Parotid tumors

Overview

Parotid tumors are growths of cells that start in the parotid glands. The parotid glands are two salivary glands that sit just in front of the ears. There is one on each side of the face. Salivary glands make saliva to help with chewing and digesting food.

There are many salivary glands in the lips, cheeks, mouth and throat. Growths of cells, which are called tumors, can happen in any of these glands. The parotid glands are the most common place that salivary gland tumors happen.

Most parotid tumors aren't cancerous. These are called noncancerous or benign parotid tumors. Sometimes the tumors are cancers. These are called malignant parotid tumors or parotid gland cancers.

Parotid tumors often cause swelling in the face or jaw. They often don't cause pain. Other symptoms include problems swallowing or a loss of facial movement.

Diagnosis and treatment for parotid tumors is often done by doctors who specialize in problems that affect the ear, nose and throat. These doctors are called ENT specialists or otolaryngologists.

Diagnosis

Tests and procedures used to diagnose a parotid tumor may include:

• A physical exam. A health care provider feels the jaw, neck and throat for lumps or swelling.

• Collecting a sample of tissue for testing. A biopsy is a procedure to collect a sample of tissue for testing. It typically involves using a needle to collect fluid or tissue from the parotid gland. The needle may be inserted through the skin on the face and into the parotid gland.

  In the lab, tests can show what types of cells are involved and tell if they're cancerous. This information helps your health care team understand your prognosis and which treatments are best for you.

  Results from a needle biopsy aren't always correct. Sometimes the results say a tumor isn't cancerous when it is. For this reason, some doctors don't do a biopsy before surgery. Instead, they may take a sample of tissue for testing during surgery.

• Imaging tests. Imaging tests help your health care team understand the size and location of your tumor. If your parotid tumor is cancerous, imaging tests help look for signs that the cancer has spread. Tests may include ultrasound, MRI and CT.

Treatment

Parotid tumor treatment often involves surgery to remove the tumor. If the tumor is cancerous, you might need more treatment. This could be with radiation therapy and chemotherapy.

Surgery

Operations used to remove parotid tumors include:

• Removing part of the parotid gland. For most parotid tumors, surgeons may cut away the tumor and some of the healthy parotid gland tissue around it. The part of the parotid gland that's left continues working as before.
• Removing all of the parotid gland. Surgery to remove all of the parotid gland is called parotidectomy. It might be needed for larger tumors, tumors that are cancerous and those that affect the deeper parts of the parotid gland.
• Removing more tissue to get all of the cancer. If parotid gland cancer has grown into nearby bone and muscles, some of these may be taken out with the parotid gland. Surgeons try to remove all of the cancer and a small amount of the healthy tissue that surrounds it. Then they work to repair the area so that you can continue to chew, swallow, speak, breathe and move your face. This may involve moving skin, tissue, bone or nerves from other parts of your body to make repairs. This type of surgery isn't needed for parotid tumors that aren't cancerous.

To get to the parotid gland, surgeons make a cut in the skin near the ear. The cut is often hidden in a crease of skin or behind the ear.

Sometimes a sample of tumor tissue is tested during surgery to see if it's cancer. A doctor who uses blood and body tissue to diagnose diseases, who is called a pathologist, looks at the sample right away. The pathologist tells the surgeon if the tumor is cancerous. This helps the surgeon decide how much of the parotid gland to remove. The pathologist also might test nearby lymph nodes and other tissue for signs of cancer.

The parotid gland surrounds the nerve that moves the muscles of the face. This nerve is called the facial nerve. Surgeons take special care to avoid hurting it. They might use electrical devices to check on the nerve and make sure it works as expected after surgery.

Sometimes the facial nerve gets stretched during surgery. This can cause loss of movement in the face muscles. Muscle movement often gets better over time. Rarely, the facial nerve must be cut in order to get all of the tumor. Surgeons can repair the facial nerve using nerves from other areas of the body or from artificial nerves.

Parotid tumor surgery can be complex. It requires well-trained surgeons and specialists for the best outcome. If you're facing surgery for a parotid tumor, meet with your surgeon before your operation to ask questions. Learning more about the procedure can help you feel more comfortable about your treatment plan. You might consider asking:

• Where will you cut into the skin to reach the parotid gland? Will I have a scar?
• How much of the parotid gland do you plan to remove?
• How likely is it that the facial nerve will be hurt? How will you manage this?
• How will you be sure that you've removed all of the tumor?
• Will you remove any lymph nodes?
• Will I need reconstructive surgery? What will that involve?
• What should I expect during recovery? How long will it take to heal?

Radiation therapy

Radiation therapy uses powerful energy beams to kill cancer cells. The energy can come from sources such as X-rays and protons.

Radiation therapy is used to treat parotid gland cancers. Radiation therapy might be recommended after surgery. The radiation can kill any cancer cells that remain. If surgery isn't possible, radiation therapy might be the first treatment for parotid cancers.

Chemotherapy

Chemotherapy uses strong medicines to kill cancer cells. Chemotherapy is sometimes used to treat parotid gland cancers. It might be needed if there's a risk that the cancer might spread or if surgery isn't an option. In these situations, chemotherapy might be done at the same time as radiation therapy.

Chemotherapy is sometimes used on its own for advanced cancer, such as cancer that has spread to other parts of the body. Chemotherapy may help relieve pain and other symptoms caused by the cancer.