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salivary glands Flashcards

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1
Q

what % of H&N cancers are pf the salivary glands

A

they are very RARE 2% of all H&N cancer

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2
Q

where do most salivary gland cancers arise

A

70% arise in the parotid gland

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3
Q

malignant vs bening men and women

A

benign salivary gland tumours occur more frequently in women and malignant occur equally in men and women

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4
Q

age groups benign vs malignant

A

benign 45yo and malignant 55 yo

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5
Q

causes of salivary gland cancer

A

previous radiation
dental radiographs
this cancer is NOT associated with smoking and drinking
family history

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6
Q

salivary gland cancer can cause which other cancers after treatment

A

oral cavity, lung, thyroid and kidney

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7
Q

what 3 gland comprise salivary glands

A
  1. parotid glands
  2. submandibular glands
  3. sublingual glands
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8
Q

which is the largest gland that are part of the salivary glands

A

the parotid glands

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9
Q

where are the parotid glands

A

they are located superficially and slightly behind the rams of the mandible

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10
Q

saliva secretion from the parotid glands

A

secretes saliva through stensen’s ducts to the oral cavity to help with mastication and swallowing

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11
Q

location of the submandibular glands

A

located beneath the lower jaws superior to the digastric muscles

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12
Q

saliva secretion from the submandibular glands

A

enters the oral cavity by the whartons ducts and they produce a mixture of serous fluid and mucus

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13
Q

which salivary gland produces the most saliva that is within the oral cavity

A

70% of the saliva in the oral cavity comes from the submandibular glands even though these glands are much smaller than the parotid glands

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14
Q

LN drainage of the submandibular glands

A

drains to the submandibular and subdigastric Ln

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15
Q

location of the sublingual glands

A

located beneath the tongue anterior to the submandibular glands

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16
Q

secretion of the sublingual glands

A

sublingual glands is mainly mucus secretion but it is considered as a mixed gland accounts for 5% of the saliva in the oral cavity

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17
Q

saliva secretion from the sublingual glands

A

unlike the submandibular and parotid glands the sublingual glands do not have striated ducts and exit from 8-20 excretory ducts

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18
Q

LN drainage of the sublingual glands

A

drains to the submandibular or deep internal jugular chain

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19
Q

which glands are most commonly cancerous ?

A

the parotid glands

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20
Q

Minor salivary glands

A

there are about 600 minor salivary glands
usually only about 1-2mm in diameter
surrounded by connective tissue
secretion is mostly mucous in nature and functions to coat the oral cavity with saliva

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21
Q

initial route of spread for malignant salivary gland tumours

A

initial route of spread is through local extension

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22
Q

are most salivary gland tumours benign or malignant

A

most are benign

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23
Q

which salivary gland tumours commonly have LN invasion at presentation

A

submandibular tumours are most common to have LN + at presentation

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24
Q

which salivary gland tumours have this spread: spread beyond the gland early and enter surrounding tissue such as the lower jaw or skin

