Salivary gland malignancies affect 2.5 to 3 in 100,000 people each year in the United States, and comprise only 6% of head and neck cancers.1,2 Despite current imaging technologies, tumor location and heterogeneity render diagnosis and treatment decisions challenging for the treatment team. Dealing with treatment sequelae is often daunting for patients, who can face potentially devastating side effects, such as disfigurement and facial nerve paralysis.
Explore this issue:November 2008
Jesus E. Medina, MD, currently the Paul and Ruth Jonas Professor and Chairman of the Department of Otorhinolaryngology at the University of Oklahoma, has treated these patients at his tertiary referral center in Oklahoma City for more than 20 years. In that time, Dr. Medina has observed the refinement of diagnosis using superior imaging techniques in combination with fine-needle aspiration biopsy. The addition of neutron beam radiation, and facial nerve reconstruction options, have also moved the field forward. Combination treatment using surgery and radiation therapy has had a tremendous effect in our ability to give these patients a long term of tumor-free survival, he said.
-Barry M. Schaitkin, MD
Not Only Rare, but Also Diverse
At least 90% of parotid tumors are benign, but the parotid remains the most common site of malignant tumors. According to the American Cancer Society, approximately 80% of malignant salivary gland tumors originate in the parotid gland; 10% to 15% in the submandibular gland; and the remainder in the sublingual and minor salivary glands.3 Tumors in the latter tend to be malignant but are quite uncommon. As has been reported in Australian studies, the parotid is also a frequent site of metastasis from melanoma.4 Those at risk to develop salivary gland malignancies include people over the age of 50; people who received radiation treatment to the head and neck in childhood or young adulthood (such as for acne or tonsillitis); and heavy smokers (Warthin’s tumor).