Ear, Nose, Throat, Head and Neck Surgery Specialist
Prof. Dr. Murat Topdağ

Born in Malatya in 1978, Murat Topdağ completed his primary and secondary education, then attended high school in Istanbul. He graduated from the English program of Cerrahpaşa Tıp Fakültesi. Prof. Dr. Murat Topdağ is married and has two children.

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What Is Salivary Gland Cancer?

Salivary gland cancer is a rare group of tumors with different histological features. They develop in the salivary glands located in the face. These glands are also found in the mouth and throat and produce the saliva necessary for digestion. Cancers can begin in any part of the salivary glands. In particular, the parotid, submandibular, and sublingual glands are common locations for these tumors. Each gland has a different risk profile for cancer. The parotid glands are the most common site of salivary gland tumors. Most parotid tumors are benign, but malignant tumors can also occur here. Tumors in the submandibular and sublingual glands are less common. Salivary gland cancers can appear in various forms:

• Mucoepidermoid carcinoma
• Acinic cell carcinoma
• Adenoid cystic carcinoma
• Carcinoma arising from ex-pleomorphic adenoma
• Adenocarcinoma

These cancer types are classified according to their microscopic structure. Defined by the World Health Organization, these cancer types are recognized by their growth patterns and cellular properties. The treatment of salivary gland cancers varies depending on the type and stage of the tumor. Making the correct diagnosis is crucial for choosing an effective treatment method. The treatment process generally includes surgery and radiotherapy. Salivary gland cancer is treatable if diagnosed early. Therefore, timely and accurate medical intervention is needed if this type of cancer is suspected. Advanced diagnostic and treatment methods are important for improving patient quality of life and extending survival.

The Importance of Saliva and the Salivary Glands

Saliva is produced in the mouth and has several important functions for the body. This fluid, containing water and various minerals, helps protect oral health. It also lubricates food and contributes to the sense of taste. It provides significant ease during swallowing and supports speech capability. By constantly cleaning, it maintains dental and oral health.

Saliva is produced by the salivary glands in the body:

1. Parotid gland: Located in front of each ear.
2. Submandibular gland: Located under the jaw.
3. Sublingual gland: Located under the tongue.

These glands transfer saliva to the mouth through ducts that open into the oral cavity. Salivary glands can also be found in the mucosa of the mouth, nose, sinuses, throat, larynx, trachea, and bronchi. The 400-600 minor salivary glands are scattered throughout the body. The healthy functioning of these glands is very important for both oral health and overall health.

The Importance of Salivary Glands

Salivary glands are an important part of the human body, producing about 1000 to 1500 cc of saliva daily. These glands play a critical role in maintaining oral health. First, they help remove food debris in the mouth, preventing cavities and other oral diseases.

Additionally, saliva neutralizes acids, protecting tooth enamel and providing a protective barrier against stomach acids. This process also contributes to the digestive system. Saliva fulfills the following functions:

1. Maintaining oral and dental health.
2. Contributing to the digestion process.
3. Preventing bad breath.
4. Easing the swallowing of food.

Thus, the healthy functioning of these glands is vital for overall body health. Disorders such as salivary gland cancer should therefore be taken seriously. This type of cancer can disrupt the functionality of the salivary glands, leading to various health problems. Hence, salivary gland health is directly linked to general oral and dental health.

What Causes Salivary Gland Cancer?

The causes of salivary gland cancer have not been fully determined by researchers. Usually, it arises from changes in the DNA of cells in the salivary glands. These changes give cells the wrong instructions to multiply and grow uncontrollably. They also allow tumor cells to persist when they should die. This leads to an accumulation of abnormal cells in the salivary gland and eventually a tumor. Based on studies about this cancer type, some risk factors have been identified:

• Smoking
• Radiation exposure for cancer treatment

These are the main known risk factors for salivary gland cancer. However, the disease may also occur in individuals who do not possess these risk factors. Hence, more scientific research is needed to pinpoint its exact causes. Over time, these harmful changes in DNA can lead to cancer cells that damage healthy body tissue. Cancer cells can spread to other parts of the body, forming metastatic cancer. During this process, it is known that cancer cells can spread regionally or distantly to other organs.

Symptoms of Salivary Gland Cancer

Salivary gland cancer starts in the glands that produce vital fluids for the body. In the early stages of the disease, symptoms rarely appear. In later stages, however, some distinctive signs begin to emerge.

Initially, a lump or swelling in the glands becomes noticeable. These swellings are usually painless and gradually grow over time. However, as the cancer progresses and spreads to surrounding tissues, pain becomes more pronounced.

