The diagnosis is often made through fine needle aspiration biopsy which is a minimally invasive technique to get a limited tissue sample. Tissue sampling is an important part of the care and treatment of salivary gland tumors. Understanding the type of tumor in the salivary gland can help determine the management and treatment.
Benign Tumors
Many types of benign tumors can occur in the salivary glands. The most common is pleomorphic adenomas (also called benign mixed tumor). Saliva cysts, saliva stones, reactive lymph nodes, Warthin’s Tumor, oncocytomas, adenomas are other benign lesions to affect salivary glands. A full evaluation including a needle biopsy will inform the discussion with your otolaryngologist as to what treatment is in your best interest - to undergo surgical removal or to monitor.
Benign Tumors with Malignant Potential
Pleomorphic adenomas can undergo malignant transformation. This benign tumor can be present for many years before an undetermined molecular process triggers invasive growth, making the tumor cancerous. This transformed cancer is quite aggressive. For this reason benign pleomorphic adenomas are surgically excised to pre-empt the risk of a salivary gland cancer in the future.
Malignant Tumors
Malignant (cancerous) tumors can also arise from salivary gland tissue. There is a wide range of presentation of cancers in the salivary glands from indolent slow painless enlargement to rapid painful invasion of adjacent structures. In addition, cancers from other organ systems such as skin cancers or lymphoma can spread (metastasize) to the parotid gland. Tissue biopsy obtained through fine needle aspiration can determine the type of salivary gland cancer, which will dictate additional tests needed to assess the extent of the cancer. Personalized treatment of a salivary gland cancer is developed in collaboration with other specialists including radiation oncologist, pathologist, medical oncologist, neuroradiologist. Low grade salivary cancers are curatively treated with surgery. In contrast, after surgery to remove large, aggressive tumors additional treatment such as radiation therapy is administered to reduce risk of cancer recurrence.
Parotid Gland Surgery
Parotid surgery or parotidectomy is a well-tolerated outpatient surgery. It is a technically delicate procedure primarily due to the nerve structures found near or within the parotid gland. There are many superficial sensory nerves around the outer ear and cheek that become dull or numb initially after surgery. Small nerve fibers that control saliva production will self-repair after parotid surgery. Remarkably patients do not experience mouth dryness after parotidectomy. A very important nerve called the facial nerve travels within the parotid gland. The facial nerve divides into smaller individual nerves to reach individual muscles of the face. All parotid surgery, whether limited or extensive, involves mobilizing the tumor off the facial nerve. When the facial nerve is minimally disturbed, either by the tumor or during surgery, then the facial muscles will also function normally. In some cases however, the facial nerve is involved by the tumor or during the surgical dissection and facial movement weakness or asymmetries can occur.
