Surgery for salivary gland cancer

Surgery is the main treatment for salivary gland cancer. The type of surgery you have depends mainly on where the tumour is found, the type of tumour, the grade of the tumour and the stage. When planning surgery, your healthcare team will also consider other factors, such as the effect that surgery will have on your ability to speak, chew and swallow.

Surgery may be done for different reasons. You may have surgery to:

• completely remove the tumour
• remove as much of the tumour as possible (called debulking) before other treatments
• remove lymph nodes in the neck

The salivary glands and the nerves around them help you eat and digest food, so surgery to remove part or all of a salivary gland has to be planned very carefully. Your healthcare team may include a head and neck surgeon, plastic surgeon, dentist, speech pathologist and social worker. Before you have surgery, your healthcare team will carefully explain any side effects that can happen with surgery.

The following types of surgery are used to treat salivary gland cancer. You may also have other treatments after surgery.

A parotidectomy removes all or part of a parotid gland, the most common site of salivary gland tumours. There are 2 types of parotidectomy.

Total parotidectomy removes all of the parotid gland. It is used to treat tumours in the deep lobe of the parotid gland. The facial nerve runs through this part of the parotid gland, so the surgeon will try to remove the tumour without damaging the nerve. If the tumour has grown into or along the nerve, the surgeon will have to remove part of the nerve to make sure that all of the cancer is removed.

Superficial parotidectomy removes only the superficial lobe of the parotid gland that has the tumour in it. The superficial lobe is the part of the parotid gland that is closest to the front of the neck. The facial nerve doesn't run through this part of the parotid gland, so there a smaller risk for any nerve damage after a superficial parotidectomy than after a total parotidectomy.

A sialoadenectomy removes a salivary gland with a margin of tissue around it. This surgery is used for tumours found in the salivary glands in the lower jaw and under the tongue.

For submandibular tumours, a cut, or incision, is made just below the lower jaw.

For sublingual tumours, an incision is made inside the mouth, under the tongue.

Sialoadenectomy must be done very carefully because the tongue's nerves run through these salivary glands. These nerves control movement, feeling and the sense of taste. The surgeon will find these nerves during surgery so that they won't get damaged. If cancer has spread to these nerves, they will have to be removed.

A wide excision removes the salivary gland along with a margin of tissue around it. This type of surgery is used to remove cancer in a minor salivary gland.

Other types of surgery may be used if the cancer has spread from the minor salivary gland. The type of surgery will depend on where the cancer has spread.

A neck dissection is a surgery to remove lymph nodes from the neck. The lymph nodes in the neck are called cervical lymph nodes.

A neck dissection is usually done for high–grade salivary gland tumours because they have a high risk of spreading to the lymph nodes. It is also done when the lymph nodes near a salivary gland tumour are swollen or enlarged. Neck dissections aren't done for low-grade salivary gland tumours if there are no enlarged lymph nodes in the neck.

Neck dissections are done through a small cut, or incision, on the side of the neck. Depending on the type of neck dissection, a longer incision may be needed to remove lymph nodes.

Selective neck dissection removes only the lymph nodes where the cancer is most likely to spread. This includes the lymph nodes close to and on the same side of the neck as the salivary gland tumour.

Radical neck dissection removes all of the lymph nodes around and on the same side of the neck as the salivary gland tumour. Other tissues are sometimes removed if the cancer has spread to them. This type of neck dissection may also be called a comprehensive neck dissection. Find out more about neck dissection.

Find out more about neck dissection.

You may need reconstructive surgery after surgery to remove salivary gland cancer. If the facial nerve is removed, the surgeon can graft a nerve taken from another part of your body. This helps keep normal feeling and movement of the muscles in your face. This reconstructive surgery is more successful when it is done at the same time as surgery to remove the tumour. If radiation therapy is given after surgery, there may be problems with the nerve graft.

Sometimes the surgeon needs to remove skin or other tissues and structures around the salivary gland to make sure all of the tumour is removed. A plastic surgeon will do reconstructive surgery after the other surgeon has finished. Skin and tissue grafts are used to repair the damage and improve appearance after surgery. Most of the reconstruction is done at the same time as the surgery to remove the tumour. Some surgery may be delayed until after radiation therapy is finished because radiation can damage the skin and tissue grafts.

Side effects can happen with any type of treatment for salivary gland cancer, but everyone's experience is different. Some people have many side effects. Other people have only a few side effects.

If you develop side effects, they can happen any time during, immediately after or a few days or weeks after surgery. Sometimes late side effects develop months or years after surgery. Most side effects will go away on their own or can be treated, but some may last a long time or become permanent.

Side effects of surgery will depend mainly on the type of surgery and your overall health.

Surgery for salivary gland cancer may cause these side effects:

• pain
• scarring
• flushing and sweating on one side of the face when eating (called Frey syndrome)

Nerve damage from surgery for salivary gland cancer can cause:

• drooping of the face on the side of the surgery
• problems moving the tongue, speaking or swallowing
• ear numbness
• weakness in raising your arm above your head (on the side of the surgery)
• weakness in your lower lip (causing drooping, inability to close lips together)
• inability to close the eyelid properly

Tell your healthcare team if you have these side effects or others you think might be from surgery. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Find out more about surgery and side effects of surgery. To make the decisions that are right for you, ask your healthcare team questions about surgery.