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Salivary Gland Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Salivary Gland Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.  

About the salivary glands

The salivary glands are tissues that produce saliva. Saliva is the fluid that is released into the mouth to keep it moist and contains enzymes that begin breaking down food. Saliva also helps prevent infections of the mouth and throat.

There are clusters of salivary glands in several places in the head and neck, including below the tongue, on the sides of the face (in the cheek area) just in front of the ears, in the area of the upper jaw along the inside of the teeth and the soft palate, and under the jawbone. There are also smaller clusters of salivary glands in parts of the tissue that lines the upper digestive tract, known as the mucosa, and the windpipe.

Doctors often refer to three pairs of salivary glands as the major salivary glands:

Parotid glands. These are the largest salivary glands, and they are located on either side of the face in front of the ears.

Submandibular glands. These are found under the jawbone.

Sublingual glands. These are found in the bottom of the mouth under the tongue.

As described above, there are many other smaller areas that contain salivary glands. These are often called the minor salivary glands.

About salivary gland cancer

Cancer begins when normal cells change and grow uncontrollably, forming a mass of tissue called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread.

Both benign and cancerous tumors can begin in any of the major or minor salivary glands. Most tumors (80%) in the parotid gland, and about half of the tumors in the submandibular gland, are benign. Sublingual gland tumors are almost always cancerous. Most cancerous tumors of this type begin in the parotid gland or in the submandibular glands.

There are many subtypes of salivary gland tumors, depending on the type of cell where it started and an evaluation of tumor cells under a microscope. This is explained in more detail in the Stages section.

This section covers primary salivary gland cancer, which is cancer that begins in the salivary glands. Sometimes another type of cancer, most commonly melanoma or another type of skin cancer, can spread to the salivary glands or to the nearby lymph nodes located inside and surrounding the parotid gland and next to the submandibular gland. Lymph nodes are tiny, bean-shaped organs that fight infection.  For more information about cancer that started in another part of the body and then spread to the salivary glands, please see Cancer.Net’s guide for that type of cancer.

Salivary gland cancer is one of the five main types of cancer in the head and neck region, a grouping called head and neck cancer.

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Salivary Gland Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find information about how many people learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

Salivary gland cancer is uncommon in the United States. An estimated one adult out of 100,000 will be diagnosed with salivary gland cancer this year. Survival rates for people with this type of tumor vary depending on the type and the stage (extent) of the cancer. The five-year survival rate is the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases. The five-year survival rate of people with salivary gland cancer that has not spread at the time of diagnosis is 91%. If the cancer has spread to the surrounding lymph nodes (local spread) the five-year relative survival rate is 75%. If the cancer has spread to parts of the body far away from the salivary gland (distant spread), the five-year relative survival rate is 39%.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with salivary gland cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society.

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Salivary Gland Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find a basic drawing illustrating the location of the major salivary glands. To see other pages, use the menu on the side of your screen.

Salivary Gland Cancer

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For medical illustrations showing the different stages of salivary gland cancer, please visit the Stages section.

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Salivary Gland Cancer - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The cause(s) of most salivary gland cancers are unknown, but the following factors may raise a person’s risk of developing salivary gland cancer:

Age. Two out of every three salivary gland cancers are found in people 55 and older, with an average age of 64.

Radiation exposure. Radiation to the head or neck for another medical reason may increase the risk of developing salivary gland cancer.

Radioactive substance exposure. In some reports, exposure to certain radioactive substances has been linked to an increased risk of salivary gland cancer. In other reports, there is not enough evidence to support this. Talk with your doctor for more information.

Environmental/occupational exposure. Exposure to sawdust and chemicals used in the leather industry, pesticides, and some industrial solvents may increase the risk of a type of salivary gland cancer that occurs in the nose and sinuses.

Other possible risk factors that doctors are investigating but have not proven include exposure to certain metals (nickel alloy dust) or minerals (silica dust), a diet low in vegetables and high in animal fats, and exposure to hair dye or hairspray.

Research continues to look into what factors cause this type of cancer and what people can do to lower their personal risk. Currently there are no known ways to prevent salivary gland cancer. Talk with your doctor if you have concerns about your personal risk of developing this type of cancer.

