What is salivary gland cancer?

唾液腺由大腺和小腺两部分组成. 主要的腺体是双侧腮腺、下颌骨腺和舌下腺. 小唾液腺是分布在口腔内的小腺体, predominately on the palate, and in the upper aerodigestive tract.

Most salivary gland tumors are benign, 唾液腺癌是一种罕见的恶性肿瘤，占头颈部癌症的比例不到5%. 它们是一种具有不同临床行为的异质性肿瘤. 大约60%的恶性唾液腺肿瘤发生在双侧腮腺, 约30%发生在下颌腺，10%-15%发生在舌下和小唾液腺.

What are the causes of salivary gland cancer?

不像其他头颈部癌症是由已知的致癌物如吸烟、酒精或HPV引起的, the causes of most salivary gland cancers are often unclear. Radiation exposure, 例如先前的低剂量放射治疗和多次牙科x光片, 唾液腺肿瘤最常被怀疑的因素是什么. eb病毒与淋巴上皮癌有关. 其他涉及的因素包括工作场所暴露(镍, rubber, silica), diet, age and genetic susceptibility. 此外，约2%的多形性腺瘤可发生恶性转化.

皮肤癌如鳞状细胞癌和黑色素瘤可转移到双侧腮腺内或附近的淋巴结, and thus mimic a primary parotid tumor.

What are the symptoms of salivary gland cancer?

大多数涎腺癌发生在双侧腮腺和下颌下腺，在腺体中表现为肿块, not uncommonly painless.

• 对于腮腺癌:可能出现疼痛、感觉丧失或难以打开下巴.
• Probable cancer: rapid recent tumor enlargement, facial nerve weakness, deep tumor fixation and enlargement of the neck lymph node.
• 下颌骨癌通常表现为无痛性颈部肿块. 当有疼痛时，这可能与炎症性疾病混淆. 下颌腺癌不太常见的征象包括肿瘤固定, skin invasion, lower facial paralysis and enlarged neck nodes.
• 舌下腺癌通常表现为口腔底部的肿块.

小的唾液腺肿瘤通常表现为无溃疡, painless submucosal mass of the oral cavity, typically in the hard or soft palate. 轻微唾液腺肿瘤的症状与肿瘤部位有关, extent, tumor type, 以及肿瘤是否造成了肿块效应或正在侵入局部结构.

How are salivary gland cancers diagnosed?

彻底的病史和体格检查对唾液腺癌的诊断很重要. 仔细寻找症状，包括肿块进展、疼痛、感觉丧失或咬牙. In addition, symptoms including facial weakness, facial asymmetry, facial spasm or twitching, and eye symptoms are sought. The patient’s medical history is queried, 包括先前的辐射暴露和皮肤或其他恶性肿瘤的历史.

A complete head and neck examination is performed. 检查和触诊唾液腺以确定肿瘤大小, consistency, and mobility relative to adjacent tissues. The neck is examined for enlarged lymph nodes. 评估面神经和其他颅神经的功能.

细针穿刺活检(FNA)是一种准确的方法来确认临床怀疑肿瘤腮腺和下颌骨肿块. 超声引导可以帮助确保正确的FNA肿瘤取样. 切口或穿孔活检对小涎腺肿瘤的诊断是有用的.

Imaging studies, MRI in particular, 是否有助于评估原发肿瘤的范围和肿瘤沿神经或颈部淋巴结的潜在扩散. Chest radiographs, CT扫描和正电子发射断层扫描(PET)/CT扫描可以帮助评估远处转移.

What is the treatment of salivary gland cancer?

Management of salivary gland cancers is complex. 最佳的治疗和随访需要一个多学科的团队，拥有全方位的专家和支持服务，具有管理这些肿瘤的专业知识. Surgery is the primary treatment for salivary gland cancers, 以手术完全切除原发肿瘤为目标. 对于临床发现的颈部淋巴结转移，需要进行全面的颈部清扫. 重建手术可在初次手术期间进行, 例如，这取决于切除了哪些结构以确保完全切除癌症, the facial nerve, skin, soft tissues and bone. This ensures the best cosmetic and functional results.

辅助放射治疗适用于晚期和高级别癌症患者. In select patients with minor salivary gland cancer, 如果认为手术切除过于病态，有时建议进行初级放射治疗. 长期临床随访对需要接受唾液腺癌治疗的患者很重要, as salvage surgery is feasible for select patients. All decisions are made with a multidisciplinary team.