Parotid Tumors

Diagnosis

Tests and procedures used to diagnose a parotid tumor help identify the type of growth and guide your treatment plan. A healthcare professional may begin with a physical exam and then suggest imaging or tissue sampling to understand the nature of the tumor.

A physical exam
A healthcare professional examines the jaw, neck and throat to feel for lumps or swelling. This helps determine if further evaluation is needed.

Collecting a sample of tissue for testing
A biopsy is commonly used to collect a sample of parotid tissue. A thin needle may be inserted through the skin into the parotid gland to draw out cells or fluid. In the lab, specialists examine the sample to determine what types of cells are present and whether they are cancerous. These results guide your healthcare team in planning treatment and determining your outlook.

Biopsy results aren’t always accurate. Sometimes the biopsy might suggest a tumor is not cancerous when it is. For this reason, some healthcare professionals prefer to take a tissue sample during surgery rather than doing a biopsy beforehand.

Imaging tests
Imaging tests show the size, location and features of the tumor. If the parotid tumor is cancerous, these tests also help determine if the cancer has spread. Common imaging methods include ultrasound, MRI and CT scans.

Treatment

Treatment for a parotid tumor often starts with surgery. The specific approach depends on whether the tumor is cancerous, how large it is and whether it affects nearby structures. Additional treatments such as radiation therapy or chemotherapy may be needed for cancerous tumors.

Surgery
Surgical procedures for parotid tumors vary depending on the tumor’s size, location and whether cancer is present.

• Removing part of the parotid gland may be recommended for many tumors. Surgeons remove the tumor and some surrounding tissue. The remaining part of the gland continues to function normally.
• Removing all of the parotid gland, called parotidectomy, may be required for larger or cancerous tumors or tumors located deeper in the gland.
• Removing additional tissue around the gland may be necessary if cancer has spread to nearby bone or muscle. In these cases, reconstructive surgery may follow to help restore chewing, swallowing, speaking, breathing and facial movement.

To access the parotid gland, surgeons make a cut near the ear, often placed within a natural crease or behind the ear to minimize noticeable scarring.

During surgery, a pathologist may examine a sample of the tumor to determine if it is cancerous. This information helps the surgeon decide how much tissue to remove. Nearby lymph nodes and surrounding tissues also may be checked.

The facial nerve runs through the parotid gland and controls facial muscle movement. Surgeons take great care to avoid damaging this nerve. Special devices may be used during the procedure to monitor the nerve’s function. Sometimes the nerve can become stretched, causing temporary facial weakness. Rarely, the nerve must be cut to completely remove the tumor. When this happens, surgeons may reconnect it using nerves from other parts of the body or artificial nerve grafts.

Parotid surgery is complex and requires experienced specialists. Before the operation, you can discuss important questions with your surgeon, such as the location of the incision, the amount of gland to be removed, the risk to the facial nerve, the need for lymph node removal, the possibility of reconstruction and what to expect during recovery.

Radiation therapy
Radiation therapy uses powerful energy beams, such as X-rays or protons, to kill cancer cells. It is commonly recommended after surgery to destroy any remaining cancer cells. If surgery isn’t possible, radiation therapy may be the first line of treatment for parotid gland cancer.

Chemotherapy
Chemotherapy involves strong medicines that attack cancer cells. It may be used when cancer has a higher risk of spreading or when surgery is not an option. Chemotherapy also may be combined with radiation therapy. For advanced cancer that has spread to distant areas, chemotherapy may help relieve symptoms and improve comfort.

Targeted therapy
Targeted therapy uses medicines that block specific chemicals inside cancer cells. By interfering with these processes, the treatment can cause cancer cells to die. Targeted therapy may be considered when other treatments are not effective.