Consult the medical resource doctors trust

UpToDate is one of the most respected medical information resources in the world, used by over 360,000 doctors and thousands of patients to find answers to medical questions.

  • Content written by a faculty of over 4,000 physicians from leading medical institutions
  • Unbiased: free of advertising or pharmaceutical funding
  • Evidence-based treatment recommendations
  • Continuously updated to incorporate new medical findings

Salivary gland tumors: Epidemiology, pathogenesis, evaluation, and staging

INTRODUCTION

Salivary glands produce and secrete saliva from a glandular structure, the secretory acini, ducts, and myoepithelial and basal cells. Salivary gland tumors (SGTs), which can be benign or malignant (table 1), can arise from either the major salivary glands (parotid, submandibular, and sublingual) (figure 1) or the minor salivary glands, which are located throughout the submucosa of the mouth and upper aerodigestive tract, including the oral cavity (especially the palate), paranasal sinuses, larynx, and pharynx [1,2].

The epidemiology, pathogenesis, preoperative evaluation, and staging of salivary gland tumors are presented here. Treatment of salivary gland tumors, for both locoregional and metastatic disease, is discussed separately. (See "Salivary gland tumors: Treatment of locoregional disease" and "Malignant salivary gland tumors: Treatment of recurrent and metastatic disease" and "Pathology of head and neck neoplasms".)

EPIDEMIOLOGY AND PATHOGENESIS

The epidemiology of SGTs is not well documented and varies based upon geography and populations studied. In general, tumors of the salivary gland are relatively rare, comprising 3 to 6 percent of head and neck neoplasms in adults [3].

The factors responsible for salivary gland tumorigenesis are unclear. In comparison to most other head and neck cancers, exposure to tobacco smoke and alcohol intake have not been consistently associated with the development of SGTs, whereas previous radiation exposure appears to be a risk factor for the development of SGTs, particularly mucoepidermoid carcinoma [4-11].

Warthin tumor, in contrast to other SGTs, does have a strong association with smoking. Although this benign tumor has been historically associated with older men, the incidence in women has increased and parallels the increased smoking rates of women [2,12,13].
To continue reading this article you need to subscribe.

