[Sportschosun Reporter Jang Jong-ho] When a small lump is felt in front of the ear or under the jaw, many people tend to dismiss it as a swollen lymph node caused by fatigue. That is because tumors that develop in the salivary glands often cause no pain in the early stages and do not greatly interfere with daily life. But salivary glands are not simply organs that produce saliva. In particular, the facial nerve that controls facial expressions runs through the parotid gland, which is located in front of the ear. If a malignant tumor develops there, it can lead to one side of the face not moving or the corner of the mouth drooping. Salivary gland cancer is relatively rare among all cancers, but treatment and prognosis can vary greatly depending on where it occurs and what type of cancer it is, making an accurate diagnosis essential.
◇In the early stages, the lump grows without pain... As it worsens, facial nerve paralysis and other sensory abnormalities may appear
Salivary gland cancer is a malignant tumor that arises in the tissue that produces saliva. It can develop in the major salivary glands, such as the parotid, submandibular, and sublingual glands, as well as in the minor salivary glands widely distributed in the lips, tongue, palate, and inner lining of the cheeks. When it occurs in the parotid gland, also known as the gland near the ear, a lump that can be felt from the outside is often discovered first. If it develops in the minor salivary glands of the mouth or pharynx, however, it may cause symptoms such as discomfort inside the mouth or bleeding in the oral cavity. In particular, because the parotid gland lies very close to the facial nerve, a tumor in this area can invade the nerve as it progresses and lead to facial paralysis. During surgery, whether the nerve can be preserved is also a key factor in decision-making.
In the early stages, salivary gland cancer usually begins as a lump that grows slowly without pain. As the disease progresses, additional symptoms may appear, including facial nerve paralysis, such as one side of the face not moving or the corner of the mouth drooping; paralysis or sensory changes on the same side of the tongue; pain in the mass; a lump that is fixed to surrounding tissue or skin and does not move easily; and enlarged lymph nodes around the neck.
◇Surgery is the primary treatment... If malignancy is suspected, surgery should not be delayed
Salivary gland cancer is histologically diverse and complex, so there are limits to diagnosis based only on preoperative evaluation. Fine-needle aspiration cytology is simple and safe, so it is widely used as the first-line test, and core needle biopsy or incisional biopsy may also be performed if needed. The final diagnosis is confirmed through histopathological examination of the removed tissue. CT and MRI are used to check the location, size, and extent of invasion into surrounding structures, and PET-CT may also be used when necessary to assess whether the cancer has spread.
For resectable salivary gland cancer, surgery is the primary treatment. For parotid tumors, a superficial parotidectomy, in which the facial nerve is carefully identified and dissected, is commonly performed, and a total parotidectomy may be needed depending on the extent of the tumor. If there is cervical lymph node metastasis or a high risk of spread, neck dissection is performed as well. Postoperative radiation therapy is generally added when the tumor was located in the deep lobe of the parotid gland, when the cancer is highly aggressive, when there was invasion of the nerve, bone, or soft tissue, or when lymph node metastasis is confirmed. Chemotherapy has limited effectiveness, so it is considered selectively depending on the patient's condition and the characteristics of the cancer.
Professor Kang Min-seok of the Department of ENT at Soonchunhyang University Seoul Hospital said, "If a painless lump near the ear or under the jaw continues to grow slowly for more than one or two months and is accompanied by symptoms such as facial paralysis or enlarged neck lymph nodes, you must get examined," and added, "Salivary gland cancer has many different histological types, so it is difficult to make a definite diagnosis before surgery. However, by combining preoperative tissue tests and imaging studies to assess the tumor comprehensively, it is most important to proceed with surgery quickly when malignancy is suspected, both for cancer treatment and for preserving function."
Jang Jong-ho, bellho@sportschosun.com
This article has been translated by GripLabs Mingo AI.
