Salivary gland cancer

Salivary gland cancer treatment with curative intent is primarily surgical. For malignancies of the minor salivary glands of the check, palate and floor of mouth, and the sublingual gland the timelines are identical to that of mouth cancer.

Excision of the submandibular or parotid gland for malignant disease is often a combination of conventional neck dissection plus parotidectomy, with the submandibular gland being excised as part of level 1 in all neck dissections involving cancer of the mouth.

In this case, the timelines are similar to that of mouth cancer, but with additional impact of the mastoid facial incision scar for parotidectomy , and most importantly the impact on the facial nerve. If the facial nerve is not involved in the cancer and not damaged during surgery, then the medium to long term impact of gustatory sweating (excessive sweating in regions of the face) may be the only additional concern.

If in the removal of a parotid gland the facial nerve (which is embedded in the parotid gland) has to be sacrificed, then some form of functional rehabilitation is necessary. This may be surgical simultaneously, as a second procedure, by physiotherapy or a combination thereof.

When treatment is staged it is reasonable to expect only limited return to previous function and over the medium (months) to long term (years) the emphasis needs to be on adjusting to a ‘new normal’.

Where treatment is palliative in nature, a relatively immediate but limited ‘new normal’ is the expectation.

Chemotherapy currently is of no benefit in the treatment of salivary gland malignancies and it is highly unlikely that this type of intervention will affect the timeline for any of the options.

Long-term monitoring and reviewing in an out-patient setting are highly desirable for all malignancies of the salivary glands, spaced out-patient review visits for up to 5 years after treatment.