Parotid cancer: symptoms, what prognosis?

Parotid cancer is a salivary gland cancer. It represents less than 5% of head and neck cancers. “It’s cancer. quite rare but who is increasing in Western countries”informs us Professor Olivier Malard, Head of ENT and head and neck surgery services at Nantes University Hospital. “In 70% of casesparotid tumors are benign but some of them can be transformed“ continues the doctor. There most common benign tumor is called pleomorphic adenoma. “This adenoma has a potential to degenerationwhich is done slowly. Not every adenoma degenerates in cancer but in the history of people who have parotid cancer, we can find the presence of a adenoma for ten years which degenerated because it was not diagnosed and taken care of.” Symptoms, screening, examination, treatment and prognosis of parotid cancer with advice from our expert.

What is parotid cancer?

This cancer affects the parotid, one of the largest salivary glands in the body. There are other salivary glands which can also be sources of cancer but it is less common. “It is thanks to the salivary glands that we always have a moist mouth when we eat and express ourselves” calls back the doctor.

The parotid gland is the size of a large almond at the corner of the jaw

To find out where the parotid is located, simply place your finger on the angle of the jaw, “we feel that it is a a little soft, it feels like a mattress, This is the parotid gland, it measures 5-6 centimeters which is the size of a large almond, and we have one on each side”. Parotid cancer has no defined risk factors – the tobacco and alcohol are not included for example- and it is one-sided. “There’s no risk of another one on the other side.”

Symptoms: a hard lump that persists?

Pleomorphic adenoma is characterized by swelling (small mass or hard ball) at the level of playsin front of the ear or a little below, not always visible and which doesn’t hurt. “Any swelling warrants a consultation, especially if it persists. It should alert you but not necessarily to worry because it could be a pleomorphic adenoma. underlines the ENT doctor. On the other hand, what should alert:

• if the mass hurts straight away or recently when it had been painless for several years
• if there is a rapid growth (she’s growing fast)
• if there isappearance of lymph nodes around

“At a later stage, there may be a small paralysis of the facial nerve leading to facial asymmetry” adds the doctor. The facial nerve passes into the parotid and this nerve participates in facial motor skills.

Who to consult? What tests to do?

In the event of symptoms, you should consult your doctor but “be careful not to be falsely reassured by the fact that it is old therefore not worrying which is not always true” warns our interlocutor. If in doubt, consult an ENT specialist. Two examinations then allow us to know the nature of the tumor:

► MRI

► there cytopuncture : it is not a biopsy but a puncture made with a needle (like a vaccine) which allows the contents of the lesion to be recovered for analysis. This orientation examination makes it possible to refine the quality of the diagnosis “in 70-80% of cases“. “Fine aspiration is only of value if it brings back cancer cells. If it shows benign cells this is reassuring but it does not exclude the risk of cancer: the lesion must be regularly removed and an extemporaneous examination carried out.” explains the doctor. This examination analyzes the lesion removed during an operation under general anesthesia under a microscope.

What are the treatments for parotid cancer?

► If it is a pleomorphic adenoma without degenerationthere is no treatment other than ablation, “no chemotherapy, no radiation, no cure”.

Radiotherapy and chemotherapy alone “are not enough”

► If the tumor is malignantit must be removed widely during a surgical procedure. “Parotid tumors are cured in the majority of cases by surgery. In addition, we can carry out a lymph node removal by a lymph node dissection. Possibly additional treatment (radiotherapy alone or radiotherapy and chemotherapy)”, specifies Dr. Malard. Radiotherapy and chemotherapy alone shrink tumors “but are not enough“.

What is the prognosis for recovery?

If it is a non-degenerated adenoma “he is excellent” replies the ENT. In case of cancerTHE prognosis depends on sizethe nature of the grade of the tumor determined after examination of the lesion under the microscope:

• low grade : “The prognosis is very good with more than 80% recovery with surgery”
• ranking officer : “If the tumor is stage 1 or 2, the prognosis is good, 60-70% cure. If the tumor is stage 3-4, the prognosis is lower.” High-grade parotid cancer can metastasize SO “put life at risk”.

Thanks to Professor Olivier Malard, Head of the ENT and head and neck surgery department – Nantes University Hospital Center.