What is 'Salivary Gland Cancer''? Most Salivary-Gland-Cancer-HANCA2020-docx_4Salivary Gland Cancers are found in the parotid glands. The parotid glands contain glands of the immune system (lymph nodes). If this is not the cancer type you're looking for, please explore the information about other types of Throat Cancers or other types of Head and Neck Cancers.
Following a diagnosis of Salivary Gland Cancer, your cancer care team will discuss treatment options that are suitable for you. This is also a good time to consider if you would like a second opinion. The most suitable treatment of Salivary Gland Cancer depends on many things. These include:
type and grade of Salivary Gland Cancer
size and location of the cancer
whether it has spread
personal factors (e.g. age, general health and treatment history)
treatments available (and whether any clinical trials are available)
your preferences for treatment.
A week or two after surgery, your pathologist will give a detailed report on the cancer. This will be used by your cancer care team to decide if you need more treatment to reduce the risk of the cancer coming back. This treatment may be radiation therapy alone or radiation combined with chemotherapy (chemoradiation) and, occasionally, it may be radiation therapy followed by chemotherapy. Adding another treatment after surgery is called adjuvant therapy. Adjuvant therapy usually starts about 4–6 weeks after surgery so that you have time to recover from your surgery. Adjuvant therapy usually lasts for about 6 weeks.
Low-grade cancer is usually treated with surgery alone and, usually, the lymph nodes do not need to be removed.
High-grade cancer usually involves removing the lymph nodes during surgery and adjuvant radiation therapy after surgery. Sometimes chemotherapy is added, however, this will depend on the features of the cancer, your cancer care team and, sometimes, what clinical trials are available.
Your doctor will explain details of the surgery, general risks and side effects of surgery. Ask your doctor if you have questions. They may recommend:
stopping blood thinners (e.g. aspirin) before surgery to reduce the risk of bleeding
special stockings to reduce the risk of blood clots
early mobilisation (i.e not staying in bed) to reduce the risk of blood clots and chest infection
antibiotics to lower the risk of wound infection.
Before starting treatment, it is important that you consider stopping smoking to reduce the risk of infection and help you fully recovery after your treatment.
There are a number of different types of operations that can be used to remove Salivary Gland Cancer. The type of surgery used will depend on the size and the location of the cancer. The different operations that can be used for Salivary Gland Cancers are:
This is removal of one or both of the parotid glands (pair of major salivary glands located in front of each ear) and the surrounding tissue.
This is removal of the submandibular glands (located beneath the floor of your mouth) and some of the surrounding tissue and/or bone.
This is removal of the sublingual glands (located in the mouth) and some of the surrounding tissue.
This is removal of facial nerve, which controls facial expression. It is performed when a cancer in the parotid glands has spread to surrounding facial nerve.
This is the removal of some or all of the bone in the temple and behind the ear. It is used when a cancer in the parotid glands spreads into the nearby bone.
This involves taking out the lymph nodes from the neck. It is used when cancer of the salivary glands has spread to the lymph nodes in the neck or there is a risk of cancer in the lymph nodes of the neck.
This may be considered if you have a large area of tissue removed. This may involve taking tissue from another part of the body, this is called a free flap repair. This operation is carried out by a surgeon who specialises in reconstructive surgery, your head and neck surgeon or another surgeon.
A tracheostomy is used to create an opening in the trachea (windpipe) after major head and neck surgery. A tube is inserted into the opening to help you breathe until normal breathing is possible.
Tooth extractions may be recommended to remove any broken or infected teeth before radiation therapy. This is important because removal of unhealthy teeth after radiation therapy can cause problems with the jaw bone.
The most common approach of radiation therapy for Salivary Gland Cancer is called external beam radiation. This type of radiation therapy applies radiation from outside the body. Radiation therapy can be used in the following ways:
This is when radiation therapy is used on its own without surgery to cure Salivary Gland Cancer. It is used in Salivary Gland Cancer when surgery is not a treatment option.
This is when radiation therapy is given after surgery, to kill cancer cells that may not have been taken out during surgery. It can be used either on its own or at the same time as chemotherapy (chemoradiation), to make it more effective. The decision to give radiation therapy, either alone or with chemotherapy, is based on the pathology results after surgery. The aim of adjuvant radiation therapy is to reduce the risk of Salivary Gland Cancer coming back. Not everyone will require adjuvant radiation therapy.