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Salivary Gland Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with salivary gland cancer may experience the following symptoms or signs. Sometimes, people with salivary gland cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

  • A lump on the face, neck, or mouth that is usually painless
  • Numbness in the face
  • Inability to move some facial muscles, especially if the muscle on one side of the face stops moving and the area affected slowly expands. This is known as progressive facial muscle paralysis.
  • Pain or swelling in the face, chin, jawbone area, or neck
  • A difference between the size and/or shape of the left and right sides of the face or neck

If you are concerned about one or more of the symptoms or signs on this list, talk with a doctor and/or dentist right away, especially if they are persistent or get worse. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis. When detected early, cancer of the head and neck have a much better chance of cure.

Because many of the symptoms listed above can also be caused by other noncancerous health conditions, it is always important to receive regular health and dental screenings, especially for those who routinely drink alcohol or use tobacco products or have used them in the past. In fact, people who use alcohol and tobacco should receive a general screening examination at least once a year. This is a simple, quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination using one or more of the diagnostic procedures mentioned under the Diagnosis section.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.

Salivary Gland Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

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

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. For a salivary gland tumor, a fine needle aspiration biopsy (see below) is the preferred method of examination in making a diagnosis. A surgical (incisional) biopsy should be avoided in almost every case with rare exceptions. Imaging tests may be used to find out whether the cancer has spread.

This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Results of previous tests

A medical history and physical examination should be done carefully, and the doctor will ask about potential risk factors. A thorough examination of the skin by a doctor is particularly important if the patient has 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.

In addition to a physical examination, the following tests may be used to diagnose salivary gland cancer:

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. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

Fine needle aspiration (cytology). In this type of biopsy, cells are withdrawn using a thin needle inserted directly into the tumor. Then the cells are examined under a microscope for signs of cancer. A cytologist with expertise in salivary gland cancer should do the examination.

Endoscopy. This test 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.

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

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. 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 patient’s vein or given as a pill 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. MRI can also 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 patient’s vein or given as a pill to swallow.

Positron emission tomography (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 the patient’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.

Panorex. This is a rotating, or panoramic, x-ray of the upper and lower jawbones to detect cancer or evaluate teeth before cancer treatment.

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

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 describe the cancer; this is called staging.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages and Grades, or you can select another section, to continue reading this guide.

Salivary Gland Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until the doctor performs a biopsy. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for salivary gland cancer:

Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: Indicates the primary tumor cannot be evaluated.

T0: No evidence of a tumor is found.

T1: Describes a small, noninvasive (has not spread) tumor that is 2 centimeters (cm) at its greatest dimension.

T2: Describes a larger, noninvasive tumor between 2 cm to 4 cm.

T3: Describes a tumor that is larger than 4 cm, but not larger than 6 cm, that has spread beyond the salivary glands but does not affect the seventh nerve, the facial nerve that controls expression, such as smiles or frowns.

T4a: The tumor invades the skin, jawbone, ear canal, and/or facial nerve.

T4b: The tumor invades the skull base and/or the nearby bones and/or encases the arteries.

Node. The “N” in the TNM staging system is for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the head and neck are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. There are many nodes located in the head and neck area, and careful evaluation of lymph nodes is an important part of staging cancer of the major salivary glands.

NX: Indicates the regional lymph nodes cannot be evaluated.

N0: There is no evidence of cancer in the regional nodes.

N1: Indicates that cancer has spread to a single node on the same side as the primary tumor, and the cancer found in the node is 3 cm or smaller.

N2: Describes any of these conditions:

N2a: Cancer has spread to a single lymph node on the same side as the primary tumor and is larger than 3 cm, but not larger than 6 cm.

N2b: Cancer has spread to more than one lymph node on the same side as the primary tumor, and none measure larger than 6 cm.

N2c: Cancer has spread to more than one lymph node on either side of the body, and none measure larger than 6 cm.

N3: Cancer found in lymph nodes is larger than 6 cm.

Distant metastasis. The "M" in the TNM system describes cancer that has spread to other parts of the body.

MX: Indicates distant metastasis cannot be evaluated.

M0: Indicates the cancer has not spread to other parts of the body.

M1: Describes cancer that has spread to other parts of the body.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage I: Describes noninvasive tumors (T1, T2), with no spread to lymph nodes (N0) and no distant metastasis (M0).

Salivary Gland Cancer Stage I

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Stage II: Describes an invasive tumor (T3), with no spread to lymph nodes (N0) or distant metastasis (M0).

Salivary Gland Cancer Stage II

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Stage III: Describes smaller tumors (T1, T2) that have spread to regional lymph nodes (N1), but have no sign of metastasis (M0).

