Salivary Gland Cancer: Diagnosis

Approved by the Cancer.Net Editorial Board, 05/2020

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

For a salivary gland tumor, a needle biopsy (see below) is the preferred test for making a diagnosis. A surgical (incisional) biopsy should be avoided in almost every case, except in rare exceptions. Imaging tests may be used to find out whether the cancer has spread.

This section describes options for diagnosing salivary gland cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

Tests and procedures (updated 04/2021)

To diagnose salivary gland cancer, the doctor will ask about your medical history and potential risk factors. Then they will do a careful physical examination. A thorough examination of the skin is particularly important if you have ever had a skin tumor. If there is facial nerve paralysis, specific tests will be necessary, and an examination of the oral cavity (mouth), hypopharynx (lower throat), and larynx (voice box) will also be done.

There are no specific blood or urine tests that can detect a salivary gland tumor because there are no known tumor markers for salivary gland cancer at this time. Tumor markers are substances found in higher-than-normal amounts in the blood, urine, or body tissues of people with certain kinds of cancer.

In addition to a physical examination, the following tests may be used to diagnose salivary gland cancer or be done as part of treatment planning:

  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The pathologist will also look at the tissue and may perform lab tests on the sample to learn more about it. The results will be part of the pathology report.

  • Ultrasound-guided needle biopsy. During this type of biopsy, the doctor uses the images produced by an ultrasound to guide a needle into the tumor. The doctor may perform a fine needle aspiration biopsy or a core needle biopsy depending on the location of the tumor. A fine needle aspiration biopsy uses a thin, hollow needle attached to a syringe to collect a small amount of tissue from the tumor to examine and test. A core needle biopsy is similar to a fine needle aspiration biopsy, but it uses a larger needle to remove a larger amount of tissue.

  • Endoscopy. An endoscopy allows the doctor to see inside the body with a thin, lighted, flexible tube called an endoscope. The person may be sedated while the tube is inserted through the mouth, down the esophagus, and into the stomach and small bowel. The examination has different names depending on the area of the body that is examined, such as laryngoscopy (larynx), pharyngoscopy (pharynx), or a nasopharyngoscopy (nasopharynx). Sedation is giving medication to become more relaxed, calm, or sleepy.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, cross-sectional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size or to see if a tumor involves nearby bone. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a person's vein or given as a liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body, especially images of soft tissue, such as the tonsils and base of the tongue, as well as images of the neck and base of the skull. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a person's vein or given as a pill or liquid to swallow.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into a person's body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body

  • Panoramic radiograph. Also called a Panorex, this is a rotating, or panoramic, x-ray of the upper and lower jawbones to find cancer or evaluate teeth before cancer treatment. This x-ray is not generally used to evaluate salivary gland tumors because it mostly evaluates only bone and teeth structures.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor figure out the tumor’s subtype.

This information is based on the ISOO/MASCC/ASCO guideline, “Management of Salivary Gland Malignancy.” Please note that this link takes you to another ASCO website.

The next section in this guide is Subtypes. It lists the types of salivary gland tumors that may be diagnosed. Use the menu to choose a different section to read in this guide.