Exploring Alternatives to Surgery for Suspected Salivary Gland Tumors

20% suspected salivary gland cancer (tumor)

Hello, doctor.
My father has been experiencing abnormalities in his left cheek, and after three years of monitoring, this year the doctor cultured cells and believes there is a 20% chance of salivary gland cancer.
He recommends surgical removal.
We suggested that my father seek a second opinion at another hospital, but he feels more comfortable following the original doctor's advice to proceed with the surgery.
However, my father has hypertension, which increases the risk of stroke during anesthesia, and there is also a 3-5% risk of nerve paralysis.
Are there any alternatives to surgical removal? Additionally, how can the 20% probability be confirmed? Do you have any recommended doctors in Taichung? Thank you very much for your assistance.

Ben, 30~39 year old female. Ask Date: 2012/08/06

Dr. Chen Sirong reply Oncology

Ben/35/01.
Are there any other methods besides surgical removal? Benign tumors do not necessarily need to be excised, but many benign tumors are removed, while malignant tumors must be excised.
There is no method that can guarantee 100% certainty that a tumor is benign, so if your goal is certainty, then there are no other options.
2.
How can we confirm a 20% possibility? Besides removal, there is no method that can guarantee 100% certainty that it is benign.
3.
Do you have any recommended doctors (in Taichung)? Thank you very much for your assistance.
I don't personally know any doctors, so I suggest you look for one yourself.
4.
My advice is to respect your father's opinion; otherwise, he will continue to worry and won't be happy.
The risks of surgery will be assessed jointly by the anesthesiology and surgical teams, so you don't need to worry too much.
Thank you for your message.
Chen Si-Rong.

Reply Date: 2012/08/06

More Info

When dealing with suspected salivary gland tumors, particularly in the case of your father, it is crucial to weigh the risks and benefits of surgical intervention against alternative approaches. Salivary gland tumors can be benign or malignant, and the decision to proceed with surgery often hinges on the tumor's characteristics, the patient's overall health, and the potential risks involved.

Alternatives to Surgery
1. Observation and Monitoring: If the tumor is small and asymptomatic, a "watchful waiting" approach may be appropriate. This involves regular imaging studies and clinical evaluations to monitor any changes in the tumor's size or characteristics. This approach is often used for benign tumors or when the risk of surgery outweighs the benefits.

2. Fine Needle Aspiration (FNA) Biopsy: This minimally invasive procedure can help determine the nature of the tumor. By extracting cells from the tumor, pathologists can assess whether it is benign or malignant. This can provide more information before making a decision about surgery.

3. Radiation Therapy: In cases where surgery is not feasible due to health risks or the tumor's location, radiation therapy may be considered. This can be particularly effective for certain types of malignant tumors and can help shrink the tumor or control its growth.

4. Chemotherapy: For malignant tumors, especially those that are aggressive or have metastasized, chemotherapy may be an option. This is typically more common for tumors that are not amenable to surgical resection.

5. Targeted Therapy: Depending on the tumor's specific characteristics, targeted therapies may be available. These treatments focus on specific pathways or mutations associated with cancer cells.

Assessing the 20% Probability
The 20% probability of malignancy mentioned by your father's doctor likely stems from a combination of clinical findings, imaging studies, and cytological analysis. Factors that contribute to this assessment include:
- Imaging Characteristics: Certain features on imaging studies (like ultrasound or MRI) can suggest malignancy, such as irregular borders, increased vascularity, or rapid growth.

- Cytological Findings: If a fine needle aspiration was performed, the cytology report can provide insights into the likelihood of malignancy based on the cellular characteristics observed.

- Patient History and Symptoms: Symptoms such as pain, swelling, or changes in sensation can also influence the perceived risk of malignancy.

Recommendations
Given your father's health conditions, including hypertension, it is essential to have a thorough discussion with his healthcare provider about the risks associated with surgery. If surgery is deemed necessary, the surgical team can take precautions to minimize risks, such as optimizing blood pressure control before the procedure.

If you are considering a second opinion, it is advisable to seek out an otolaryngologist or a head and neck surgeon who specializes in salivary gland tumors. They can provide a comprehensive evaluation and discuss all available options, including non-surgical approaches.

Conclusion
In summary, while surgery is often the standard treatment for suspected malignant salivary gland tumors, there are alternatives worth considering, especially in light of your father's health concerns. A multidisciplinary approach involving oncologists, surgeons, and radiologists can help ensure that the best course of action is taken. It is crucial to have open discussions with healthcare providers to make informed decisions that prioritize your father's health and well-being.

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