In cases where a cure is not possible, radiation therapy is used to relieve symptoms of advanced Salivary Gland Cancer. Symptoms that may require palliative radiation therapy include pain, bleeding, breathing and trouble swallowing.
You will meet with many members of the cancer care team, who will help you learn how to look after yourself through radiation therapy, recovery and long term follow-up. They will also talk to you about side effects and how to manage them. It may be helpful to write down questions as they come up, so you can ask anyone in your cancer care team when you see them.
You might need to have some of your teeth taken out, this will depend on the area being treated and the dose of radiation therapy. It is important to take out any broken or infected teeth before radiation therapy. Taking out unhealthy teeth after radiation therapy can cause problems with the jaw bone. Further information about removing teeth and what to expect during and after the operation is available here.
Your cancer and its treatment can make it hard to eat and drink. Your doctor will recommend you see a dietitian to maximise your nutrition during treatment as well as while you are recovering. Sometime feeding tubes may be recommended depending on the area being treated and the dose of radiation therapy. There are two common types of feeding tubes:
Gastrostomy tube (sometimes called a PEG tube): this type of tube is inserted through your abdominal wall into your stomach, with part of the tube staying outside the stomach. A syringe can be attached to the tube to give you food this way if needed. The tube is inserted using a camera through the mouth into the stomach (gastroscopy) or using a CT scanner to guide insertion directly through the skin. If a PEG tube is needed, your doctor will organise this before starting your radiation therapy
Nasogastric tube: this type of tube goes through the nose down into the stomach and is usually used for short periods (days or weeks). A nasogastric tube can be inserted at any time (before, during or after treatment).
There are many other aspects of supportive care that are available, ask your doctor if you have any specific needs.
The side-effects of radiation therapy start around two weeks into treatment and progress through treatment to peak in the last week or just after treatment ends. The side effects start to improve 2-3 weeks after the end of treatment.
the dose of radiation therapy
the area being treated
whether or not chemotherapy is added to the radiation.
tiredness
skin irritation in the treated area e.g. redness, dryness and itching, weeping skin, scaling or sometimes skin breakdown (sores)
dry mouth or throat due to lack of saliva (called xerostomia)
ulcers in the mouth or throat that make it painful or difficult to chew or swallow
sticky or thick saliva
altered taste, which is usally a loss of taste or sometimes an unpleasant taste in the mouth
weight loss
blocked ears from inflammation within the ear canals.
Most side effects are short lived and may go away within 4–6 weeks of finishing radiation therapy. Some side effects may last for months after you finish radiation therapy and some may be permanent.
Chemotherapy works by destroying or damaging cancer cells. For Salivary Gland Cancer, it is usually given into a vein through a needle with a cannula (tube) attached. There are a number of ways that chemotherapy may be used to treat Salivary Gland Cancer including:
Adjuvant
This is when chemotherapy is given after surgery and is usually combined with radiation therapy (chemoradiation). It is usually given once a week during radiation therapy. Adding chemotherapy makes the radiation more effective at destroying cancer cells, but also leads to increased side effects for most patients
Neo-adjuvant
This is when radiation therapy is given before surgery or radiation therapy. It is used to shrink large cancers so they are easier to remove during surgery or target with radiation therapy. Neoadjuvant chemotherapy is rarely used for Salivary Gland Cancer.
Palliative
This is given when the cancer is incurable, because the cancer is too big or has spread too far to be removed by surgery. Even if a cancer is incurable, some patients feel better from palliative chemotherapy as it slows the growth of the cancer, and can relieve or prevent symptoms.
Before you start treatment, your medical oncologist will choose one or more chemotherapy medications that will be best to treat the type of cancer you have. The chemotherapy medications your doctor chooses may depend on:
whether the treatment is curative or palliative
when it is used
your medical history.
ulcers on the lining of the mouth and throat
a feeling of wanting to vomit (nausea) and vomiting
loss of feeling in the fingers and toes
ringing in the ears (tinnitus), or hearing loss
rash
change in taste
hair loss or thinning
higher risk of infection (if the chemotherapy reduces the number of white cells in the blood)
low levels of red blood cells, sometimes requiring a blood transfusion.
Most of these side effects are short lived and go away once you finish chemotherapy. Some side effects like hearing loss, may be permanent.
1. Introduction to Salivary Gland Cancer
2. Symptoms, signs and tests of Salivary Gland Cancer
3. Treatment for Salivary Gland Cancer
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