(HealthDay News) — Salivary gland cancer is caused by tumors that grow in any area of the salivary glands.

During any physical exam, your doctor should check your salivary glands for any lumps or anything unusual.

The American Cancer Society says symptoms of salivary gland cancer usually include an unexplained lump on or persistent pain in the face, mouth or neck. Any sudden difference in size or shape of one side of the face or neck, or numbness or weakness in these areas should be reported to your doctor.

A family history of salivary gland cancer may make you more likely to develop the disease, says the Cancer Society. Tobacco use and high-fat diets without enough vegetables may also raise a person’s risk for salivary gland cancer. Links have been reported between the disease and exposure to radiation of the face and neck, and exposure to nickel alloy dust and silica dust.

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My husband was diagnosed with a salivary gland cancer, went through treatment and he is doing fine now. About 8 months before diagnosis he had the stop smoking shot which is an injection right around the saliva gland followed up with a patch that has to be worn for about 3 days behind the ear. It has been about 2 years since- but it has always stuck in my mind that this could have contributed if not caused the cancer. The doctors all have said that his particular cancer was not related to smoking. They don’t really have much to say about the shot. How can I find out if there are others out there that this has happened to?

By the way the shot worked for a short time about 3 months. What made him quit for good was the cancer. Cold Turkey

Also, for any of you out there with swollen saliva glands get it checked out don’t wait. They thought he had a blocked duct. We found out during treatment that this happens to many people. The only way for them to find out if a persistant swollen gland is cancer is for them to do an asperation.

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(HealthDay News) — Salivary gland cancer is caused by tumors that grow in any area of the salivary glands.

During any physical exam, your doctor should check your salivary glands for any lumps or anything unusual.

The American Cancer Society says symptoms of salivary gland cancer usually include an unexplained lump on or persistent pain in the face, mouth or neck. Any sudden difference in size or shape of one side of the face or neck, or numbness or weakness in these areas should be reported to your doctor.

A family history of salivary gland cancer may make you more likely to develop the disease, says the Cancer Society. Tobacco use and high-fat diets without enough vegetables may also raise a person’s risk for salivary gland cancer. Links have been reported between the disease and exposure to radiation of the face and neck, and exposure to nickel alloy dust and silica dust.

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It is possible that the main title of the report Polymorphous Low-Grade Adenocarcinoma is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

—      PLGA

—      Lobular Carcinoma of the Minor Salivary Glands

—      Low-Grade Papillary Carcinoma of the Palate

—      Pleomorphic Adenoma

—      Terminal Duct Carcinoma

Disorder Subdivisions

—      None

General Discussion

Polymorphous low-grade adenocarcinoma (PLGA) is a rare tumor of the salivary glands that is limited, to a great extent, to the minor salivary glands and commonly, but not exclusively, localized in the palate of the mouth. The major salivary glands are the parotid glands (at the side of the face, below the ears), the sublingual glands (below the tongue), and the submandibular glands (below the lower jaw). As the name suggests, each of the major salivary glands is of substantial size and visible to the naked eye. There are about 600 to 1,000 minor salivary glands that are microscopic in size. These minor salivary glands are found in the lining (mucosa) of the lips, tongue, and hard and soft palate, as well as inside the nose, cheeks, and sinuses.

Less than one (1%) per cent of all cancers reported in the USA are salivary cancers and, of these, 80% begin in the parotid glands, and about 15% begin in the submandibular glands, leaving only 5% that begin in the sublingual and minor salivary glands. Most of the tumors that start in the major salivary glands turn out to be benign, while most, but not all, of the cancers that start in the minor salivary glands turn out to be malignant.

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 I will begin by stating that I am a student of the disease at hand and by no

>means an expert. But allow me to bemoan my struggles with the literature

>concerning adenoid cystic carcinoma and some of my most gut wrenching tumor

>boards.

> 

>So now I preach to the choir.

> 

>I will look forward to reviewing a couple of these articles which I have not

>already read. A few are familiar and point to a few problems which nag me at

>every tumor board I go to concerning adenoid cystic carcinoma of minor

>salivary origin.