Read the rest of this article and others like it

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2010 UpToDate, Inc.
References Top
  1. Jones, AV, Craig, GT, Speight, PM, Franklin, CD. The range and demographics of salivary gland tumours diagnosed in a UK population. Oral Oncol 2008; 44:407.
  2. Barnes, L, Eveson, JW, Reichart, P, Sidransky, D. World Health Organization Classification of Tumors. Pathology and Genetics of Head and Neck Tumours, IARC Press, Lyon 2005.
  3. Ward, MJ, Levine, PA. Salivary gland tumors. In: Essentials of Head and Neck Oncology, 1st ed, Close, LG, Larson, DL, Shah, JP (Eds), Thieme, New York, NY 1998.
  4. Muscat, JE, Wynder, EL. A case/control study of risk factors for major salivary gland cancer. Otolaryngol Head Neck Surg 1998; 118:195.
  5. Horn-Ross, PL, Ljung, BM, Morrow, M. Environmental factors and the risk of salivary gland cancer. Epidemiology 1997; 8:414.
  6. Sadetzki, S, Oberman, B, Mandelzweig, L, et al. Smoking and risk of parotid gland tumors: a nationwide case-control study. Cancer 2008; 112:1974.
  7. Whatley, WS, Thompson, JW, Rao, B. Salivary gland tumors in survivors of childhood cancer. Otolaryngol Head Neck Surg 2006; 134:385.
  8. Saku, T, Hayashi, Y, Takahara, O, et al. Salivary gland tumors among atomic bomb survivors, 1950-1987. Cancer 1997; 79:1465.
  9. Preston-Martin, S, White, SC. Brain and salivary gland tumors related to prior dental radiography: implications for current practice. J Am Dent Assoc 1990; 120:151.
  10. Sun, EC, Curtis, R, Melbye, M, Goedert, JJ. Salivary gland cancer in the United States. Cancer Epidemiol Biomarkers Prev 1999; 8:1095.
  11. Boukheris, H, Ron, E, Dores, GM, et al. Risk of radiation-related salivary gland carcinomas among survivors of Hodgkin lymphoma: a population-based analysis. Cancer 2008; 113:3153.
  12. Pinkston, JA, Cole, P. Cigarette smoking and Warthin's tumor. Am J Epidemiol 1996; 144:183.
  13. de Ru, JA, Plantinga, RF, Majoor, MH, et al. Warthin's tumour and smoking. B-ENT 2005; 1:63.
  14. Kim, KI, Kim, YS, Kim, HK, et al. The detection of Epstein-Barr virus in the lesions of salivary glands. Pathol Res Pract 1999; 195:407.
  15. Hsu, YC, Lu, HF, Huang, CC, et al. Malignant lymphoepithelial lesions of the salivary gland. Otolaryngol Head Neck Surg 2006; 134:661.
  16. Jen, KY, Cheng, J, Li, J, et al. Mutational events in LMP1 gene of Epstein-Barr virus in salivary gland lymphoepithelial carcinomas. Int J Cancer 2003; 105:654.
  17. Vageli, D, Sourvinos, G, Ioannou, M, et al. High-risk human papillomavirus (HPV) in parotid lesions. Int J Biol Markers 2007; 22:239.
  18. Stenner, M, Klussmann, JP. Current update on established and novel biomarkers in salivary gland carcinoma pathology and the molecular pathways involved. Eur Arch Otorhinolaryngol 2009; 266:333.
  19. Skalova, A, Starek, I, Vanecek, T, et al. Expression of HER-2/neu gene and protein in salivary duct carcinomas of parotid gland as revealed by fluorescence in-situ hybridization and immunohistochemistry. Histopathology 2003; 42:348.
  20. Cerilli, LA, Swartzbaugh, JR, Saadut, R, et al. Analysis of chromosome 9p21 deletion and p16 gene mutation in salivary gland carcinomas. Hum Pathol 1999; 30:1242.
  21. Nishimine, M, Nakamura, M, Kishi, M, et al. Alterations of p14ARF and p16INK4a genes in salivary gland carcinomas. Oncol Rep 2003; 10:555.
  22. Press, MF, Pike, MC, Hung, G, et al. Amplification and overexpression of HER-2/neu in carcinomas of the salivary gland: correlation with poor prognosis. Cancer Res 1994; 54:5675.
  23. Yoo, J, Robinson, RA. H-ras gene mutations in salivary gland mucoepidermoid carcinomas. Cancer 2000; 88:518.
