Parotid gland tumor is a rare malignancy contributing to only 12% of oral and pharyngeal cancers or 0.3% of all tumors affecting humans in the United States.(1)
Parotid malignancies carry a poor prognosis owing to its widespread metastasis.(1)
What Does A Parotid Gland Tumor Feel Like?
The patients present with complaints of swelling in the region below and in front of the earlobe that is slowly progressive. It is followed by pain, facial palsy, and trismus, or lockjaw. There is discharge from swelling along with ulceration and recurrence of tumors in almost 5.09% of the cases.(2)
On examination, the parotid tumor can be felt as a firm, hard swelling. The features of facial fixity, stiffness, and paralysis with nodal involvement indicate the malignant nature of the tumor. The size of the tumor is mostly seen between the range of 2 cm to 6 cm or more. The size of the tumor has shown no relationship with malignancy. Although a sudden increase in the size of the tumor can be a sign of the malignant transformation of the parotid tumor.(2)
Should A Parotid Gland Tumor Be Removed?
The removal of the parotid gland tumors mainly depends on the type, location, and size of the tumor. FNAC will diagnose the accuracy of the benign as well as malignant tumors. A few imaging tests, such as CT, MRI, will help in determining the size and extent of the spread of the tumor. Keeping in mind the clinical presentation and FNAC analysis a treatment mode can be planned for the tumor.(1)
Surgery is the mainstay of treatment in all parotid gland tumors. It becomes important to remove the tumor, whether benign or malignant, both due to cosmetic as well as medical reasons. A benign parotid tumor will grow slowly into the surrounding structures pushing through the surrounding tissues and nerves, destroying them, and also making the surgery difficult at a later time. Therefore it should be removed in the early stages to prevent further complications. Whereas a malignant tumor has high chances of spreading to the lymph nodes and other parts of the body.(3)
All masses need to be carefully assessed and diagnosed for a better outcome and less invasive surgery. A qualified and experienced Head & Neck surgeon will perform a surgery known as parotidectomy (removal of the parotid gland) to remove the whole tumor and affected surrounding parts or tissues safeguarding the facial nerve.(3) This is mostly sufficient in the case of benign parotid gland tumors.
In the case of malignant conditions, additional treatments such as postoperative radiotherapy and chemotherapy are also required to prevent the spread of the tumor. This adjuvant RT/chemotherapy becomes necessary in intermediate and high-grade tumors due to limitations in the surgical margins in resection of parotid tumors. Neutron-beam radiation has shown high efficacy in destroying the malignant parotid tumor cells as compared to conventional radiation therapy. Along with being more effective, it also has fewer toxic effects to the surrounding normal tissues.(1)
Chemotherapy is advisable in the advanced stage of disease for palliative care. The drugs used are cisplatin, paclitaxel, cyclophosphamide, doxorubicin, mitoxantrone, carboplatin, and vinorelbine combinations. Good responses have been seen in cases after single-agent chemotherapy or the use of combination agents (polychemotherapy).(1)
The parotid gland is one of the three major salivary glands that is located in front of the ears extending to the area underneath the earlobe along the lining of the lower jawbone. Out of all the parotid gland tumors, only 20% become malignant. The etiology of cancer remains unclear as there have been no incidences of it being associated with exposure to tobacco smoke or alcohol intake. Although some studies have established its link to exposure to radiation, making it one of the risk factors for parotid gland tumors.(1) The incidence rate is higher in males (34%) compared to females (25%). The parotid gland tumor can affect any age group from 18 to 71 years.(2)