Salivary gland tumour
What is it?
A tumor that can develop in the large salivary glands, such as the parotid (in front of the ear), submandibular (located under the chin), sublingual (under the tongue) and the small salivary glands on the lips and in the mucosa of the mouth and throat. The parotid glands are most commonly affected (40-60%), then the minor salivary glands (30-50%), and finally the submandibular glands (10%).
Which are the symptoms?
Symptoms associated with salivary gland tumors are scant or absent in the early stages, other than the presence of non-painful, progressive swelling in front or under the ear, under the jaw, and in the oral cavity. The presence of rapid growth, pain, and/or paralysis of the midface muscles are signs of tumor severity.
- swelling of the gland
- neurologic deficits of the facial nerve
- pain
- progressive growth of the cervical glands
- irregular swelling of the face
How is it diagnosed?
The main examination even today is ultrasound, a simple and inexpensive examination that also allows diagnosis by needle aspiration, that is, puncturing the tumor to collect cells and formulate a presumptive diagnosis.
Unfortunately, however, the success of the examination depends on the experience of the examiner, so it is not always adequate and in any case does not allow you to see the inside of the glands.
The MRI (magnetic resonance imaging), much more than the CT (computed axial tomography), provides important information about the size of the tumor, the involvement of nearby structures such as bones, blood vessels or nerves, and the possible presence of affected lymph nodes. In addition, recent technological advances in magnetic resonance imaging also make it possible to formulate a presumptive diagnosis, which, however, cannot currently replace the diagnosis obtained by needle aspiration.
Biopsy of salivary gland tumors is almost always contraindicated because of the risk of spread of the disease into the surrounding tissue, which is characteristic of this type of tumor.
The diagnosis of the tumor must be confirmed by needle aspiration of the site of origin or, if this is not possible, by needle aspiration of a lymph node.
Metastases are initially rare, usually occurring after years in 2-30% of cases, depending on the initial stage and histopathology, while at locally advanced stages they are very common. The most affected organ is the lungs.
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How is it treated?
As a rare disease, there is little research to determine the best therapeutic approach, but surgery, when possible, is the best therapeutic strategy to treat salivary gland tumors. Obviously, surgical intervention depends on which gland is involved in the process, and consists of removing the entire gland (for sotomandibular and submandibular tumors) or even just part of it (for parotid gland tumors). In 20% of cases, removal of lymph nodes of the neck may also be required, depending on the size of the disease, the site of localization, and histological degree.
Radiation therapy may be required in addition to the surgical approach.
The main indications for postoperative radiation therapy are as follows:
- tumors of the deep part of the parotid gland;
- large lesions (T3-T4);
- microscopic (R1) or macroscopic (R2) residue after surgery;
- high histological degree (G3-G4);
- nerve involvement (perineural invasion);
- involvement of lymph nodes;
- capsule rupture (extracapsularity);
- relapse after previous surgery.
In locally advanced stages, recovery is still possible, but a combination of chemotherapy with surgery and radiotherapy may be necessary, depending on the characteristics of the disease, risk of tumor recurrence, patient age, and other conditions.
However, in the case of inoperability, treatment is only with radiotherapy.
In the case of involvement of other organs (metastatic disease), the goal can no longer be a cure, but the chronicity of the disease through: chemotherapy (cisplatin and adriamycin-based CAP therapy (cisplatin, adriamycin, cyclophosphamide) or taxol (not effective for adenoid cystic carcinoma), or radiotherapy for symptomatic areas/risk of bleeding/fractures is most commonly used.
Alternatively, in metastatic adenocarcinomas expressing hormone receptors, hormone therapy will be a further treatment option until the maximum response is achieved or depending on tolerability.
The above treatments may be combined with radiotherapy for symptomatic sites or sites at risk of bleeding/fracture and surgical treatment of individual metastases, especially if there are less than 6 of them, without pleural involvement, and 3 years after previous treatment.
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