  24. Yamamoto, Y, Kishimoto, Y, Wistuba, II, et al. DNA analysis at p53 locus in carcinomas arising from pleomorphic adenomas of salivary glands: comparison of molecular study and p53 immunostaining. Pathol Int 1998; 48:265.
  25. Gallo, O, Franchi, A, Bianchi, S, et al. p53 oncoprotein expression in parotid gland carcinoma is associated with clinical outcome. Cancer 1995; 75:2037.
  26. Tonon, G, Modi, S, Wu, L, et al. t(11;19)(q21;p13) translocation in mucoepidermoid carcinoma creates a novel fusion product that disrupts a Notch signaling pathway. Nat Genet 2003; 33:208.
  27. Fehr, A, Roser, K, Belge, G, et al. A closer look at Warthin tumors and the t(11;19). Cancer Genet Cytogenet 2008; 180:135.
  28. Okabe, M, Miyabe, S, Nagatsuka, H, et al. MECT1-MAML2 fusion transcript defines a favorable subset of mucoepidermoid carcinoma. Clin Cancer Res 2006; 12:3902.
  29. Behboudi, A, Enlund, F, Winnes, M, et al. Molecular classification of mucoepidermoid carcinomas-prognostic significance of the MECT1-MAML2 fusion oncogene. Genes Chromosomes Cancer 2006; 45:470.
  30. Cheuk, W, Chan, JK. Advances in salivary gland pathology. Histopathology 2007; 51:1.
  31. Speight, PM, Barrett, AW. Salivary gland tumours. Oral Dis 2002; 8:229.
  32. Spiro, RH. Salivary neoplasms: overview of a 35-year experience with 2,807 patients. Head Neck Surg 1986; 8:177.
  33. Bell, RB, Dierks, EJ, Homer, L, Potter, BE. Management and outcome of patients with malignant salivary gland tumors. J Oral Maxillofac Surg 2005; 63:917.
  34. O'Brien, CJ, Malka, VB, Mijailovic, M. Evaluation of 242 consecutive parotidectomies performed for benign and malignant disease. Aust N Z J Surg 1993; 63:870.
  35. Schramm, VL Jr, Imola, MJ. Management of nasopharyngeal salivary gland malignancy. Laryngoscope 2001; 111:1533.
  36. Caughey, RJ, May, M, Schaitkin, BM. Intraparotid facial nerve schwannoma: diagnosis and management. Otolaryngol Head Neck Surg 2004; 130:586.
  37. Licitra, L, Grandi, C, Prott, FJ, et al. Major and minor salivary glands tumours. Crit Rev Oncol Hematol 2003; 45:215.
  38. Kotecha, S, Bhatia, P, Rout, PG. Diagnostic ultrasound in the head and neck region. Dent Update 2008; 35:529.
  39. Koischwitz, D, Gritzmann, N. Ultrasound of the neck. Radiol Clin North Am 2000; 38:1029.
  40. Bialek, EJ, Jakubowski, W, Karpinska, G. Role of ultrasonography in diagnosis and differentiation of pleomorphic adenomas: work in progress. Arch Otolaryngol Head Neck Surg 2003; 129:929.
  41. Feld, R, Nazarian, LN, Needleman, L, et al. Clinical impact of sonographically guided biopsy of salivary gland masses and surrounding lymph nodes. Ear Nose Throat J 1999; 78:905.
  42. Lee, YY, Wong, KT, King, AD, Ahuja, AT. Imaging of salivary gland tumours. Eur J Radiol 2008; 66:419.
  43. Hisatomi, M, Asaumi, J, Yanagi, Y, et al. Diagnostic value of dynamic contrast-enhanced MRI in the salivary gland tumors. Oral Oncol 2007; 43:940.
  44. Koyuncu, M, Sesen, T, Akan, H, et al. Comparison of computed tomography and magnetic resonance imaging in the diagnosis of parotid tumors. Otolaryngol Head Neck Surg 2003; 129:726.
  45. Cohen, EG, Patel, SG, Lin, O, et al. Fine-needle aspiration biopsy of salivary gland lesions in a selected patient population. Arch Otolaryngol Head Neck Surg 2004; 130:773.
  46. Zbaren, P, Guelat, D, Loosli, H, Stauffer, E. Parotid tumors: Fine-needle aspiration and/or frozen section. Otolaryngol Head Neck Surg 2008; 139:811.
  47. Howlett, DC, Menezes, LJ, Lewis, K, et al. Sonographically guided core biopsy of a parotid mass. AJR Am J Roentgenol 2007; 188:223.
  48. Wan, YL, Chan, SC, Chen, YL, et al. Ultrasonography-guided core-needle biopsy of parotid gland masses. AJNR Am J Neuroradiol 2004; 25:1608.
  49. Schindler, S, Nayar, R, Dutra, J, Bedrossian, CW. Diagnostic challenges in aspiration cytology of the salivary glands. Semin Diagn Pathol 2001; 18:124.
