Surgery for salivary gland cancer

If you have salivary gland cancer, one of the first things your doctor will do is to find out if the cancer can be removed by surgery. Surgery is the main form of treatment in many cases. Most often, the surgeon will remove the cancer and some of the nearby tissue. If the cancer is a high grade (more likely to grow quickly) or if it has spread to the lymph nodes, the doctor may suggest removing the lymph nodes, too. This is called a neck dissection.

Before surgery, ask your doctor exactly what will be done during the operation, whether there are other options, and what side effects you can expect. Make sure that your surgeon has experience with this kind of operation. 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.

The type of surgery depends on which salivary gland is affected.

Parotid gland surgery

Salivary gland tumors often start in the parotid gland, but most parotid gland tumors are benign. The facial nerve, which controls movement of that side of the face, passes through this gland. This can make the surgery tricky. If your cancer has spread into the deeper part of the parotid gland, the surgeon may have to remove part of the facial nerve in order to remove the entire gland. You should ask your doctor about operations to repair the nerve and ways to treat side effects caused by removing the nerve.

Submandibular or sublingual gland surgery

If your cancer is in the submandibular or sublingual glands, the surgeon will remove the entire gland and maybe some of the nearby tissue or bone. Some important nerves pass through or near these glands. These nerves control movement of the tongue and the lower half of the face. They also affect feeling and taste. The surgeon may need to remove some of these nerves to remove this salivary gland.

Minor salivary gland surgery

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

Risks and side effects of surgery

With any of these operations, the surgeon may need to cut through your skin or your mouth. You might have problems with healing, infections, or bleeding after surgery. If your facial nerve is damaged, you may lose control of your facial muscles on the side where the surgery was done and that side of your face may droop. Sometimes the damage gets better over time, but this problem won’t get better on its own if a piece of the nerve had to be removed. Damage to other nerves may cause speech or swallowing problems.

Sometimes, nerves cut during surgery grow back in a way that isn’t normal. They may become connected to the sweat glands of the face. This is called Frey syndrome or gustatory sweating, and it causes flushing or sweating on your face when you chew. Frey syndrome can be treated with medicines or with surgery.

Depending on the extent of the operation needed, the way you look may be changed as a result of surgery. This can range from a simple scar on the side of the face or neck to larger changes if nerves, parts of bones, or other structures need to be removed. Talk to your doctor about what to expect after your surgery and what you can do to help reduce any side effects.

Lymph node removal

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 your treatment. Surgery to remove lymph nodes is called a lymph node dissection, and if the neck lymph nodes are removed it is called a neck dissection.

If neck lymph nodes are enlarged or if a PET scan suggests that they contain cancer, they may be taken out to make sure that all the cancer is removed. They might also be removed if your cancer is high grade (likely to grow and spread quickly), to check for cancer spread. If this is done, muscle, nerve, and other tissue might also be removed. This could cause things like ear numbness, weakness in raising your arm above your head, and weakness of the lower lip. These problems could get better with time. A physical therapist can teach you exercises that can help.

To learn more about surgery, see our document, Surgery.