Surgical Procedures: Surgery and Staging for Salivary Cancer

What is Salivary Cancer?

When there are cancer cells in the salivary glands, it is called salivary cancer. Your salivary glands make and release saliva (spit). Saliva helps you digest food, kills bacteria in your mouth, and prevents tooth decay.

Most salivary tumors are found in the major salivary glands:

• Parotid glands: Found on each side of the face, just in front of the ears.
• Submandibular glands: Found below the jaw on each side of the face.
• Sublingual glands: Found under the floor of the mouth and under each side of the tongue.

The minor salivary glands are tiny glands that sit around the lips, tongue, roof of the mouth, cheeks, nose, sinuses, and voice box.

Most tumors in the salivary glands are benign (not cancerous). Your provider will do testing to see if a tumor is benign or malignant (cancerous).

What is staging and how is it done?

Staging is a way to find out if and how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. These tests may be:

Physical Exam: This is a general exam to look at your body and to talk about past health issues.

Imaging: Radiology tests can look inside your body to look at the cancer and see if it has spread. These tests can include:

• CAT scan (CT scan).
• Positron emission tomography scan (PET scan).
• Magnetic resonance imaging (MRI).

Procedures: Special procedures may be needed and may include:

• Endoscopy: An endoscope, or a lighted tube, looks for any abnormal areas. If needed, the endoscope can get tissue for a biopsy.
• Biopsy: A biopsy takes cells from the tumor, or a piece of the tumor, to see if it is cancer, what type it is, and how it behaves. A doctor called a pathologist looks at the sample under a microscope.
  • Fine needle aspiration (FNA): A small needle is used to remove tissue or cells to be tested.
  • Incisional biopsy: A piece of the tumor is removed to be tested.
  • Surgery: Surgery may be needed to remove the mass to be tested.

Benign salivary tumors cannot spread to other parts of the body and can often be removed by surgery. Cancerous salivary tumors can spread to other parts of the body through the tissue, lymph, and blood systems. Because of this, it is important to “stage” a cancerous tumor to know its size, if/where it has spread, and how aggressive it is.

Salivary cancer is both graded and staged.

• The grades are numbered 1 to 3. Grade 1 cancers are often slow-growing cancers. Grade 3 cancers grow more quickly.
• The stages of salivary cancer range from stage 1 through stage 4.

There are a few different types of salivary cancer. Each type of salivary cancer acts differently, so it is important to know the type. Mucoepidermoid is the most common type. A biopsy is done to find out the type. The results of the biopsy are written in a pathology report. You should ask for a copy of your report to keep in your records.

Surgery for the Treatment of Salivary Tumors

If you have salivary cancer, you may need surgery. The kind of surgery depends on a few things, like where and how big the tumor is. Your provider will talk with you about the surgery that is best for you.

Common surgeries to treat salivary cancers are:

• Superficial parotidectomy: The superficial (outer part) of the parotid gland is removed. The surgeon makes a cut (incision) in front of the ear and down the neck. This does not often affect how the face moves, because the surgeon tries to stay away from the facial nerve.
• Total parotidectomy: The whole parotid gland is removed. The surgeon makes a cut in front of the ear and down the neck. The facial nerve, as well as other tissues, may need to be removed depending on where the tumor is. This could affect how your face moves.
• Submandibular sialadenectomy: The whole submandibular gland is removed through a small cut made below the lower jaw.
• Sublingual gland surgery: The whole sublingual gland and, in some cases, tissue and bone are removed through a mouth or facial/neck incision. Nerves that control tongue and face movement, sensation (feeling), and taste may be affected.
• Minor salivary gland surgery: Removes cancer from minor salivary glands. These glands can be found in the lips, tongue, palate (roof of mouth), mouth, throat, voice box (larynx), nose, and sinuses. Some tissue may also be removed.
• Lymphadenectomy (also called neck dissection): Lymph nodes from the neck are removed. Connective tissue, muscles, nerves, and blood vessels may also need to be removed through a large cut in the neck.

What are the risks of surgery to treat salivary cancer?

As with any surgery, there are risks and possible side effects. These can be:

• Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, to not remember it, and to manage pain. Reactions can include wheezing, rash, swelling and low blood pressure).
• Bleeding.
• Blood clots.
• Infection.
• Facial nerve damage. This can lead to facial muscle loss, facial droop, problems with tongue movement, speech and/or swallowing, arm weakness and/or weakness in the lower lip.
• Frey syndrome (A condition caused by facial nerve damage. It causes facial flushing and sweating when eating a meal, or even thinking, dreaming, or talking about eating).
• Loss of feeling in the ear.
• Dry eye.
• Salivary fistula (an abnormal opening in the skin that saliva might leak through).
• A change in how you look.

Before surgery, your provider will talk to you about any other risks based on your health and the surgery you are having.

What is recovery like?

Recovery and your hospital stay from surgery to treat salivary gland cancer depends on the type of the procedure you have had.

You will be told how to care for your surgical incisions and will be given any other instructions before leaving the hospital.

Your care team will talk with you about the medications you will be taking, such as those for pain, blood clot, infection, and constipation prevention and/or other conditions.

Your provider will talk to you about any changes to your activity level, which depend on the surgery you had. Often, you should:

• Take prescribed medications as directed.
• Eat a bland diet, staying away from sour, tart, or spicy foods.
• Treat constipation as needed to reduce straining when having a bowel movement.
• Sleep with your head elevated (propped up) above your heart.
• Talk to your healthcare team about when you should start taking your pre-operative medications, especially medications that can affect blood clotting like blood thinners, aspirin and non-steroidal anti-inflammatory medications (NSAIDs like ibuprofen, naprosen).
• Not drink alcohol.
• Not smoke. Smoking will lessen the blood flow to the surgical wound. If the wound does not have enough blood flow, it will not heal.
• Not lift anything over 10 pounds.
• Not bend, stoop or lift objects, or exercise until told that it is okay to do so.
• Not travel by air for 2 weeks after surgery.
• Care for your incision and shower as directed. Do not put the incision under water.
• Use a thermometer to check for fever, which can be a sign of infection.
• Have enough wound and drain care supplies if needed.

What will I need at home?

• Thermometer to check for fever (101°F or 38.3°C), which can be a sign of infection. Your care team will tell you at what temperature you should call them.
• Wound and drain care supplies if needed.

When should I call my provider?

Your provider should give you details about when to call the office. Often, you should call the office if you have:

• Redness, swelling and/or drainage at the incision.
• Any other questions or concerns.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation.

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

• Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.