Head and Neck Cancer Introduction Page
oral cavity
oropharynx (soft palate, tonsil, base of tongue)
larynx (voice box)
hypopharynx (pyriform sinus, posterior phanryngeal wall, post-cricoid region)
nasal cavity/paranasal sinuses
nasopharynx
salivary glands
paragangliomas (glomus tumors)
thyroid

•Background
•Signs and Symptoms
•Clinical Evaluation
•Treatment
•Follow-Up

Background

There are two major salivary glands in the neck. The parotid gland is the larger of the two, and it is located just in front of the ear. The nerve leading to the muscles of the face (facial nerve) runs through and branches within the parotid gland. Approximately 20 percent of the tumors occurring in this gland are malignant. The other gland is called the submandibular gland, which is located below the lower jawline. Approximately 50 percent of tumors affecting this gland are malignant.

The two most common type of malignancies are called mucoepidermoid and adenoid cystic carcinomas. The adenoid cystic carcinoma is characterized by early involvement of nearby nerves, with the ability to spread by traveling along these nerves. Each type of malignant tumor has its own potential to spread to adjacent lymph nodes.

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Signs and Symptoms

The most common sign is an enlarging mass developing in the salivary gland. Often, the more aggressive tumors grow faster. There may be associated pain. In the parotid gland, tumor involvement of the facial nerve may cause a weakness of part of the face.

Clinical Evaluation

The physician will first obtain a history of the symptoms and then perform a thorough physical examination of the head and neck. The size of the mass will be noted, as well as involvement of adjacent lymph nodes and facial nerve weakness. A fine needle aspiration biopsy will be performed help to define the type of salivary gland tumor. A fine needle aspiration biopsy involves inserting a small needle into the mass and withdrawing cells. The pathologist examines these cells under a microscope to see if they are cancerous. A CT scan (which uses X-rays to create a two-dimensional image of the area), an MRI scan (which uses a magnetic field and pulses of radio wave energy to visualize the detailed anatomy), and/or a PET scan (which creates computerized images of the metabolic changes that occur in tissue), will also aid in visualizing the extent of tumor and in diagnosing any spread to the lymph nodes of the neck.

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Treatment

Surgery is the initial treatment for malignant salivary gland tumors unless the patient has a significant medical problem. Depending on the size and type of tumor, and the results of the scans, there may be a recommendation to remove the adjacent lymph nodes of the neck. Removal of parotid gland malignant tumors may require resection of all or part of the facial nerve. This can result in facial weakness. Sometimes the nerve can be reconstructed at the time of surgery, which can restore some form of facial motion in 6-12 months. Occasionally, the nerve cannot be reconstructed and other means of improving the facial weakness are used. Radiation therapy is frequently recommended after the operation, depending on the type of tumor and the results of microscopic analysis of the removed tissue.

Click Here for more information about radiation oncology treatments for head and neck cancer.

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Follow-Up

After treatment is completed, the patient enters the follow-up phase. Usually, all of the treating physicians are involved in follow-up evaluations. For the first year, patients are usually seen every one to two months. During the second year, they are often seen every two to three months. After the second year, patients are usually seen every three to six months. Of course, the follow-up schedule is individualized for each patient.
Imaging procedures like CT scans, PET scans, or fused PET/CT scans, are done according to a routine that is individualized for each patient. Not all patients require these studies. A chest X-ray is usually done on an annual basis. Regular dental evaluation is done, because good dental care is essential to the head and neck health.

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