Submandibular Tumors: To Remove or Not to Remove? - Oncology

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When considering the management of a submandibular tumor, particularly one that has been present for a significant duration and has grown to a size of 2 cm in diameter and 4 cm in length, it is essential to weigh the potential benefits of surgical removal against the risks associated with the procedure and the possibility of leaving the tumor in place.


(1) Should the Tumor be Removed?
In general, the decision to remove a tumor depends on several factors, including its size, growth rate, imaging characteristics, and the results of fine needle aspiration (FNA) biopsy. Since your tumor has been evaluated by two large hospitals and has not shown any malignant cells on cytological examination, this is a positive indicator. However, the fact that it has grown to a considerable size raises concerns.
While benign tumors can remain stable for years, there is always a risk that they could undergo changes that might lead to malignancy, especially if they are symptomatic or causing discomfort. Additionally, larger tumors can sometimes lead to complications such as infection, pain, or pressure effects on surrounding structures, including nerves and blood vessels.

If the tumor is indeed benign and asymptomatic, some physicians may recommend a "watchful waiting" approach, where the tumor is monitored over time with regular follow-ups and imaging studies. However, if there is any doubt about the tumor's nature or if it is causing symptoms, surgical removal is often recommended.

(2) Potential Adverse Effects of Removal
Surgical removal of a submandibular tumor can have several potential complications, which include:
- Nerve Injury: The submandibular region contains important nerves, including the facial nerve and the hypoglossal nerve. Injury to these nerves during surgery can lead to weakness or paralysis of the muscles of facial expression or tongue movement, respectively.

- Bleeding and Hematoma Formation: As with any surgical procedure, there is a risk of bleeding during or after the surgery, which may require further intervention.

- Infection: Post-operative infections can occur, particularly if the surgical site is not properly cared for or if there are underlying health issues that predispose to infection.

- Scarring: Surgical removal will leave a scar, which may be a cosmetic concern for some patients.

- Salivary Gland Dysfunction: If the tumor is located near the submandibular gland, there may be a risk of affecting salivary function, leading to dry mouth or other salivary gland issues.


Conclusion
In summary, while the absence of malignant cells is reassuring, the size and growth of the tumor warrant careful consideration. Surgical removal is often the best course of action to prevent potential complications and to provide a definitive diagnosis. It is crucial to discuss all these factors with your healthcare provider, who can provide personalized recommendations based on the specifics of your case, including the tumor's characteristics and your overall health. Regular follow-up and monitoring are essential, regardless of the decision made.