Salivary Gland Cancer Stage III

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Stage IVA: Describes any invasive tumor (T4a), with either no lymph node involvement (N0) or spread to only a single same-sided lymph node (N1), but no metastasis (M0). It is also used for a T3 tumor with one-sided nodal involvement (N1), but no metastasis (M0), or any tumor (any T) with extensive nodal involvement (N2).

Salivary Gland Cancer Stage IVA

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Stage IVB: Describes any cancer (any T), with more extensive spread to lymph nodes (N2, N3), but no metastasis (M0).

Salivary Gland Cancer Stage IVB

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Stage IVC: Describes any cancer with distant metastasis (any T, any N, and M1).

Salivary Gland Cancer Stage IVC

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Recurrent: Recurrent cancer is cancer that has come back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Grades and Subtypes

In addition to the stage of the cancer, doctors will classify the subtype of salivary gland tumor using a histologic evaluation. By looking at how tumor cells look under a microscope, doctors can also assign a grade to the cancer. To do this, the doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade can help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

There are many subtypes of salivary gland cancer, and your doctor can provide more information regarding your specific diagnosis:

Benign tumor subtypes

Pleomorphic adenoma (benign mixed tumor)

Papillary cystadenoma-lymphomatosum (Warthin’s tumor)

Oncocytoma

Monomorphic adenoma (including basal cell adenoma, glycogen-rich adenoma, and clear cell adenoma, among others)

Sebaceous adenoma

Sebaceous lymphadenoma

Papillary ductal adenoma

Benign lymphoepithelial lesion

Cancerous tumor subtypes

Carcinoma ex-pleomorphic adenoma

Mucoepidermoid carcinoma (including high grade, intermediate grade, and low grade)

Hybrid basal cell carcinoma-adenoid cystic carcinoma

Adenoid cystic carcinoma

Acinic cell carcinoma

Adenocarcinoma

Polymorphous low-grade adenocarcinoma

Oncocytic carcinoma (malignant oncocytoma)

Clear cell carcinoma

Epithelial-myoepithelial carcinoma of intercalated ducts

Squamous cell carcinoma

Undifferentiated carcinoma

Metastatic carcinoma

Source: Tumors of the Head and Neck, Clinical and Pathological Considerations 2nd Edition, John G. Batsakis, MD, Copyright 1979, published by The Williams & Wilkins Company.

Information about the cancer’s stage and grade will help the doctor recommend a treatment plan. The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

Salivary Gland Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials and Latest Research sections.

Treatment overview

Cancer of the salivary gland can often be cured, especially if found early. Although curing the cancer is the primary goal of treatment, preserving the function of the nearby nerves, organs, and tissues is also very important. When doctors plan treatment, they consider how treatment might affect a person’s quality of life, including how a person feels, looks, talks, eats, and breathes.

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. An evaluation should be done by each head and neck specialist before any treatment begins. The team may include medical, surgical, and radiation oncologists; otolaryngologists (ear, nose, and throat doctors); maxillofacial prosthodontists (specialists who perform restorative surgery in the head and neck areas); dentists; physical therapists; speech pathologists; psychiatrists; nurses; dietitians; and social workers.

Descriptions of the most common treatment options for salivary gland cancer are listed below. Treatment options and recommendations depend on several factors, including the type, stage, and location of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is performed in nearly all cases of salivary gland cancer and is usually the first treatment. During surgery, a doctor performs an operation to remove the cancerous tumor and some of the healthy tissue around it, called a margin. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The goal of surgery is to remove as much of the tumor as possible and leave negative margins. This means no trace of cancer was found in the healthy tissue surrounding the tumor that was removed.

Surgery is typically followed by additional treatment, most often radiation therapy. Sometimes, some people may need more than one operation to remove the cancer and to help restore the appearance and function of the tissues affected.

The type of surgery depends on the location and extent of the tumor.

Parotidectomy. The removal of the parotid gland is called a parotidectomy. This surgery may involve the facial nerve. If cancer has spread to the facial nerve, frequently a nerve graft is necessary for the person to regain use of some facial muscles. Any tissue that is removed can often be restored by reconstructive surgery and tissue transplantation. 

Endoscopic surgery. Occasionally, it is possible to remove the tumor by endoscopic surgery (see Endoscopy, under Diagnosis), which is less destructive to healthy tissues than conventional surgery. This is used particularly when a salivary gland tumor begins in the paranasal area (around the nose) or in the larynx. However, this is rare. More often, a tumor may be found unexpectedly during endoscopic surgery for what is believed to be chronic sinusitis (inflammation).