• Formation of lumps or swelling
• Difficulty swallowing
• Trouble opening the mouth
• Numbness or weakness in the face or neck
• Facial asymmetry or deformity
• Speech disorders

These symptoms may indicate that salivary gland cancer is at an advanced stage. Additionally, if the cancer metastasizes, other organs can show symptoms too. For instance, if it spreads to the lungs, shortness of breath may occur. If you notice any of these signs, seek medical attention immediately. Early detection significantly increases the success rate of treatment.

How Is It Diagnosed?

The diagnosis of salivary gland cancer involves carefully administered tests and procedures. First, your doctor will conduct a detailed discussion about your medical history. Then a skin examination is performed. Observing signs of cancer is an important part of this process. If a suspicious area is identified, a biopsy is performed. During this procedure:

• The tissue sample is sent to the lab.
• Fine needle aspiration guided by ultrasound is often preferred for masses in the parotid or submandibular glands.
• This procedure is usually done in an office setting by head and neck surgeons or interventional radiologists.

Another diagnostic method, nasopharyngolaryngoscopy, involves examining the oropharynx and surrounding structures through the nose. Imaging tests are also used to determine the spread of the cancer. These tests:

• CT scans to detect advanced tumors
• Supported by MRI techniques

Finally, blood tests are used to monitor changes in the body. With a complete blood count:

• The number of red blood cells and platelets
• The number and type of white blood cells are analyzed

All these steps are rigorously followed to accurately and effectively diagnose salivary gland cancer.

Types of Salivary Gland Tumors

Salivary gland cancer can encompass different tumor types that may affect both the major and minor salivary glands. Generally, tumors are divided into two main categories: benign and malignant. Benign tumors tend to grow slowly and usually do not metastasize. Among the most common benign tumors are:

1. Pleomorphic Adenoma
2. Whartin Tumor
3. Monomorphic Adenoma

Malignant tumors, on the other hand, grow more rapidly and carry a risk of metastasis. Malignant tumors include:

1. Mucoepidermoid Carcinoma
2. Adenoid Cystic Carcinoma
3. Adenocarcinoma

These tumors can develop in various ways within the glands. While benign tumors are usually treated surgically, malignant tumors require more comprehensive treatment methods. A treatment plan is determined based on the stage of the disease and the type of tumor. Early diagnosis is the most significant factor that increases the likelihood of success with this type of cancer.

Stages of Salivary Gland Cancer

Stage 0 (Carcinoma in situ):

• Cancer cells are located within the lining of a salivary gland duct and have not spread to surrounding tissues. Also called carcinoma in situ.

Stage I:

• Stage IA: A tumor up to 2 cm in diameter with no spread to local lymph nodes or distant organs.
• Stage IB: A tumor between 2 and 4 cm in diameter, with no spread to local lymph nodes or distant organs.

Stage II:

• Stage IIA: A tumor larger than 4 cm, with no spread to local lymph nodes or distant organs.
• Stage IIB: A tumor of any size that has spread to lymph nodes on the same side as the tumor. However, lymph node metastasis must be under 3 cm, and there must be no distant metastasis.

Stage III:

• Stage IIIA: A tumor of any size that has spread to one or more lymph nodes on the same side of the face. Lymph node metastasis may be larger than 3 cm.
• Stage IIIB: A tumor of any size that has either spread to the soft tissues or nerves around the salivary gland, or spread to multiple lymph nodes on the same or opposite side of the face, but has not spread to distant organs.
• Stage IV: Salivary gland cancer has spread to distant parts of the body, such as the lungs, bones, or liver. This is the most advanced stage.

Key Points in Diagnosing Salivary Gland Cancer

Salivary gland cancer presents with certain symptoms. The distinction between benign and malignant tumors is crucial in this type of cancer. Benign tumors tend to grow slowly and are usually painless.

Encapsulated by a capsule, these tumors are less likely to spread to surrounding tissues. Malignant tumors, however, grow more aggressively and often cause pain. They have a high spread potential and can affect surrounding tissues.

Symptoms of salivary gland cancer include:

1. Lump or swelling: abnormal growth in the salivary glands.
2. Pain: linked to the growth of malignant tumors.
3. Loss of function: may cause speech and swallowing difficulties by pressing on nerves.
4. Rapid growth: malignant tumors can grow quickly and damage surrounding tissues.

Patients who notice these symptoms should seek medical attention as soon as possible for early diagnosis and intervention. Early detection reduces the risk of spread and increases treatment success. People in risk groups, in particular, should not neglect regular health check-ups.