> 

>The first thing I look at in articles about adenoid cystic carcinoma is

>whether or not they took into account the advent of polymorphous low-grade

>carcinoma in the 1980’s. Trying to find what is “clean” data, has been

>nearly impossible.  I will relish the first article that specifically

>accounts for polymorphous low-grade adenocarcinoma and realizes that this

>now common diagnosis was often pigeonholed as adenoid cystic carcinoma prior

>to the mid-1980’s. Certainly polymorphous low-grade adenocarcinoma’s

>behavior could drastically skew any data in which they were intermixed with

>biometric data from adenoid cystic carcinoma. Most data is suspect in my

>mind for this reason. (ref for PLGA interpretation and biometrics is at end

>of message) My gut instinct is that adenoid cystic carcinoma of minor

>salivary glands may be an even worse actor than we give it credit for. I

>also wonder whether data taken from major gland disease or co-mingled with

>data thereof confounds the issue of radiation.

> 

>The local control of adenoid cystic carcinoma with radiation has some better

>data. But then I’m always drawn to what the long-term outcome is and still

>come up with the dismal longterm prognosis.  Even then, finding articles

>which specifically state the difference between local control vs. metastases

>and survival can be a challenge.

> 

>To date the tumor boards I’ve been associated with have recommended

>radiation and surgery in 5 of 5 cases of minor salivary gland adenoid cystic

>carcinoma. 4 of 5 patients elected to have radiation following surgery. As I

>see the patients deal with the salivary, dental and osseous, post-radiation

>sequelae, I always wonder. If I have to keep telling them the quantitative

>survival is no better, it’d be nice to tell them the qualitative survival is

>better. I sure wish I had some science to give me a better warm and fuzzy

>that decreasing the local recurrences was better than a second surgery if a

>recurrence ensued. But until then….

> 

> 

>TITLE:  Polymorphous low grade adenocarcinoma: a clinicopathologic study of

>164 cases.

>AUTHORS:  Castle JT; Thompson LD; Frommelt RA; Wenig BM; Kessler HP

>AUTHOR AFFILIATION:  Department of Oral and Maxillofacial Pathology, Armed

>Forces Institute of Pathology, Washington, DC 20306-6000, USA.

>SOURCE:  Cancer 1999 Jul 15;86(2):207-19.

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Part II: Cancer Terms to Know: Newly Diagnosed

October 23, 2006

This is the second in a four-part series of articles designed to help people with cancer understand commonly used oncology terms. The following article defines cancer terms that you may hear your doctor use if you are newlydiagnosed with cancer.

Acute: Symptoms that start and worsen quickly but do not last over a long period of time.

CBC (complete blood count): A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood. Platelets are the components of blood that help it to clot.

Chronic: A disease or condition that persists or progresses over a long period of time.

In situ: Cancer that has not spread to nearby tissue. Also called non-invasive cancer.

Invasive cancer: Cancer that has spread outside the layer of tissue in which it started and is growing in other tissues or parts of the body. Also called infiltrating cancer.

Localized cancer: Cancer that is confined to the area where it started and has not spread to other parts of the body.

Neutropenia: An abnormal decrease in the number of neutrophils in the blood. Neutrophils are a type of white blood cell that fights infection.

Prognosis: Chance of recovery; a prediction of the outcome of a disease.

Protocol: An action plan for how a clinical trial will be carried out. It states the goals and timeline of the study, who is eligible to participate, what treatments and tests will be given and how often, and what information will be gathered.

Regimen: A treatment plan that includes which treatments and procedures will be done, medications and their doses, the schedule of treatments, and how long the treatment will last.

Stage: A measurement given or a diagnosis that describes the size of the original tumor and identifies whether the tumor has spread to lymph nodes or other parts of the body.

Standard of care: A set of common guidelines that is followed for the diagnosis and treatment of a certain type of disease.

Additional resources

National Cancer Institute—Dictionary of Cancer Terms

American Cancer Society—Glossary

Stedman’s Medical Dictionary

More Information

Read more articles in this four-part series.

Part I: Cancer Terms to Know: Basic Oncology Terms

Part III: Cancer Terms to Know: During Treatment

Part IV: Cancer Terms to Know: After Treatment

Medical Dictionary Resources

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Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For salivary gland tumors, a fine needle aspiration biopsy (cytology) is the preferred method of examination in making a diagnosis. Incisional biopsy should be avoided in essentially every case (with rare exceptions). Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

—      Age and medical condition

—      The type of cancer

—      Severity of symptoms

—      Results of previous tests

A medical history and physical examination have to be done carefully, identifying potential risk factors. If a facial nerve paralysis is present, specific function tests will be required, and an inspection of the oral cavity, hypopharynx, and larynx will also be done. There are no specific blood or urine tests that can detect a salivary gland tumor, and there are no tumor markers (substances found in higher than normal amounts in the blood, urine, or body tissues of people with certain kinds of cancer) for salivary gland cancer known at this time.

