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Salivary Gland Cancer

What to Expect at Your Doctor’s Visit

Step 1: History

First, your head and neck specialist will take a thorough history of your health and address any specific concerns you may have.

Your doctor might ask questions such as:

  • How long has the lump been there?
  • Is it growing, and if so, how quickly?
  • Does it come and go?
  • Is it painful?
  • Do you have numbness or tingling anywhere in your face?
  • Have you ever been exposed to high levels of radiation in the area?
  • Do you have a family history of cancer?
  • Have you been treated for any other cancers, including skin cancer?

Step 2: Physical Exam

Next, your doctor will examine you. Typically, if you’re seeing a specialist in head and neck disorders, you will get a thorough physical examination focused on the area of concern. There are a few “red flag” features your doctor will be looking for that increase the likelihood that a lump in the region of the salivary gland is actually cancer.

Some of these “red flag” features include:

  • You feel weakness when moving all or some parts of the face on the side of the lump.
  • The lump is fixed, or attached, to the skin on top of it.
  • The skin or the lining inside the mouth is ulcerated (has a sore) or looks different from the tissue around it.
  • There is numbness or tingling in certain parts of the face.
  • There is a lesion inside your ear canal on the side of a parotid tumor.13Mehanna H, McQueen A, Robinson M, Paleri V. Salivary gland swellings. BMJ. 2012 Oct 23;345-352.

Your doctor will also test your facial nerve by having you move your face. However, note that even if the nerve appears to be working perfectly when a doctor examines you, it doesn’t mean the nerve is not infiltrated (invaded) by a tumor.25Terhaard CHJ et al. Salivary gland carcinoma: independent prognostic factors for locoregional control, distant metastases, and overall survival: results of the Dutch head and neck oncology cooperative group. Head & Neck 2004; 26(8):681-693.

Step 3: Reviewing Tests

After getting your history and performing a physical exam, your doctor will review any imaging, laboratory work and pathology results you may have already had. Be sure to bring all of these with you to your appointment. Bring actual discs of any scans you’ve had, as well as any reports of those scans. If you are seeing a head and neck cancer specialist after a lesion was removed by a non-cancer specialist, you need a thorough review of the pathology to discuss whether additional treatment is necessary. You might need more tissue removed or further treatment.

Step 4: Recommendations

Finally, your doctor will make recommendations about your next steps. This will likely include reviewing some of the studies you’ve already had done or ordering more tests. Once your doctor has all the necessary information, you should be given a preliminary stage and discuss treatment plans.

References

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13 Mehanna H, McQueen A, Robinson M, Paleri V. Salivary gland swellings. BMJ. 2012 Oct 23;345-352.

14 Wierzbicka M, Kopeć T, Szyfter W, Kereiakes T, Bem G. The presence of facial nerve weakness on diagnosis of a parotid gland malignant process. European Archives of Oto-Rhino-Laryngology 2012:1-6.

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18 Eveson JW, Auclair PL, Gnepp DR, et al. Tumors of the salivary glands: introduction. In: Barnes EL, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumours: pathology & genetics. Head and neck tumours. Lyon: IARCPress; 2005. p. 220–1.

19 Agulnik M, McGann CF, Mittal BB, Godon SC, Epstein JB. Management of salivary gland malignancies: current and developing therapies. Oncol Rev (2008) 2:86–94.

20 Eveson JW, Auclair PL, Gnepp DR, et al. Tumors of the salivary glands: introduction. In: Barnes EL, Eveson JW, Reichart P, Sidransky D, editors. World Health Organization classification of tumours: pathology & genetics. Head and neck tumours. Lyon: IARCPress; 2005.

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25 Terhaard CHJ et al. Salivary gland carcinoma: independent prognostic factors for locoregional control, distant metastases, and overall survival: results of the Dutch head and neck oncology cooperative group. Head & Neck 2004; 26(8):681-693.

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28 Spiro et al. Stage means more than grade in adenoid cystic carcinoma. The American Journal of Surgery 1992; 164(6): 623-628.

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30 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2014. © National Comprehensive Cancer Network, Inc 2014. All rights reserved. Accessed June 18, 2014. To view the most recent and complete version of the guideline, go online to www.NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.