Neck dissection. A neck dissection is when the surgeon removes lymph nodes in the neck. This may be performed if the doctor suspects that the cancer has spread. A neck dissection may cause numbness of the ear, weakness when raising the arm above the head, and weakness of the lower lip. These side effects are caused by injury to nerves in the area. Depending on the type of neck dissection, weakness of the lower lip and arm may go away in a few months. Weakness will be permanent if a nerve is removed as part of the dissection.

Reconstructive surgery. Reconstructive (plastic) surgery may be used to replace normal tissues and nerves that have to be removed to eliminate the cancer.

Learn more about cancer surgery. Surgery can have significant risks, because the cancer may be close to the eyes, mouth, brain, and important nerves and blood vessels in the area. Surgical side effects can include swelling of the face, mouth, and throat, making it difficult to breathe and swallow. Frequently, a person may receive a temporary tracheostomy (hole in the windpipe) to make breathing easier. Also, facial nerves may also be affected, either temporarily or permanently. Facial disfigurement may need to be addressed using reconstructive plastic surgery. If the maxilla (upper jaw) is removed, a prosthodontist, which is a dentist who specializes in replacing teeth and parts of the jaw, will play a large role in the rehabilitation process. Learn more about cancer rehabilitation.

Occasionally, it is not possible to remove salivary gland cancer using surgery. This type of tumor is called inoperable. In these cases, doctors will recommend other treatment options (see below).

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A specific method of external radiation therapy, known as intensity modulated radiation therapy (IMRT), allows for more effective doses of radiation therapy to be delivered while reducing the damage to nearby healthy cells and causing fewer side effects.

When radiation is given using implants, it is called internal radiation therapy or brachytherapy. Internal radiation therapy involves tiny pellets or rods containing radioactive materials that are surgically implanted in or near the cancer site. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

For a salivary gland tumor, radiation therapy is most often used in combination with surgery, given either before or after the operation. It may also be given along with chemotherapy (see below). Radiation therapy can also be the main treatment for certain types of tumors or if a person cannot have surgery or decides not to have surgery.

Proton therapy may be used in instances when a tumor is located close to structures of the central nervous system, such as the brain and spinal cord. Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells.

Before beginning radiation treatment for salivary gland cancer, a person should receive a thorough examination from an oncologic dentist, a dentist experienced in treating people with head and neck cancer, since radiation therapy can cause tooth decay. Often, tooth decay can be prevented with proper treatment from a dentist before beginning treatment. Learn more about dental and oral health.

Side effects from radiation therapy to the head and neck may include redness or skin irritation in the treated area, dry mouth (xerostomia) or thickened saliva from damage to salivary glands, bone pain, nausea, fatigue mouth sores, and/or sore throat. There may be dental problems, as noted above. Other side effects may include pain or difficulty swallowing; loss of appetite, often due to a change in sense of taste; hearing loss, due to the buildup of fluid in the middle ear; and buildup of earwax that dries out because of the radiation therapy’s effect on the ear canal. Radiation therapy may also cause a condition called hypothyroidism in which the thyroid gland (located in the neck) slows down and causes the person to feel tired and sluggish. People who receive radiation therapy to the neck area should have their thyroid checked regularly. Talk with your health care team about what side effects of your treatment plan are possible, and how they can be prevented or relieved.

Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or a combination of different drugs at the same time.

Chemotherapy is seldom used in the initial treatment of salivary gland cancer. Combining chemotherapy with radiation therapy is being studied as part of clinical trials to determine its effectiveness. For salivary gland cancer, chemotherapy is most often used in later stage cancer or to relieve symptoms. Some chemotherapy drugs are available in clinical trials that may treat cancer at an earlier stage.

Each drug or combination of drugs can cause specific side effects, and it is important to talk with your doctor about which side effects to expect and whether any may be permanent. In general, chemotherapy side effects can include fatigue; nausea; vomiting; hair loss; dry mouth; loss of appetite, often due to a change in sense of taste; weakened immune system; diarrhea and/or constipation; and open sores in the mouth. Open sores in the mouth, coupled with a low immunity, can lead to infections. Your health care team can help manage or relieve treatment side effects.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person at any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.   

Metastatic salivary gland cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes one or more of the treatments listed above. Typically, the main treatment is chemotherapy or taking part in a clinical trial for investigational drugs. Supportive care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage and grade has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above, such as surgery, radiation therapy, and chemotherapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.

