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Parotid gland tumours are abnormal growths in the salivary glands near the ear and jaw. About 80% are benign, with Pleomorphic Adenoma being the most common type. The other benign lesions of the parotid gland include Warthin’s Tumour, Monomorphic Adenoma, Lymphangioma, Oncocytoma, etc. The remaining 20% are malignant, mainly Mucoepidermoid Carcinoma and Adenoid Cystic Carcinoma. Though these tumours affect the head and neck, they are rare, accounting for only 2% of all head and neck cancers. Parotid tumour treatment requires identifying the signs early and becoming familiar with their diagnostic and therapeutic options. In this blog, let’s explore how parotid gland tumours can be detected and treated early on.
Synopsis
Parotid Gland Tumours: Types
The parrotid gland is one of the major salivary glands (the gland that produces saliva) located behind the jaw (below the earlobule). The facial nerve (the nerve that supplies the face) traverses in between both the superficial and deep parts of the parotid gland. Parotid gland tumours are abnormal growths in the parotid glands, the most prominent salivary glands near the ears. They can be benign (non-cancerous) or malignant (cancerous). These abnormal lesions occur commonly due to infective (parotitis), inflammatory, duct stones, or neoplastic processes. Exposure to ultraviolet rays, industrial silica, asbestos dust, and increased intake of polyunsaturated fats can lead to parotid cancers. These conditions can cause weakness of the facial nerve due to the proximity of the nerve to this gland.
Below are the main types of parotid gland tumours:
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Pleomorphic Adenoma
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This is the most common benign salivary gland tumour, accounting for about 80% of benign parotid tumours. It typically presents as a slow-growing, painless mass. While generally benign, there is a small risk of it becoming malignant over time.
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Warthin's Tumour
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Also known as papillary cystadenoma lymphomatosum, this benign tumour primarily affects the parotid gland. It is more common in older individuals and has been associated with smoking. Warthin's tumours are typically slow-growing and may occur bilaterally.
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Mucoepidermoid Carcinoma
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Mucoepidermoid carcinoma is the most common malignant parotid gland tumour. It consists of both mucus-secreting and epidermoid (squamous) cells. These tumours can vary in aggressiveness, some being low-grade and others high-grade.
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Acinic Cell Carcinoma
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This malignant tumour predominantly occurs in the parotid gland and is characterised by cells that resemble normal acinar cells that produce saliva. Acinic cell carcinomas are generally slow-growing and have a relatively favourable prognosis compared to other malignant salivary gland tumours.
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Adenoid Cystic Carcinoma
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Adenoid cystic carcinoma is a slow-growing but aggressive malignant tumour that can occur in the parotid gland. It is known for its tendency to invade nerves, leading to potential facial pain or paralysis. Despite its slow growth, it has a high recurrence rate and can metastasise to distant sites.
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Causes and Risk Factors
Parotid gland tumours develop in the most prominent salivary glands near the ears. While the exact parotid tumour causes remain unclear, certain factors can increase your risk of developing these tumours. Here are some known risk factors:
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Age: The risk of parotid gland tumours increases as you age, with most cases occurring in individuals in their 50s or 60s.
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Radiation Exposure: Previous radiation therapy to the head and neck area can elevate the risk of parotid gland tumours.
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Tobacco Use: Smoking tobacco has been linked to a higher risk of certain types of salivary gland tumours, including Warthin's tumour.
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Viral Infections: Epstein-Barr, human immunodeficiency virus (HIV), and human papillomavirus (HPV) may increase the risk of salivary gland tumours.
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Occupational Hazards: Exposure to substances like nickel alloy dust and silica dust, as well as working in industries such as rubber manufacturing, plumbing, and certain types of woodworking, may raise the risk of salivary gland tumours.
Common Symptoms to Watch For
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Parotid gland tumours develop in the most prominent salivary glands near the ears. Recognising early symptoms is crucial for timely diagnosis and treatment. Common signs to watch for include:
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Lump or Swelling: A noticeable lump or swelling in the cheek, jaw, neck, or mouth area.
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Facial Numbness or Weakness: Experiencing numbness or muscle weakness on one side of the face.
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Persistent Pain: Ongoing pain in the mouth, cheek, jaw, ear, or neck that doesn't subside.
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Difficulty Swallowing or Opening Mouth: Trouble swallowing or opening the mouth widely.
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Facial Asymmetry: A recent difference between the size and/or shape of the left and right sides of the face or neck.
If you notice these symptoms, consult an experienced ENT and head and neck surgeon in Bangalore for evaluation and appropriate management.
Treatment of Parotid Gland Tumours
The first line of investigation for parotid neoplasm is usually an ultrasound scan (USG) followed by fine needle aspiration (FNAC) of the swelling. Ultrasound-guided core biopsy can also be done when FNAC is non-diagnostic. A contrast enhanced MRI scan is mandatory to identify the extent of the mass and regarding the involvement of the facial nerve.
Treatment for parotid gland tumours varies based on the tumour's type, size, and whether it's benign or malignant. Standard treatment options include:
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Surgery (Parotidectomy): The primary treatment involves surgically removing the tumour, often through a procedure called parotidectomy. This approach aims to excise the cancer while preserving facial nerve function. Dr. Satish Nair has pioneered the minimally invasive approach to parotid surgery called Mini-incision Parotidectomy, developing the "Nair Incision," a small, hidden incision. At Manipal Hospital Old Airport Road, Dr. Nair performs the procedure via a 2.5-3cm incision placed behind the earlobe, leaving a hidden scar behind the ear.
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Radiation Therapy: Post-surgical radiation therapy may be recommended, especially for malignant tumours, to eliminate residual cancer cells and reduce recurrence risk.
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Chemotherapy: While less common, chemotherapy might be used for advanced or inoperable tumours to shrink the cancer and alleviate symptoms.
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Targeted Therapy: This treatment uses drugs to target specific molecules involved in cancer growth. It offers a more focused approach with potentially fewer side effects.
Conclusion
Parotid gland tumours can be benign or malignant and require timely diagnosis and appropriate treatment. Early detection improves treatment outcomes and helps prevent complications. Maintaining a healthy lifestyle, avoiding tobacco, and minimising exposure to harmful substances may reduce risk. Consult our ENT and head and neck clinic in Bangalore if you notice unusual swelling or persistent facial symptoms. Proper awareness and medical care are key to managing parotid gland tumours effectively.
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