Risk Factors and Preventive Measures

Salivary gland cancer can develop under the influence of various factors, and knowing these factors is essential to prevent the disease. First, benign tumors that remain in the salivary gland for a long time can become malignant over time. Therefore, early removal of benign tumors can lower the risk of cancer.

Additionally, radiation exposure is a significant factor that increases the risk of salivary gland cancer. Hence, it is advised for those who work with radiation to undergo regular health check-ups. Smoking is also known to increase the risk of salivary gland cancer. The harmful effects of smoking can trigger various types of cancer. In such cases:

1. Early removal of benign tumors
2. Reducing radiation exposure
3. Refraining from smoking

are measures that can be taken to minimize the risk of salivary gland cancer.

Treatment Methods for Salivary Gland Cancer

In salivary gland cancer treatment, the stage of the disease is the main determinant. Factors such as the size of the tumor, whether it has spread to surrounding tissues, and whether it has reached the lymph nodes are considered when determining the stage.

Additionally, the tumor’s histological structure is important for formulating the treatment plan. At this stage, doctors decide on the most appropriate treatment method. A combination of multiple treatment methods is commonly used.

1. Surgery: Involves completely removing the tumor.
2. Radiotherapy: Uses high-energy beams to destroy cancer cells.
3. Chemotherapy: Uses drugs to kill or slow the growth of cancer cells.

Each treatment method is tailored to the patient’s overall health and the specific characteristics of the cancer. Surgery is often performed if the tumor is locally confined, while radiotherapy and chemotherapy are chosen for more widespread or advanced cancers. Close follow-up and supportive care during the treatment process also contribute to treatment success.

Postoperative Recovery Process

The complexity of the surgery directly affects the recovery time. Patients generally show signs of improvement within a few weeks. Many people can return to their daily activities about a month after surgery. However, it may take from several months to a year for symptoms like facial numbness or weakness to fully resolve. During this period, the patient follows certain guidelines to alleviate the effects of the operation. Additionally, maintaining regular communication with healthcare professionals can speed recovery.

• If numbness or weakness in the face increases
• If pus, fluid, or blood oozes from the wound
• If the wound feels hot, swollen, and painful
• If the wound emits a foul odor

Seek medical attention immediately if these signs appear. Your healthcare provider will assess your condition and take the necessary steps. Removing the parotid gland does not affect the body’s ability to produce saliva. The other salivary glands can produce enough saliva. The submandibular and sublingual glands also continue saliva secretion. The minor salivary glands in the mouth and throat further contribute to saliva production. If you notice any sign of infection or unexpected symptoms during the recovery period, do not wait until your next check-up; consult your healthcare provider.

Diet and Lifestyle Changes After Salivary Gland Cancer Surgery

After salivary gland cancer surgery, the following dietary and lifestyle changes should be implemented:

• Drink plenty of water. Avoid soda and caffeinated beverages for the first few days.
• Avoid spicy or acidic foods and drinks. Particularly citrus fruits may increase saliva flow and cause issues in the surgical site.
• In the first two to three days, focus on nutritious and beneficial foods to help regain strength:
  • Prefer soft foods.
  • Mashed potatoes, warm soups, and cooked vegetables are ideal for recovery.
  • Choose canned fruit, oatmeal, and semolina.
  • You can start with baby food, yogurt, bananas, and applesauce.
  • Pudding and fruit smoothies are also recommended.
• Do not smoke.
• Avoid alcohol.
• Refrain from diet foods or diet drinks, as adequate calorie intake is important for recovery.
• Avoid aspirin or aspirin-containing products.
• Steer clear of salty and spicy foods.
• Avoid fatty foods.
• Prefer warm foods over hot foods.
• Start with small, light meals rather than heavy or large portions, and gradually increase.

F.A.Q.

Where Does Salivary Gland Cancer Spread?

Salivary gland cancer most frequently appears in the parotid gland. Over time, it may spread to different areas. The main places it can spread are:

• Neck lymph nodes
• Ear
• Oral cavity
• Facial bones

Moreover, cancer cells originating from microscopic salivary glands can similarly spread. This underscores the importance of early diagnosis and treatment. As cancer cells reach different tissues and organs, the treatment process becomes more complex.

Thus, the potential for salivary gland cancer to spread must be carefully examined in disease management. This process requires determining specific treatment strategies for the patient.

Is Salivary Gland Cancer Fatal?

Salivary gland cancer is a rare type of cancer. Often, this form of cancer manifests as benign tumors, which is encouraging for many patients. However, as with any cancer, salivary gland cancer should be taken seriously. Early diagnosis and the right treatment methods can significantly alter the disease’s course.

