There are 3 major salivary glands on each side of our face which make saliva which is important for our oral health. Saliva contains enzymes which help in the process of digesting food as well as antibodies to prevent infections of the mouth. It also helps to lubricate our mouth and throat to allows us to swallow dry or hard foods easily and prevent sore or dry throat after talking too much.

The salivary glands are:

  • The parotid gland is the largest salivary gland and is situated just in front of the ear and accounts for around 70% of all salivary cancers
  • The sub-mandibular gland is smaller and is situated just below the jaw.
  • The sublingual gland is the smallest and is situated under the floor of the mouth and below either side of the tongue.

Symptoms & Signs of Salivary Gland Cancer

  • Mass or Swelling at the neck region
  • Difficulty opening mouth or swallowing
  • Change in voice
  • Numbness or weakness in the face
  • Pain on one side of the face

Treatment of Salivary Gland Cancer

Salivary Gland cancer is treated by a team of doctors and healthcare professionals which include the ENT surgeon, Cosmetic & Plastic Surgeon, Speech Therapist and Oncologist. Treatment may involve:

  • Surgery & reconstruction
  • Radiotherapy
  • Chemotherapy
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Oral cancer is when a tumour develops in the lining of the mouth. The tumour can be on the surface of the tongue, the insides of the cheeks, the roof (palate) or floor of the mouth, the gums or the lips. Oral cancers are NOT very common accounting for around only 2-3% of all cancers. They are usually found in older adults over the age of 50 years.

Main Causes of Oral Cancers are:

  • Tobacco smoking
  • Betel nut chewing
  • Ill-fitting dentures
  • Human Papilloma Virus
  • Spicy hot foods
  • Excessive alcohol consumption
  • Unexplained bleeding in the mouth

Symptoms & Signs of oral cancer

  • Ulcer in the mouth which is NOT painful and NOT healing
  • Mass or swelling
  • Neck swelling
  • Unexplained loose tooth which does NOT heal
Treatment of Oral Cancer

Oral cancer is treated by a team of doctors and health professionals which include the ENT surgeon, Dentist, Maxillo-Facial surgeon, Speech Therapist and Oncologist. Treatment may involve:

  • Surgery & reconstruction
  • Radiotherapy
  • Chemotherapy

How to self-examine yourself for Oral Cancer

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VMAT is the latest arc therapy technique which delivers more tightly focused treatment to tumours in a significantly shorter time. Using VMAT, single or multiple radiation beams sweep in uninterrupted arc(s) around the patient. VMAT technique provides the oncologists with greater freedom of choice on how an optimum dose can be delivered to cancer cells.

How VMAT works

Using VMAT, radiation is precise targeted at the intended area allowing oncologists to preserve more of the surrounding healthy normal tissue. VMAT treatment which consists of one or several arcs, enables the radiation to remain on while the linear accelerator movements occur. During VMAT treatment, the shape and intensity of the radiation beams changes as the machine rotates. The radiation beam comes from an infinite number of angles, thereby reducing the dose to the surrounding tissue while increasing the dose to the cancer cells.

As such, with VMAT treatment, the duration of the procedure is shortened and the patient spends less time on the treatment table. The simplest treatment can be completed as fast as 2 minutes while more complex cases may take up to only 5 minutes.

What equipment is used?

A medical linear accelerator is used in delivering VMAT. The machine is about the size of a small car approximately 10 feet in height and 15 feet in length.

Types of Cancers which can be treated with VMAT

Most cancer types can benefit from VMAT treatment. Every case is unique but VMAT treatment is typically used for cancers of the :

  • Prostate
  • Lung
  • Head and lung
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Stereotactic Radiosurgery is a highly precise form of radiation therapy which can be used to treat:

  • Brain tumours
  • Extra cranial lesions (Stereotactic Body Radiotherapy – SBRT)
  • Post-operative treatment to eliminate any residual tumour tissue
  • Abnormal blood vessels (known as AVM)

Despite its name, Stereotactic Radiosurgery does NOT involve any surgery. It is a procedure which allows precisely focused high-dose X-ray beams to be delivered to a small, localised area targeting the tumour.

Goal of Stereotactic Radiosurgery

The goal of radio surgery is to destroy tumour cells without harming surrounding healthy normal tissue.

Advantages of using Stereotactic Radiosurgery

It works the same way as other forms of radiation treatment. It does not remove the tumour but it will damage the DNA inside cells making them unable to divide or reproduce. Abnormal cancer cells are more sensitive to radiation because they divide more quickly than normal cells. After the treatment, benign tumours usually shrink over a period of 18-24 months. In malignant tumours, the shrinkage many occur more rapidly.

Types of Cancers which can be treated with Stereotactic Radiosurgery:

  • Meningioma
  • Astrocytoma
  • Glioblastoma
  • Brain lymphoma
  • Nasopharyngeal carcinoma
  • Liver metastasis
  • Prostate cancer
  • Small cell lung carcinoma
  • Acoustic neuroma
  • Arteriovenous malformation (AVM)

Side effects of Stereotactic Radiosurgery

Like radiation therapy, the general side effects include fatigue, loss of appetite and headache. The side effects vary from person to person depending on the location of the treatment. Some people experience no side effects at all.

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Radiation therapy uses controlled high-energy rays to treat tumours and other diseases of the body. The machine used to deliver this treatment is called a Linear Accelerator. Radiation is given:

  • to destroy cancer tumours and cure the disease
  • to relieve symptoms such as pain or seizures (known as palliative treatment)
  • to prevent tumours from developing or spreading to surrounding organs (known as prophylactic treatment)

How does it work?