  50. Burgess, AN, Serpell, JW. Parotidectomy: preoperative investigations and outcomes in a single surgeon practice. ANZ J Surg 2008; 78:791.
  51. Hughes, JH, Volk, EE, Wilbur, DC. Pitfalls in salivary gland fine-needle aspiration cytology: lessons from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Arch Pathol Lab Med 2005; 129:26.
  52. Layfield, LJ. Fine-needle aspiration in the diagnosis of head and neck lesions: a review and discussion of problems in differential diagnosis. Diagn Cytopathol 2007; 35:798.
  53. Maiorano, E, Lo Muzio, L, Favia, G, Piattelli, A. Warthin's tumour: a study of 78 cases with emphasis on bilaterality, multifocality and association with other malignancies. Oral Oncol 2002; 38:35.
  54. Hilton, JM, Phillips, JS, Hellquist, HB, Premachandra, DJ. Multifocal multi-site Warthin tumour. Eur Arch Otorhinolaryngol 2008; 265:1573.
  55. van Tongeren, J, Creytens, DH, Meulemans, EV, et al. Synchronous bilateral epithelial-myoepithelial carcinoma of the parotid gland: case report and review of the literature. Eur Arch Otorhinolaryngol 2009; 266:1495.
  56. Cermik, TF, Mavi, A, Acikgoz, G, et al. FDG PET in detecting primary and recurrent malignant salivary gland tumors. Clin Nucl Med 2007; 32:286.
  57. Otsuka, H, Graham, MM, Kogame, M, Nishitani, H. The impact of FDG-PET in the management of patients with salivary gland malignancy. Ann Nucl Med 2005; 19:691.
  58. Roh, JL, Ryu, CH, Choi, SH, et al. Clinical utility of 18F-FDG PET for patients with salivary gland malignancies. J Nucl Med 2007; 48:240.
  59. King, AD, Yeung, DK, Ahuja, AT, et al. Salivary gland tumors at in vivo proton MR spectroscopy. Radiology 2005; 237:563.
  60. Yabuuchi, H, Matsuo, Y, Kamitani, T, et al. Parotid gland tumors: can addition of diffusion-weighted MR imaging to dynamic contrast-enhanced MR imaging improve diagnostic accuracy in characterization?. Radiology 2008; 249:909.
  61. AJCC (American Joint Committee on Cancer) Cancer Staging Manual, Greene, FL, Page, DL, Fleming, ID, et al (eds), Springer-Verlag, New York 2002. p.70.
  62. Greig, SR, Chaplin, JM, McIvor, NP, et al. Acinic cell carcinoma of the parotid gland: Auckland experience and literature review. ANZ J Surg 2008; 78:754.
  63. Goode, RK, El-Naggar, AK. Mucoepidermoid carcinoma. In: World Heath Organization Classification of Tumors: Pathology and Genetics: Head and Neck Tumors. Barnes, L, Everson, JW, Reichart, P, Sidransky, D. (Eds). WHO Press, Switzerland 2005. p. 219.
  64. Lima, RA, Tavares, MR, Dias, FL, et al. Clinical prognostic factors in malignant parotid gland tumors. Otolaryngol Head Neck Surg 2005; 133:702.
  65. Gomez, DR, Katabi, N, Zhung, J, et al. Clinical and pathologic prognostic features in acinic cell carcinoma of the parotid gland. Cancer 2009; 115:2128.
  66. Terhaard, CH. Salivary glands. In: Principles and Practice of Radiation Oncology, 5th edition, Halperin, EC, Perez, CA, Brady, LW (Ed), Lippincott Williams & Wilkins, Philadelphia 2004. p. 407.
  67. Goode, RK, Auclair, PL, Ellis, GL. Mucoepidermoid carcinoma of the major salivary glands: clinical and histopathologic analysis of 234 cases with evaluation of grading criteria. Cancer 1998; 82:1217.
  68. Spiro, RH, Huvos, AG, Strong, EW. Adenocarcinoma of salivary origin. Clinicopathologic study of 204 patients. Am J Surg 1982; 144:423.
  69. Nascimento, AG, Amaral, AL, Prado, LA, et al. Adenoid cystic carcinoma of salivary glands. A study of 61 cases with clinicopathologic correlation. Cancer 1986; 57:312.
  70. Spiro, RH, Huvos, AG. Stage means more than grade in adenoid cystic carcinoma. Am J Surg 1992; 164:623.
  71. Witt, RL. Adenoid cystic carcinoma of the minor salivary glands. Ear Nose Throat J 1991; 70:218.
white circle LOG IN
white circle DEMO