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 oral salivary gland cancers that can be used alone or in combination.
For an oral salivary gland cancer, complete surgical removal of the tumour is almost always the first treatment, unless a doctor decides that it is not possible or safe to proceed with surgery. Oral salivary gland cancers may be treated with a soft tissue resection.
If a doctor decides that surgery is a good option, he or she will walk the patient through the risks and extent of the surgery necessary to remove the entire tumour. Reconstruction of the structure involved by the cancer may be required, and will depend on the exact location and the extent of the disease.
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 pathological diagnosis and the grade of the tumour and whether the surgeon thinks the salivary gland cancer has the potential to spread to the lymph nodes in the neck.
The most common use of radiation for the treatment of oral salivary gland cancers is called adjuvant radiation, which is radiation given after surgery in order to decrease the chances that the tumour will come back.
Reasons for Post-Surgical Radiation
A doctor may recommend post-surgical radiation in a few scenarios.
- If the tumour was not completely removed or if the surgical margins were positive for cancer
- 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, such as nerves or vessels
In rare cases, complete surgical removal of an oral salivary gland cancer may be impossible or unsafe, and a doctor may recommend radiation therapy as the primary treatment. In this type of treatment, an external beam of radiation, usually a photon beam, is directed at the tumour in order to destroy the rapidly dividing cancer cells. Additionally, a treatment called neutron beam radiation therapy uses high energy neutron beams to treat large slow-growing tumours. This treatment type may be considered for select un-resectable oral salivary gland cancers, such as adenoid cystic carcinoma.
Chemotherapy is not usually effective in treating oral salivary gland cancers but may, in rare cases, be used if the cancer displayed aggressive features, could not be completely removed during surgery, or 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.