ear, nose, and throat disorders
Salivary Gland Tumors
Treatment of Salivary Gland Tumors
Surgery, sometimes plus radiation therapy Treatment of benign tumors is surgery. The recurrence rate is high when excision is incomplete. For malignant salivary gland tumors, surgery, sometimes followed by radiation therapy, is the treatment of choice for resectable disease. Currently, there is no effective chemotherapy for salivary cancer. Treatment of mucoepidermoid carcinoma consists of wide excision and postoperative radiation for high-grade lesions. The 5-year survival rate is 95% with the low-grade type, primarily affecting mucus cells, and 50% with the high-grade type, primarily affecting epidermoid cells. Metastases to the regional lymphatics must be addressed with surgical resection and postoperative radiation therapy. Treatment of adenoid cystic carcinoma is wide surgical excision, but local recurrence is common due to the propensity for perineural spread. Elective nodal treatment is less likely to be required because lymphatic spread is less common. Although the 5- and 10-year survival rates are quite good, the 15- and 20-year rates are worse with many patients developing distant metastases. Lung metastases and death are common, although many years (usually a decade or more) after the initial diagnosis and treatment. The prognosis for acinic cell carcinoma is favorable after wide excision. Primary treatment for carcinoma ex pleomorphic adenoma is parotidectomy with the goal of complete resection of all disease. A neck dissection is done if there is nodal disease and is considered for some patients without evidence of nodal spread. All surgeries are designed to spare the facial nerve, which is sacrificed only in cases of direct tumor involvement with the nerve. 