Radiation works by damaging the DNA inside cells making them unable to divide or reproduce.  Abnormal cancer cells are more sensitive to radiation because they divide more quickly than normal cells. Over time, the abnormal cells die and the tumour shrinks. Normal surrounding cells can also be damaged by radiation but they can repair themselves more effectively.

Goal of Radiation Therapy

The goal of radiation therapy is to maximise the dose to abnormal cells while minimising the exposure to surrounding normal cells. The effects of radiation are not immediate and the treatment benefit occurs over some time. Radiation therapy is a painless treatment and will not cause the patient to be radioactive.


Step 1. Simulation and Treatment Planning

Before starting radiation therapy treatment, the patients is first required to undergo a simulation procedure. The simulation process is performed using a CT Simulator – CT Scanner machine with highly sophisticated software to localise the treatment area.

Step 2. Treatment Delivery

Radiation treatment is given using a machine called a Linear Accelerator. To receive the treatment, it is important that the patient remains still while lying on a treatment couch. The duration of each treatment session varies between different patients. When you come for your first treatment session, your radiographer will inform you how long each session will last.

Step 3. Treatment Course

A treatment course may consist of a single treatment session or up to five treatments session a week over a seven-week period depending on factors such as the part of body being treated and the aim of treatment. It is very important for patients not to miss their appointments because completing the treatment course within the stipulated time is essential for success.

Side effects

Side effects of radiotherapy treatment vary from patient to patient and will depend on the particular part of the body that is being treated. Once you have completed your treatment, the side effects will start to ease off within two to three weeks depending on the severity of the side effects which include fatigue, loss of appetite and red or itchy skin over area of radiation.

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Cancer cells tend to grow fast and chemotherapy drugs are used to kill fast-growing cells. But because these drugs travel throughout the body, they can also affect the healthy cells in your body that are fast-growing too. The effect to your healthy cells causes side effects. Side effects are not always as bad as you might expect and here is a list of the common side effects and some tips that you can do to reduce the effects.

Loss of appetite, cause and vomiting

It is common for your appetite to change when you are going through chemotherapy but not everyone feels sick (nauseous) after chemotherapy. However, if it does occur, it usually starts a few hours after treatment and can last for many hours. If you are vomiting a lot, keep up with your fluids intake to prevent dehydration. You may be given anti-nausea medication to take home and can be taken on a regular basis. If you continue to vomit more than 24 hours, contact your doctor.

  • Take a light meal before your treatment and drink as much fluid as possible
  • Take small amounts of fluid rather than a large amount at one time
  • Take nutritional supplement drinks or liquid food drinks
  • Take small but frequent meals rather than a large meal at one time
  • Try to avoid foods which may cause stomach upset like spicy foods or food with strong smells
  • Try deep breathing through your mouth when you feel like vomiting

Diarrhoea Diarrhoea occurs in some people and when it occurs, you may:

  • Avoid high fibre diet
  • Keep hydrated by drinking 2-3 litres daily
  • Avoid fried, oily or spicy foods

Constipation Constipation is more common as your appetite may be low.

  • Increase the fibre content in your diet
  • Keep hydrated by drinking 2-3 litres daily
  • Do light exercises such as brisk walking every day 

Mouth sores or ulcers

Some chemotherapy medication can cause mouth sores, ulcers or infections. This is more likely to occur if you have had or having radiation to the head, neck or chest region or if you have had dental or gum disease in the past. Contact your doctor or nurse if you experience any changes in your mouth or throat.

  • See your dentist BEFORE the start of your chemotherapy treatment
  • Use a toothbrush with soft bristles to clean your teeth
  • Take regular sips of fluid such as water and avoid high sugar drinks
  • Take soft foods (such as ice cream, soft fruits or porridge) and avoid hard or fried foods which may hurt your mouth
  • Rinse your mouth with water after every meal
  • Use non-alcohol mouthwash as alcohol may dry or irritate your mouth
  • Avoid spicy or acidic foods which may aggravate mouth sores

Fatigue (feeling tired or lack of energy)

Fatigue is the most common side effect of chemotherapy. It may appear suddenly and rest alone may not relieve it. You will continue to feel tired for weeks or months even after your treatment has ended.

  • Limit your physical and mental daily activity. Help your body recover from the effects of chemotherapy by doing less and resting more
  • Do light exercises such as brisk walking every day
  • If you are not sleeping well, inform your health care team. Avoid taking sleeping medication unless they have been prescribed by your doctors as they may react with your chemotherapy

Thrombocytopenia (low platelet count)

Observe signs and symptoms of thrombocytopenia such as bruises, small red spots under the skin, red or pink urine, black or bloody bowel motions and gum or nose bleeds.

  • Take high-fibre diet such as fruits or vegetables and take adequate fluids (around 2-3 litres daily) to prevent constipation
  • Create a safe environment in your house to prevent falls or injuries
  • Do not use sharp instruments for personal grooming but instead use an electric razor for shaving, toothbrush with soft bristles and mouth gargle
  • Wear soft and close-ended shoes. Do NOT walk bare foot in case of injury
  • If you have blood taken or require injection, apply pressure to the needle site for at least 10 minutes to prevent bruising
  • Consult your cancer doctor or nurse BEFORE proceeding with any invasive or surgical procedures

Febrile Neutropenia

The signs and symptoms of febrile neutropenia include high fever >38 degree Celsius, mouth ulcers or cough.There may be swelling, redness or tenderness at the wound, chemo-port or catheter. See your doctor as soon as possible.

  • Wear a surgical 3-ply face mask when going outside or to the hospital
  • Avoid crowded areas or people who are sick
  • Limit visitors (especially children) to your home
  • Avoid consuming raw foods (such as sushi or half boiled eggs)
  • Maintain strict personal hygiene and avoid getting cuts on your skin
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