Salivary Gland Tumor

Aka: Salivary Gland Tumor, Salivary Gland Neoplasm, Salivary Gland Malignancy, Salivary Gland Malignant Neoplasm, Salivary Gland Carcinoma

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II. Epidemiology

  1. Incidence: 2-8 per 100,000 people in U.S.
  2. Represent 6% of all head and neck tumors
    1. Rare compared to other Oral Growths
  3. Malignant Salivary Gland Tumors
    1. Adult: Only 16% of Salivary Gland Tumors are malignant
    2. Child: >50% of solid Salivary Gland Tumors are malignant
    3. Malignancies typically form in Submandibular Gland, Sublingual Gland or minor Salivary Glands
      1. Parotid Gland tumors are most often benign

III. Types

  1. Benign (70% of Salivary neoplasms)
    1. Benign Salivary tumors in children are typically pleomorphic adenoma, Hemangioma or lymphatic malformation
    2. Mixed Tumor (Pleomorphic adenoma)
      1. Most Common benign Salivary Gland Tumor (accounts for >50% of cases)
      2. May affect major Salivary Glands (Parotid Gland is most often affected)
      3. May also affect minor Salivary Glands (esp. Palate)
      4. Slow growing, nonulcerated painless tumor
      5. Occurs most commonly in women aged 30 to 60 years
      6. Risk of malignant transformation (excision recommended)
    3. Monomorphic Adenoma
    4. Warthin's Tumor
      1. More common in older men
      2. Associated with Tobacco Abuse
  2. Malignant
    1. Mucoepidermoid carcinoma (ages 20 to 50 years)
      1. Presents as low grade tumor in most cases
      2. Excellent prognosis with early treatment
    2. Adenoid cystic carcinoma (age over 50 years)
      1. Predisposition for nerve infiltration (often presents with facial weakness)
      2. Recurrence may occur years after excision
  3. Metastatic
    1. Cutaneous Squamous Cell Carcinoma
      1. Regional spread from the face or scalp

IV. Findings: Red Flags Suggestive of Salivary Malignancy

  1. History
    1. Intermittent, increasing localized pain and Paresthesias
    2. Prior head and neck Radiation Therapy
    3. Prior skin or Salivary Gland Neoplasm
    4. Rapid increase in size of palpable mass
    5. Sjogren Syndrome
  2. Exam
    1. Facial Nerve paresis or weakness
    2. Non-mobile mass (fixed to surrounding tissue)
    3. Neck Lymphadenopathy
    4. Overlying skin or Mucosal Ulcerations or induration

V. Symptoms

  1. Slow growing, painless Salivary Gland mass

VI. Signs: General

  1. Palpation reveals Salivary Gland Enlargement
  2. Evaluate for associated Cranial Nerve deficit

VII. Signs: Distribution (may affect any of Salivary Glands)

  1. Parotid Gland (typically benign)
  2. Sublingual Gland
  3. Submandibular Gland
  4. Minor Salivary Glands
    1. Especially on posterolateral Hard Palate
    2. Buccal mucosa and lips may also be affected

VIII. Imaging

  1. Ultrasound
  2. Computed Tomography (CT)
  3. MRI Sialography

IX. Diagnosis

  1. Fine Needle Aspirate of Salivary Gland Tumor
    1. Test Sensitivity: 80%

X. Differential Diagnosis

  1. See Salivary Gland Enlargement

XI. Management

  1. ENT referral
  2. Benign Salivary Gland Tumors are typically excised
    1. Risk of recurrence or malignant transformation (esp. if radioresistant)

XII. Prognosis: Malignant Salivary Gland Tumors

  1. Mucoepidermoid carcinoma
    1. Excellent prognosis with early treatment
    2. Five year survival dependent on grading: 50-90%
  2. Adenoid cystic carcinoma
    1. Five year survival: 65%
    2. Twenty year survival: 15%

XIII. References

  1. Kim (2024) Am Fam Physician 109(6): 550-9 [PubMed]
  2. Weinberg (2002) Am Fam Physician 65(7):1379-84 [PubMed]
  3. Wilson (2014) Am Fam Physician 89(11): 882-88 [PubMed]

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