After determining a diagnosis and completing a full pre–treatment evaluation, doctors will recommend a course of treatment for their patients. In general, there are three different options for the treatment of salivary gland cancers, that can be used alone or in combination.
Surgery
For a salivary gland cancer, complete surgical removal of the tumor is almost always the first treatment, unless a doctor decides that it is not possible or safe to proceed with surgery. Salivary gland cancers may be treated with a parotidectomy or a submandibular gland resection. Patients and their care teams should discuss the types of surgeries that may be required for the treatment of their cancer.
If necessary, a surgeon may also perform a neck dissection during surgery or soon after, which involves removing some of the lymph nodes from the neck and checking to see if they contain cancer. This decision will be made based on the pathologic diagnosis and the grade of the tumor, as well as whether the surgeon thinks that the cancer has the potential to spread to the lymph nodes in the neck.
Radiation
The most common use of radiation for the treatment of salivary gland cancers is called adjuvant radiation, which is radiation given after surgery in order to decrease the chances that the tumor will come back.
Reasons for Post-Surgical Radiation
A doctor may recommend post-surgical radiation in a few scenarios.
- If the tumor was not completely removed.
- If the type of cancer was determined to be aggressive or of a high grade or T-stage.
- If the cancer had spread to lymph nodes or other structures.
In some cases, complete surgical removal of a salivary gland cancer may be impossible or unsafe, and a doctor may recommend radiation therapy as the primary treatment. Different forms of radiation therapy have been utilized for salivary gland cancers, and they appear to have a high likelihood of success. In this type of treatment, an external beam of radiation is directed at the tumor in order to destroy the rapidly dividing cancer cells. For example, neutron beam radiation therapy, an experimental treatment, uses high energy neutron beams to treat large slow-growing tumors. This treatment type may be considered for select unresectable salivary gland cancers, such as adenoid cystic carcinoma.
Chemotherapy
Chemotherapy is not usually effective in treating salivary gland cancers but may, in rare cases, be used if the cancer has spread to other parts of the body outside of the head and neck. Chemotherapy may also be used in combination with radiation therapy in some instances.
