Surgery for salivary gland cancer
Most people with salivary gland cancer will have surgery. The type of surgery you have depends mainly on the type of tumour, its location, its grade, if it has spread and where it has spread. When planning surgery, your healthcare team will also consider other factors, such as your age and the effect that surgery will have on your ability to speak, chew and swallow.
Surgery may be done for different reasons. You may have surgery to:
- completely remove the tumour
- remove as much of the tumour as possible (debulk) before other treatments
- remove lymph nodes in the neck (if cancer may spread, or has already spread, to them)
The salivary glands and the nerves around them help you eat and digest food, so surgery to remove part or all of a salivary gland has to be planned very carefully. Your healthcare team may include a head and neck surgeon, plastic surgeon, dentist, speech pathologist and social worker. Before you have surgery, your healthcare team will carefully explain any side effects that can happen with surgery.
The following are the types of surgery most commonly used to treat salivary gland cancer. You may also have other treatments before or after surgery.
|Surgeries for salivary gland cancer|
Parotidectomy removes part or all of a parotid gland. There are 2 types of parotidectomy.
Superficial parotidectomy removes just the superficial lobe of the parotid gland with the tumour in it. It is used to treat tumours that are only in the superficial lobe. Because the facial nerve doesn’t run through this part of the parotid gland, there is little risk that it will be damaged.
Total parotidectomy removes all of a parotid gland. It is used to treat tumours in the deep lobe of a parotid gland. The facial nerve runs through this part of the parotid gland, so the surgeon will try to remove the gland without damaging the nerve. If the tumour has grown along or into the nerve, the surgeon will have to remove the nerve to make sure that all of the cancer is removed.
Sialoadenectomy removes all of a salivary gland along with a margin of tissue around it. This surgery is used for tumours in the submandibular and sublingual salivary glands. For a submandibular tumour, sialoadenectomy is done through a cut, or incision, just below the bottom jaw. For a sublingual tumour, sialoadenectomy is done through an incision in the mouth rather than in the face or neck.
Surgery to remove submandibular or sublingual glands must be done very carefully because nerves that control the tongue’s movement, its sensation and taste run through these glands. The surgeon finds the nerves during surgery so they will not get damaged or removed. If cancer has spread to these nerves, they will have to be removed.
A wide excision removes the gland along with a margin of healthy tissue around the gland.
Wide local excision is the surgery most commonly used to remove cancer in a minor salivary gland. Other surgeries may also be used, depending on where the tumour is found, its size and where it has spread.
Neck dissection, or lymphadenectomy, is surgery to remove lymph nodes from the neck (called the cervical lymph nodes). Salivary gland cancer can spread to these lymph nodes.
Selective, or limited, neck dissection removes only some of the lymph nodes close to and on the same side of the neck as the salivary gland tumour.
Radical, or total, neck dissection removes all of the lymph nodes around and on the same side of the neck as the salivary gland tumour.
Neck dissection is not done for low-grade tumours if doctors think that the cancer hasn’t spread to lymph nodes in the neck. It may be done if lymph nodes near a salivary gland tumour are swollen, or enlarged, and the doctor thinks that cancer has spread to them. It may also be done for high-grade cancer because there is a high risk that it will spread to lymph nodes in the neck.
If salivary gland cancer is found on both sides of the neck, doctors may do neck dissection on both sides of the neck (called bilateral neck dissection).
Find out more about neck dissection.
You may need reconstructive surgery after surgery to remove salivary gland cancer.
If the facial nerve is removed, the surgeon can graft a nerve taken from another part of your body. This helps keep normal feeling and movement of the muscles in your face. This reconstructive surgery is more successful when it is done at the same time as surgery to remove the tumour. If radiation therapy is given after surgery, there may be problems with the nerve graft.
Sometimes the surgeon needs to remove skin or other tissues and structures around the salivary gland to make sure all of the tumour is removed. Reconstructive surgery may use skin and tissue grafts to repair the damage and improve appearance after surgery. This may be done by a plastic surgeon at the time of surgery to remove the tumour or in another surgery at a later date. Reconstructive surgery may be delayed until after radiation therapy is finished because radiation can damage the skin and tissue grafts.
Side effects can happen with any type of treatment for salivary gland cancer, but everyone’s experience is different. Some people have many side effects. Other people have only a few side effects.
Side effects can develop any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.
Side effects of surgery will depend mainly on the type of surgery and your overall health.
Surgery for salivary gland cancer may cause these side effects:
- changes to the nerves in the face and neck
- flushing and sweating on one side of the face when eating (called Frey syndrome)
- saliva collecting in the surgery site or draining through the incision
Questions to ask about surgery
Healthy cells or tissue that is taken from a donor or another part of the body to replace diseased or injured tissue.
For example, skin grafts may be used to cover areas of skin that have been burned.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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