What are the types of salivary gland tumors?
The group of these neoplasms includes dozens of types, which makes them one of the most diverse human tumors in structure. Among benign ones, the most common is pleomorphic adenoma - a slowly growing mobile node, which, however, can degenerate over time and therefore must be removed. The most common malignant types are mucoepidermoid carcinoma and adenoid cystic carcinoma. The latter is characterized by a tendency to spread along the nerves, which explains pain and numbness, and the ability to produce late distant lesions, so observation after treatment should be many years.
- Dozens of histological types
- Pleomorphic adenoma is the most common benign tumor
- Mucoepidermoid carcinoma
- Adenocystic cancer with growth along the nerves
- The smaller the gland, the higher the risk of malignancy
- The type of tumor determines treatment tactics
Causes and risk factors
For most patients, the cause cannot be determined. The only reliably proven factor is irradiation of the head and neck area in the past, including for another disease; the tumor may appear many years later. The role of smoking, especially for certain types, professional contact with rubber and asbestos dust, and nickel compounds are discussed. The majority of patients are in the middle and older age range, but tumors can also occur in young people. Salivary stone disease and chronic inflammation of the gland do not lead to cancer.
- Radiation therapy to the head and neck in the past
- Smoking for selected tumor types
- Rubber and asbestos dust, nickel compounds
- Middle and older age range
- Chronic inflammation of the gland is not a risk
Symptoms
The most common manifestation is a painless node that a person accidentally feels in front of the ear, under the lobe or under the lower jaw. Benign tumors usually grow for years, are mobile and soft-elastic. Malignant ones are characterized by faster growth, density, limited mobility, and adhesion to the skin. The facial nerve passing through the parotid gland deserves special attention: its involvement is manifested by facial asymmetry, the inability to completely close the eye, and drooping of the corner of the mouth. Tumors of small glands look like a lump on the palate or buccal mucosa.
- A painless lump in front of the ear or under the jaw
- Fast growth and dense consistency
- Limited mobility and adhesion to the skin
- Gland or ear pain
- Facial asymmetry and weakness of facial muscles
- Numbness of the skin
- Seal on the palate due to tumors of small glands
Diagnostics
The first study is an ultrasound: it shows the location, size and structure of the formation, as well as the condition of the lymph nodes. Then a fine-needle aspiration biopsy with cytological examination is performed - it helps to distinguish between inflammation, benign and malignant tumors. Contrast-enhanced MRI best depicts the boundaries of the lesion, its relationship to the facial nerve and distribution along the nerve trunks; CT scans complement bone assessment. An open biopsy of the parotid gland node is usually not done so as not to disrupt the integrity of the tumor capsule.
- Ultrasound of the salivary glands and lymph nodes of the neck
- Fine needle puncture with cytology
- MRI with contrast
- CT scan for suspected bone involvement
- Facial nerve function assessment
- Final diagnosis based on histology of the removed tumor
Treatment and recovery
The main method is surgical. The scope of the operation depends on the type, size and location of the tumor: from removal of a lobe of the parotid gland to its complete removal, if necessary, with intervention on the lymph nodes of the neck. The key task of the surgeon is to preserve the facial nerve if it is not involved in the tumor; For this purpose, intraoperative monitoring of its function is used. Radiation therapy is prescribed after surgery for aggressive types, close resection margins and nerve damage. After treatment, you may be concerned about temporary weakness of facial expressions, which is reduced by special gymnastics.
- Removal of a lobe or the entire gland
- Preservation of the facial nerve when possible
- Surgery on neck lymph nodes according to indications
- Radiation therapy after surgery for aggressive types
- Gymnastics for facial muscles with weakness
- Eye protection for incomplete eyelid closure
- Long-term follow-up, especially for adenoid cystic cancer