The following tests may be used to diagnose salivary gland cancer:

Fine needle aspiration. Cells are withdrawn using a thin needle inserted directly into the tumor. The cells are examined under a microscope for signs of cancer, and should be examined by a cytologist with expertise in salivary gland cancer.

Endoscopy. A thin, flexible tube with an attached light and view lens is inserted through the mouth or nose to examine the head and neck areas. The examination has different names depending on the area of the body that is examined, such as laryngoscopy (larynx), pharyngoscopy (pharynx), or a nasopharyngoscopy (nasopharynx). It is performed using an anesthetic spray or general anesthesia to make the person more comfortable.

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue.

Ultrasound. In this test, a video image of the inside of the body is produced using sound waves. Ultrasound is used to check lymph nodes in the neck and to assist in fine needle aspiration biopsy.

Positron emission tomography (PET) scan. In a PET scan, radioactive sugar molecules are injected into the body. Cancer cells absorb sugar more quickly than normal cells, so they light up on the PET scan. PET scans are often used to complement information gathered from CT scan, MRI, and physical examination. PET scanning is especially useful to detect possible cancer in other organs (metastasis, or spreading) or hidden primary tumors.

Additionally, a dentist, in his or her evaluation of the person with salivary gland cancer, may order specific imaging studies for the teeth, including a panorex (a rotating, or panoramic, x-ray) of the mandible (jawbones).

To learn about the terms used in this section, read the PLWC Feature: Cancer Terms to Know: Newly Diagnosed.

To learn more about what to expect during common diagnostic tests, read PLWC: Tests and Procedures.

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B. S. Glisson, G. Blumenschein, M. Francisco, J. Erasmus, R. Zinner and M. Kies

UT MD Anderson Cancer Ctr, Houston, TX

5532

Background: Conventional chemotherapy agents offer little efficacy for patients with incurable salivary gland cancer. EGFR (her1) overexpression has been identifed in > 90% of salivary gland cancers in recent series. Thus, EGFR-targeted therapy with gefitinib offers promise in treatment of this disease. Methods: From 6/04 to 12/04 28 patients with incurable salivary gland cancer were accrued to a phase II trial of gefitinib (250 mg po daily). Eligibility: ECOG PS 0–2, measurable disease, no prior EGFR inhiibitors. Patients were accrued in two cohorts: (1) adenoid cystic and (2) other histologies. Primary endpoint was response rate based on RECIST criteria and imaging every 2 months. Analysis of EGFR and her2 expression (IHC) on archival tumor was a secondary endpoint. Results: Patient characteristics, number(%): PS 1 26(93), M 19(68), prior chemotherapy 6(21), adenoid cystic 19(68), adenocarcinoma 3(11), salivary duct 3(11), mucoepidermoid 2(7), and undifferentiated 1(3). Twenty-six patients received 71 courses. Two are in their first course. Toxicity (26 pts), number (%): grade 1 diarrhea 20(77), grade 1/2 rash 14(54), grade 1/2 anorexia 8(31), grade 1/2 fatigue 14(54), grade 1 nausea 4(15), grade 1 mucositis 4(15), grade 1 nail change 2(8). No grade 3–4 effects observed. Three patients discontinued therapy due to grade1–2 effects that were felt treatment-related in only 1/3. Response (21 pts), number(%): CR/PR 0(0), SD 14 (67), PD 7(33). 13/14 pts with SD have adenoid cystic cancer. Median duration of SD: 13 wks (4–19). One pt is dead of disease, two have died from other causes. Accrual to the adenoid cystic cohort is complete unless a reponse is observed. Accrual to the other cohort is ongoing. Conclusions: Gefitinib was well-tolerated and led to a high rate of SD in adenoid cystic cancer. Given the frequent indolent nature of salivary gland cancer, interpretation of the value of SD requires further f/u. This will be updated and expression of EGFR and her2 will be presented.

