A Family Doctor's Tale - SALIVARY GLAND CANCER

DOC I HAVE SALIVARY GLAND CANCER

Funny I thought I will never see a case of salivary gland cancer because I have never seen one in the ENT Department. Just 3 years ago I met a patient who was losing tremendous amount of weight. I refer him to the hospital  for checkup.  They could find any thing wrong with him. Eventually after all the MRI and Cat scans of the whole body, they finally found a small swelling in the salivary gland. It was confirmed as cancer of the salivary gland. By that time it has started to spread throughout the body. In three months he had succumbed to the cancer.

 





Salivary Cancer is a malignant disease of the Salivary glands.
Cancers affecting the salivary glands are rare.

They can occur at any age, but are more common in people over 50.

The cause of the cancer is unknown.

Malignant tumours of the salivary glands are rare but there are benign or non-malignant tumours of the salivary glands which are more common.

Cancer of the salivary glands cannot be transmitted to another person through the saliva.

There is no inherited gene and the cancer do not run in families.

Symptoms - non-specific and silent.

In the early stage there is no symptoms.

By the the time the symptoms appeared, the cancer may be in the advanced stage.

1.swelling on one side of the face either in front of the ear or under the jaw.

2.numbness and drooping of one side of the face (facial palsy).

3.weight loss

Signs:

palpable mass under the jaw

Definite diagnosis requre the following tests:

1.X-rays to show the size and position of the cancer and possible spread.

2.CAT (computerised tomography) scan of the skull and neck to detect the enlarged salivary tumors

3.MRI (magnetic resonance imaging) scan of the skull and neck to detect the enlarged salivary tumors

4.Biopsy of the affected salivary gland for examination under a microscope through a needle or surgical removal.

Salivary Biopsy
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Biopsy of Salivary tumor may be done to determine stage of Salivary cancer:

Stage 1 :
1.Size is < 2cm

2.no spread

Stage 2
1. Size is between 2 and 4cm

2.No spread.

Stage 3
1.Size > 4cm in size

2.There may be spread into nearby soft tissue.

Stage 4a
1.Size can be any size > 4cm

2.spread to the skin, jaw-bone, ear-canal or facial nerves.

Stage 4b
1.Size can be any size > 4cm

2.spread to other nearby bones, the base of the skull or the carotid artery.

Lymph nodes spread
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Stage 0
1. None of the lymph nodes are affected.

Stage1.
1.spread to one lymph node on the same side of the neck as the tumour.

2.Size of affected node <3cm

Stage 2a
1.spread to one lymph node on the same side of the neck as the tumour.

2.Size of the node is between 3-6cm

Stage 2b
1.spread to >one lymph node on the same side of the neck as the tumour.

2.Size < 6cm in size.

Stage 2c
1.spread to one or more lymph nodes on both sides of the neck.

2.Size < 6cm in size.

Stage3
1.Size of lymph nodes > 6cm in size.

Metastases Stages
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Stage 0
No spread to other parts of the body.

Stage 1
spread to other parts of the body, such as the lungs.

Treatment of Salivary cancer can be
1.surgery
2.chemotherapy
3.radiotherapy

The type of treatment given depend on
1.the position of the cancer,
2.the exact type of cancer,
3.the general health of the patient.

Surgery
Surgery is done to remove the salivary gland tumor.

If necessary, surgery is also done to  remove any affected lymph nodes in the neck.

Radiotherapy
Radiotherapy can be used to treat salivary gland cancers.

Radiotherapy can be used in conjunction with surgery especially where there is spread to lymph nodes and other parts of the body.

Chemotherapy
Chemotherapy involve the use of anti-cancer drugs to destroy the cancer cells.

It is however not very effective in treating salivary gland cancers and is used only more for the cancer which has spread to the lungs, bones and other parts of the body.

The prognosis of Salivary cancer is usually poor

1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.

2.Survival rates are best in the slow growing tumors.

There is no way to prevent salivary gland cancer but proper mouth hygience may hlp to prevent infections and chemicals in the mouth from causing mutations in the salivary gland cells.

Smoking should be avoided if possible.