• When treatment starts early, survival rates can reach 95%.
• Unfortunately, in poor outcomes or when treatment is delayed, this rate may drop to 50%.

Therefore, seeing a doctor as soon as you notice symptoms is vital. Early intervention is the most effective weapon against salivary gland cancer. Untreated cases can lead to serious health problems and even death. Thus, while salivary gland cancer can be fatal, it can be managed with the correct approach.

Which Department / Doctor Treats Salivary Gland Cancer?

Salivary gland cancer is a rare type of cancer. Those facing this condition wonder which specialty they should consult for the right treatment and support. The most appropriate first step is to visit the ENT (Ear, Nose, and Throat) & Head and Neck Surgery department. This department:

• Provides a comprehensive evaluation.
• Determines the diagnosis and stage of the disease.
• Presents treatment options.

In addition, a multidisciplinary approach may be needed, involving collaboration with oncology specialists. That way, patients can access various treatment methods such as surgery, radiotherapy, or chemotherapy. In short, for comprehensive care, it is crucial that individuals diagnosed with salivary gland cancer be referred to the ENT & Head and Neck Surgery department.

Is Salivary Gland Cancer Genetic or Contagious?

Salivary gland cancer is generally regarded as a non-contagious disease. It is also not classified as a strictly genetic disease. However, the development of this type of cancer involves a combination of genetic predisposition and environmental factors.

In particular, environmental factors play a prominent role in the development of salivary gland cancer. That said, in some cases, genetic predisposition may also contribute to its onset.

• Genetic predisposition: A family history of cancer.
• Environmental factors: Smoking, exposure to radiation.

In conclusion, salivary gland cancer may result from a complex interaction of genetic and environmental factors. However, environmental factors typically hold more weight. Therefore, managing risk factors is crucial to preventing the disease.

What Happens If Salivary Gland Cancer Is Not Treated?

If left untreated, salivary gland cancer can lead to serious consequences. Initially benign tumors can become malignant over time. This transformation causes more aggressive cancer growth and greater damage to surrounding tissues.

Malignant tumors can metastasize to other parts of the body. Untreated salivary gland cancer can lead to the following complications:

• Deformities in the mouth and facial area
• Difficulty swallowing and speaking
• Pain and discomfort

These conditions significantly lower a patient’s quality of life. Early diagnosis and timely treatment are crucial to preventing these complications. As the cancer advances, treatment options become more limited and recovery becomes more difficult. Therefore, when signs of salivary gland cancer appear, it’s important to seek medical help promptly.

Does Salivary Gland Cancer Go Away on Its Own?

Salivary gland cancer, which can begin in one of the salivary glands in the mouth, neck, or larynx, is a serious disease. It does not improve spontaneously and always requires medical intervention.

If untreated, the disease will inevitably progress, causing more severe health problems. Treatment methods include surgery, radiation therapy, and, in some cases, chemotherapy.

These treatments aim to reduce the risk of spread and improve the patient’s quality of life. However, because every patient’s condition is unique, the treatment plan must be personalized. Thus, if signs of salivary gland cancer are noticed, it’s important to see a healthcare provider without delay.

Which Age Group Is Affected by Salivary Gland Cancer?

Salivary gland cancer is a health problem that appears more frequently with advancing age. It is particularly common in individuals between the ages of 60 and 70. This form of cancer, characterized by the formation of benign or malignant masses in the salivary glands, is seen more often in men.

Age factors increase the risk of salivary gland cancer, and gender also plays a role. Because the disease is treatable when diagnosed early, being aware of its symptoms is vital. Below is a summary of the age groups in which it is seen and the associated risk factors:

• Mostly appears in individuals aged 60-70.
• More common in men.

Is There a Chance of Survival in Stage 4 Salivary Gland Cancer?

For patients with stage IV salivary gland cancer, the survival rate is quite low. Overall survival rates in stage IV disease have been reported at around 23%. This is due to the disease being very aggressive and often resistant to treatment at this stage. Nonetheless, there is certainly a chance of survival.

Looking at images or photos of people with salivary gland cancer for self-diagnosis can be misleading, so consult a doctor if in doubt.

What Is the Most Common Malignant Salivary Gland Tumor?

The most common malignant salivary gland tumor is mucoepidermoid carcinoma. It is a rapidly growing, malignant type of cancer in the salivary glands. It can progress in various ways, often classified as high-grade, intermediate-grade, or low-grade. High-grade tumors are more aggressive, while low-grade ones progress more slowly. Mucoepidermoid carcinoma is known as the most common salivary gland cancer type and can lead to serious health issues.