No significant financial relationships to disclose.

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Date updated: March 16, 2006
Content provided by MayoClinic.com

In general, these factors may increase the likelihood that you’ll develop salivary gland cancer:

—      Tobacco use. Smoking or using chewing tobacco can increase your risk of salivary gland cancer.

—      Radiation exposure. Because radiation has the potential to damage DNA, if you’ve had radiation treatment to your head or neck, or if you’re exposed to radioactive materials in your work, you may be more likely to develop some types of cancer, including salivary gland cancer, than may people who have not been exposed to radiation.

—      Family history. If members of your family have had salivary gland cancer, you may be at a higher risk of getting the disease.

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Researchers have investigated the associations between ammonia, air pollution, socioeconomic status, and access to medical care with incidence and mortality rates of salivary cancer in the South Carolina population. The findings from this study revealed that an association was found between emissions of ammonia and mortality rates of salivary gland cancer in Caucasian men.

Nearly 2,900 new cases of salivary gland cancer will be diagnosed in the United States in 2004, an increasing number, and no one knows why. Some studies suggest environmental factors may play a role, but no definitive data have been presented.

Ammonia is an agent that has been implicated in cancers of the stomach but is not known as a risk for salivary gland cancer. The study, “Salivary Gland Cancer Mortality and Industrial Ammonia Emissions: A Geographic Association,” examines that concept. The authors Edward D. Gorham, Ph.D, and Frank C. Garland, Ph.D both of the Naval Health Research Center San Diego, CA, and the Department of Family and Preventive Medicine University of California, San Diego, Terry Day, M.D, Medical University of South Carolina, Charleston, SC, Cedric F. Garland, Dr.P.H, Department of Family and Preventive Medicine University of California, San Diego, and Franky Hasibuan, M.P.H., GEO Centers, Inc., San Diego, CA, will present their findings at the 6th International Conference on Head and Neck Cancer  being held August 7-11, 2004, at the Marriott Wardman Park in Washington, DC.

Methodology: Mortality data for cancer of the salivary glands was extracted by ICD-9 codes from the CDC WONDER database for each of 46 South Carolina counties. The data were then stratified by five-year age groups, gender, and race for the twenty-year period from 1979-1998. The South Carolina Central Cancer Registry (SCCCR) of South Carolina Department of Health and Environmental Control provided age-, sex- and race-specific counts of new cases of salivary gland cancer during 1996-2000. Cases with ICD-10 codes of C07, parotid salivary gland cancers, and C08, other and unspecified major salivary gland cancers were included. Cancers that had not spread from the primary site (in-situ) were excluded. Data on environmental exposures were obtained from the Environmental Protection Agency AIR Data System, a comprehensive national database of air pollution emissions. Data on hospital medical and dental care resources in each county were obtained from the American Hospital Association, the American Medical Association, and the South Carolina Dental Association.

Multiple linear regression and other analyses were performed using SAS- PROC REG procedure. Each model included age-adjusted mortality rates specific for race (Caucasian, African American) and sex for the 20-year period from 1979-1998 as the dependant variable. A correlation matrix was created that included all independent variables.

Results: There were 174 deaths from cancer of the salivary glands in residents of South Carolina during 1979-1998. The ratio of male to female death rates was 3.1 in Caucasian (statistically significant) compared to 1.1 in African Americans (statistically insignificant). The rates for Caucasian men were statistically significantly higher than expected in Darlington County (p < 0.04). Annual emissions of air pollution, such as ammonia, varied widely by county, however, ammonia emissions were positively associated with salivary cancer mortality rates in Caucasian men (p < 0.05) and persisted after control for sulfur dioxide concentration (suggested as contributing to risk of other cancers). After adjustment for socioeconomic factors and indicators of access to care, there was an association between ammonia emissions at the level of the county and age-adjusted mortality rates of salivary gland cancer in Caucasian men (p < 0.03).

Conclusion: The findings point to an association between emissions of ammonia and mortality rates of salivary gland cancer in Caucasian men, but not similarly found in Caucasian women or in African Americans of either sex or as a result of airborne environmental factors. Thus, it is suggested that the association could be due to an occupational exposure more common in Caucasian men, or possibly chance. This research indicates that further study is needed regarding the association of ammonia and salivary gland cancer.

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