A

submandibular and subinguinal

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25
distant mets of salivary gland tumours
bone, lung and liver
26
diagnostic methods in salivary gland tumours
History and physical FNA biopsy CT, MRI
27
s&s of salivary gland cancer
- facial nerve palsy in 25% of patients with parotid gland but only 10% complain of pain - adenopathy - swelling - painless rapidly growing mass (mass is often present for years before a change in growth patterns)
28
most common malignant subtype of parotid gland cancer
mucoepidermoid carcinoma is most common malignant parotid gland cancer
29
most common histology of minor, major malignant salivary gland cancers except parotid
adenoid cystic carcinoma
30
malignant subtypes of salivary gland cancers
``` Mucoepidermoid carcinoma *most common in parotid Adenoid cystic carcinoma *most common minor salivary gland Polymorphous low grade adenocarcinoma Acinic cell carcinomas Malignant mixed tumours Epithelial- myoepithelial tumours Salivary duct carcinoma Squamous cell carcinoma Undifferentiated carcinoma Basal cell carcinoma ```
31
TNM staging salivary gland cancer
``` T1 <2cm T2 2-4 cm T3->4cm or extraparenchymal extension T4-invades, skin, mandible base of skull or facial nerves N1-<3cm N2 3-6 cm N3->6cm ```
32
grades for salivary gland cancer
``` (same for all H&N cancer except nasopharynx) stage1- T1 n0 stage 2-T2 N0 stage 3 T1-T3 N1 T3 N0 Stage4 any T N2,N3 T4, N0 any T any N M1 ```
33
prognostic indicators in salivary gland cancers
``` LN involvement stage grade over expression Her2neu and P53 = bad histopathology adenoid cystic tend to have perineurial involvement = poor prognosis ```
34
general management for salivary gland cancer
most patients with high risk prognostic factors get surgery followed by XRT Adjuvant chemo is not typically used except for in the palliative setting
35
surgery for low grade salivary gland tumours
low grade parotid tumours are treated with a superficial parotidectomy unless they begin in the deep lobe of the parotid neck dissection is NOT done
36
surgery for high grade salivary gland tumours with and without facial nerve involvement
NECK DISSECTION IS used in patients with high grade high stage tumours with + LN if the facial nerves are NOT involved nerve sparing surgery is performed if the facial nerves ARE involved reconstruction of the facial nerve with a cable nerve graft with the rural nerve or the auricular nerve - the incidence of facial nerve palsy
37
bulls eye technique
there is a direct high energy beam anteriorly (18025Mv)that is heavily weighted 80% and a POP for the lats with a lower energy (6Mv) the lats typically have wedges 10% each for weighting
38
advantage of bulls eye technique
to treat superficially between the eyes while still getting a high dose to the paranasal sinuses
39
3 different techniques to treating the salivary glands
1. homolatersl wedge pair 2. Bulls eye technique 3. iMRT * **IMRT id mostly used today not so much the other techniques
40
homolateral wedge pairs in treating the salivary glands
- thick ends of the wedges are together - one of the 2 beams avoids the spinal cord all together - includes a 2cm margin for ipsilateral ln - 4-10MV photons and 12-16MEV electrons are used for 80% of the dose
41
IMRT
5-7 beams allows optimal coverage while sparing structures such as the mandible, cochlea, spinal cord, brain and oropharynx
42
XRT for the parotid gland (dose) margins coverage
55-60Gy at 5cm with 2Gy/fx the surgical bed with a 2cm margin is used tumours with a high propensity for perineurial invasion (ex: adenoid cystic) will include the cranial nerves in the volume from the parotids the base of the skull
43
XRT doses and coverage for submandibular gland
dose if there is no perineurial invasion and - margins after surgery is 50/25 if there is perineurial invasion the dose should be increased to 60-66Gy and the nerves should be covered to the base of the skull entire submandibular and ipsilateral neck should be irradiated
44
XRT for minor salivary glands
similar to SCC of the H&N with 2 exceptions 1.For patients receiving post-op radiation after surgical resection, 60 Gy is given for negative margins and 66 Gy for microscopically +ve margins 2,For gross residual disease after surgery or for lesions treated with radiation alone, a total of 70 Gy is given in 2 Gy fractions
45
acidic cell carcinoma occurs in which salivary gland cancer
only in the parotid gland
46
most common histopathology in minor salivary glands and submaxillary gland
adenoid cystic tumours
47
what is pleomorphic adenoma
it is a benign tumour that accounts for 65-75% OF ALL PAROTID TUMOURS
48
Standard therapy for pleomorphic adenoma
standard treatment is conservative parotidectomy however the following are indications for adjuvant XRT 1.Involvement of the deep lobe of the parotid 2.recurrences 3.large lesions >5cm which would make the lesion in-excisable 4.microscopically + margins after resection 5.malignant transformations in a benign tumour dose of 50-60 Gy in 5-6 weeks 50/25,60/30 at 4-5cm depth
49
side effects of treatment in parotid gland cancer
facial nerve paralysis is most common a===nd is usually due to surgery partial xerostomia can occur due to XRT and can be permanent
50
most common site of disease of minor salivary gland cancers
palate is the most common followed by: paranasal sinus, tongue, and nasal cavity
51
what tumour type are most minor salivary gland tumours ?
adenoid cystic
52
adenoid cystic tumours of the minor salivary glands are less likely to have mets in which LN?
Cervical LN
53
What should the dose to the parotids be limited to avoid xerostomia
n.b. the TD5/5 for the parotid gland is 3200 | therefore one pa3rotid should be spared to 20Gy and both glands should be spared to a mean dose of 25Gy
54
most and second most common type of salivary gland cancer
parotid followed by SMD
55
what salivary gland is paired
parotid gland, and sublingual glands
56
what are the major salivary glands
parotid, submandibular and sublingual glands
57
how much saliva is excreted daily
IL/day
58
are salivary glands radioresistant or radiosensitive
sensitive (n.b. the td5/5 of parotid gland is v. low)
59
most salivary gland tumours are dx at what stage
benign is most common
60
how often are parotid tumours benign vs malignant
2/3 benign 1/3 malignant
61
a karger parotid gland is an indication of what
+ risk of benign tumour
62
what shape is the parotid gland
pyramidal
63
what location of tumour most commonly is dx with LN mets
SMD
64
Salivary glands are made of what 2 types of cells
mucinous and serous cells
65
what cell type makes salivary gland tumours radioSENSITIVE
serous cells
66
after how long of tx can xerostomia begin
after 10 GY (1 week of tx)
67
Most parotid tumours occur in what lobe?
the superficial lobe 80%
68
what pathology has the worst prognosis?
Adenoid cystic has worst prognosis
69
3 main radiation treatment modalities are used for salivary gland cancer
Homolateral wedge pair, bulls eye technique and IMRT
70
indications for ADJ XRT
``` Gross residual disease or margins <5mm T3-4 LN+ Perineural disease SCC subtype ```
71
what LN are included in parotid tx plan
subdigastric ln
72
what are the margins for a parotid TX plan
2 cm

Skin Radiation therapy (40 decks)

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