Salivary Gland Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with salivary gland cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding these studies are the only way to make progress in treating salivary gland cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with salivary gland cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for salivary gland cancer, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.

Salivary Gland Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about salivary gland cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Combining therapies. There is ongoing research evaluating the benefit of different treatment approaches, especially the use of concomitant treatment, which combines more than one treatment.

Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to improve, target, or restore immune system function. Learn more about immunotherapy.

Virus research. Researchers are investigating the role of a common virus called cytomegalovirus in the development of salivary gland cancer and how that link could be used to find new treatments.

Tumor genetics. Early laboratory research indicates that genetic changes in a salivary gland tumor, particularly those related to the tumor suppressor genes APC and PTEN, may be helpful in providing new targets for treatments. Learn more about targeted therapy.

Radiosensitizers. Researchers are investigating the use of radiosensitizers in the treatment of salivary gland cancer. Radiosensitizers are drugs that make tumor cells more susceptible to radiation therapy, making radiation therapy more effective.

Supportive care. Clinical trials are underway to find better ways to reduce or treat the side effects of cancer therapy, to improve patients’ quality of life.

Salivary gland cancer requires additional scientific understanding regarding the genetic events that affect this type of cancer. As scientists make advances in the basic fundamental knowledge of genetics and how these cancers develop, new therapies based upon those findings will develop.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding salivary gland cancer, explore these related items that take you outside of this guide:

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.

Salivary Gland Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for salivary gland cancer are described in detail in the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve then. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with salivary gland cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of cancer care.

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Salivary Gland Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for salivary gland cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years.

Most recurrences happen within the first two or three years after diagnosis, so follow-up visits will be more frequent during the first two years. Diagnostic examinations, including CT scans, may be done to watch for potential recurrences or to monitor how well treatment is working. People with a history of salivary gland cancer need to be monitored throughout their lifetime for the possibility of recurrence or distant metastasis. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

Follow-up visits will also help manage any late or long-term side effects from cancer treatment, such as buildup of earwax. Periodic ear examinations are necessary to remove buildup of dried earwax. Prevention of dental cavities is also important. Fluoride application is recommended whenever radiation therapy is directed at the oral cavity (mouth) and the salivary glands.

Rehabilitation is a major part of follow-up care after head and neck cancer treatment. People may need physical therapy and speech therapy to regain skills, such as talking and swallowing. Supportive care to manage symptoms and maintain nutrition during and after treatment may be recommended. Some people may need to learn new ways to eat or to have foods prepared differently. Special care of the eye is necessary if there is nerve function loss. Special procedures, such as moving a paralyzed vocal cord to improve voice, may be necessary after a large skull base tumor has been removed. Exposure to direct sunlight on affected skin should be avoided if radiation therapy has been used as part of the treatment.

People may look different, feel tired, and be unable to talk or eat the way they used to. Many people experience depression. The health care team can help people cope and connect them with support services.

People recovering from salivary gland cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, limiting alcohol, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.

Salivary Gland Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What type of salivary gland cancer do I have? What does this mean?
  • Where exactly is it located?
  • Can you explain my pathology report (laboratory test results) to me?
  • What stage is the cancer? What does this mean?
  • What is the grade of the cancer? What is its likely behavior?
  • What are my treatment options?
  • What clinical trials are open to me? Where are they located, and how do I find out more about them?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • Should I get a second opinion?
  • Can the tumor be completely removed by surgery? Do you recommend additional treatment, such as radiation therapy?
  • What are the possible side effects of each treatment, both in the short term and the long term?
  • Will it be necessary to remove part or all of the facial nerve? If so, can this nerve be reconstructed or can some of the function be recovered?
  • If surgery is needed, will it be necessary to have reconstruction to replace lost tissue (mandible)?
  • If surgery is needed, will there be a need for a neck dissection (removing lymph nodes)? If so, what type of dissection will be done? What does this mean?
  • Who will be part of my health care team, and what does each member do?
  • When should I talk with a dentist? Can you recommend an oncologic dentist?
  • Should I talk with other specialists, such as a speech pathologist, before treatment begins?
  • Who will be coordinating my overall treatment and follow-up care?
  • How will this treatment affect my daily life? Will I be able to work, exercise, or perform my usual activities?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • What follow-up tests will I need, and how often will I need them?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.

Salivary Gland Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Salivary Gland Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

This is the end of the Cancer.Net’s Guide to Salivary Gland Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.