Surgery for salivary gland cancer

Surgery is often the main form of treatment for salivary gland cancers. Your cancer will likely be treated with surgery if the doctor believes that he (or she) can remove it completely (the cancer is resectable). Whether or not a cancer is resectable depends largely on how far it has grown into nearby structures, but it also depends upon the skill and experience of the surgeon. Being treated by a surgeon who treats many patients with salivary gland cancer gives you the best chance of having your cancer completely removed with surgery. This, in turn, gives you the best chance of being cured.

In most cases, the cancer and some or all of the surrounding salivary gland will be removed. Nearby areas of soft tissue may be removed as well. If the cancer is high grade (more likely to grow and spread quickly) or if it has already spread to lymph nodes, the surgeon will usually remove lymph nodes from the same side of the neck in an operation called a neck dissection.

Before surgery, ask your surgeon exactly what will be done during the operation, whether there are other options, and what side effects you can expect.

The type of surgery will depend on which salivary gland is affected.

Parotid gland surgery

Most salivary gland tumors occur in the parotid gland. Most parotid gland tumors are benign. Surgery here is complicated by the fact that the facial nerve, which controls movement on the same side of the face, passes through the gland. For these operations, a cut (incision) is made in the skin in front of the ear and may extend down to the neck.

Most parotid gland cancers start in the outside part of the gland, called the superficial lobe. These can be treated by removing only this lobe, which is called a superficial parotidectomy. This usually spares (does not injure) the facial nerve and so does not interfere with facial movement.

If your cancer has spread into deeper tissues, the surgeon will remove the entire gland. This operation is called a total parotidectomy. If the cancer has grown into the facial nerve, it will have to be removed as well. If your surgeon has mentioned this surgery as a possibility, ask about operations to repair the nerve and ways to treat side effects caused by removing the nerve. If the cancer has grown into other tissues near your parotid gland, these tissues might also need to be removed.

Submandibular or sublingual gland surgery

If your cancer is in the submandibular or sublingual glands, the surgeon will remove the entire gland and perhaps some of the surrounding tissue or bone. Several important nerves pass through or near these glands. These nerves control movement of the tongue and the lower half of the face, as well as sensation and taste. Depending on the size and location of the cancer, the surgeon may need to remove some of these nerves.

Minor salivary gland surgery

Minor salivary gland cancers can occur in your lips, tongue, hard and soft palate (roof of the mouth), oral cavity, throat, voice box (larynx), nose, and sinuses. The surgeon usually removes some surrounding tissue along with the cancer. The exact details of surgery depend on the size and location of the cancer.

Possible risks and side effects of salivary gland surgery

With any salivary gland cancer surgery, the surgeon may need to cut through your skin or your mouth. You may have problems with anesthesia or with wound healing, infections, or excessive bleeding during or after surgery. Most people will have some pain for a time after the operation, although this can usually be controlled with medicines.

If your facial nerve is damaged during surgery, you may lose control of your facial muscles on the side where the surgery was done. That side of your face may droop. Damage to other nerves may cause problems with speech or swallowing. If the injury to the facial nerve is related to retraction (pulling) of the nerve during surgery and/or swelling from the operation, the weakness may just be temporary.

Sometimes, nerves cut during surgery grow back abnormally and become connected to the sweat glands of the face. This condition, called Frey syndrome or gustatory sweating, results in flushing or sweating over areas of your face when you chew. Frey syndrome can be treated with medicines or with additional surgery.

Depending on the extent of the operation needed, your appearance may be changed as a result of surgery. This can range from a simple scar on the side of the face or neck to more extensive changes if nerves, parts of bones, or other structures need to be removed. It's important to talk with your doctor before the surgery about what these changes might be to help prepare you for them. He or she can also give you an idea about what options might be available afterward, such as reconstructive surgery.

Lymph node removal

Surgery to remove lymph nodes is called a lymph node dissection or lymphadenectomy. Salivary gland cancers sometimes spread to lymph nodes in the neck (cervical lymph nodes), and these may need to be removed as a part of treating the cancer. This is called a neck dissection. If lymph nodes in the neck are enlarged or if a PET scan suggests they may contain cancer, then a neck dissection may be done to be sure all of the cancer is removed. The lymph nodes that are removed are looked at under the microscope to see if they really contain cancer cells. This information is important for staging and deciding on the need for further treatment. A lymph node dissection may also be done if the cancer is high grade (looks very abnormal under the microscope) and has a high risk of spread.

There are many types of neck dissections, but their major purpose is to remove lymph nodes that might contain cancer. In doing this, the surgeon may need to remove connective, muscle, and nerve tissues, and blood vessels from one side of your neck.

Possible side effects

The general risks with a neck dissection are similar to those with any other type of surgery, including problems with anesthesia, bleeding, infections, and poor wound healing. Because this surgery can affect nerves that run through the neck, it can sometimes lead to ear numbness, weakness in raising your arm above your head, and weakness of the lower lip. These may get better with time. You can be helped by physical therapists who can teach you exercises to improve your neck and shoulder movement.

For more general information on surgery, see our document called Surgery.