salivary gland cancer.

6.How quickly does salivary gland cancer grow?

There is low-grade and high-grade salivary gland cancer. The growth depends on the type of cancer.

7.How common is salivary gland cancer?

A salivary gland cancers are not very common. The total occurrence ranges from 6-8%.

8.Is salivary gland cancer aggressive?

Salivary duct carcinoma is an aggressive form of cancer.

9.Who gets salivary gland cancer?

Anyone can be affected by salivary gland cancer. People aged 55 and above are more prone to the disease.

10.How long does it take to recover from salivary gland surgery?

 It takes about 1-2 weeks to recover from salivary gland surgery.

11.What percentage of salivary gland tumours are malignant?

About 6% of salivary gland tumours are malignant.

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