Salivary Gland CancerLast Updated: February 07, 2012 This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/11 Overview
About the salivary glands The body’s 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 upper digestive tract mucosa (tissue lining) and the windpipe. Doctors often refer to three pairs of salivary glands as the major salivary glands:
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 benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). A tumor (benign or cancerous) 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 covered in more detail in Staging. This rest of 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 skin cancer) can spread to the salivary glands or the nearby lymph nodes (tiny, bean-shaped organs that fight infection) located inside and surrounding the parotid gland and next to the submandibular gland. 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. Find out more about basic cancer terms used in this section. Statistics
Salivary gland cancer is uncommon in the United States. An estimated two adults 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 (percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) of people with 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. Medical Illustrations
Risk Factors
A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors can 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 risk factors may include: 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 other medical reasons may increase the risk of salivary gland cancer. Radioactive substance exposure. In some reports, exposure to certain radioactive substances has been linked to an increased risk 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. There is no known way to prevent salivary gland cancer. Symptoms and Signs
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. If you are concerned about a symptom or sign on this list, please talk with your doctor.
People who notice any of these symptoms or signs should talk with a doctor and/or dentist right away, especially if they are persistent or get worse. When detected early, cancers of the head and neck have a much better chance of cure. Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often. Because many of these symptoms 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 and side effects 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. Diagnosis
Doctors use many tests to diagnose cancer and find out if it has metastasized. 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 metastasized. Your doctor may consider these factors when choosing a diagnostic test:
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 (voicebox) 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 from the biopsy is analyzed by a pathologist (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. The cells are examined under a microscope for signs of cancer. A cytologist with expertise in salivary gland cancer should conduct 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). 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. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. 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. A contrast medium may be injected into a patient’s vein to create a clearer picture. 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 substance is injected into a patient’s body. This substance is absorbed mainly by organs and tissues 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 to evaluate teeth before cancer treatment. There are no specific blood or urine tests that can detect a salivary gland tumor, and there are no 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 known at this time. Learn more about what to expect when having common tests, procedures, and scans. After these 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. Learn more about the first steps to take after a diagnosis of cancer. Staging With Illustrations
Staging is a way of describing cancer, such as where it is located, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine 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 (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. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. 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. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of 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). Stage II: Describes an invasive tumor (T3), with no spread to lymph nodes (N0) or distant metastasis (M0). Stage III: Describes smaller tumors (T1, T2) that have spread to regional lymph nodes (N1), but have no sign of metastasis (M0). 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). Stage IVB: Describes any cancer (any T), with more extensive spread to lymph nodes (N2, N3), but no metastasis (M0). Stage IVC: Describes any cancer with distant metastasis (any T, any N, and M1). Recurrent: Recurrent cancer is cancer that comes back after treatment. If there is a recurrence, the cancer may need to be staged again (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. Grading and Subtypes In addition to the stage of the cancer, doctors will classify the subtype of salivary gland tumor using a histologic evaluation (how cells look under a microscope). Doctors may grade the cancer, which describes how much the tumor tissue appears like normal tissue under a microscope. The grade of a cancer can help predict how quickly it may grow. In general, the lower the 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. Treatment
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 treatment to evaluate whether it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials and Current 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. 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 (no trace of cancer in the healthy tissue). 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 normal 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. 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, prosthodontists 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 kill 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. 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. 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. For salivary gland tumors, it is most often used in combination with surgery, given either before or after the operation. It may also be given along with chemotherapy. 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 (also called proton beam therapy) may be used in instances when a tumor is located close to structures of the central nervous system (brain and spinal cord). It is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Learn more about proton therapy. 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 health during treatment. 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. Learn more about radiation therapy. Chemotherapy Chemotherapy is the use of drugs to kill 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. 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. Combined treatments of chemotherapy with radiation therapy are being studies as part of clinical trials to research the combination’s effectiveness. For salivary gland cancer, chemotherapy is most often used in later stage cancer or to treat symptoms to improve a patient’s quality of life. 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. 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. Recurrent salivary gland cancer Once your treatment is complete and there is a remission (absence of cancer symptoms; also called “no evidence of disease” or NED), talk with your doctor about the possibility of the cancer returning. Many survivors feel worried or anxious that the cancer will come back. Learn more about coping with this fear. 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. 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 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. 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. In addition to treatment to slow, stop, or eliminate the cancer (also called disease-directed treatment), an important part of cancer care is relieving a person’s symptoms and side effects. It includes supporting the patient with his or her physical, emotional, and social needs, an approach called palliative or supportive care. Palliative care may include surgery and radiation therapy to relieve side effects. People often receive disease-directed therapy and treatment to ease symptoms at the same time. If disease-directed treatment is not successful, this may also be called advanced 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. Learn more about advanced cancer care planning. About Clinical Trials
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 people, 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. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find clinical trials. For specific topics being studied for salivary gland cancer, learn more in the Current 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. 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 trials ends, and/or if the patient chooses to leave the clinical trial before it ends. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, lymphedema, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and your overall health. Common side effects for each treatment option are described in detail within the Treatment section. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health care team. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. Care of a patient’s symptoms and side effects is an important part of a person’s overall treatment plan; this is called palliative or supportive care. It helps people with cancer at any stage of illness be as comfortable as possible. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Be sure to talk with your doctor 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 psychosocial (emotional and social) effects as well. For many patients, a diagnosis of salivary gland cancer is stressful and can bring difficult emotions. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care. A side effect that occurs months or years after treatment is called a late effect. Treatment of late effects is an important part of survivorship care. Learn more about late effects or long-term side effects by reading the After Treatment section or talking with your doctor. After Treatment
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 in the first two or three years after diagnosis, so follow-up visits will be more frequent in the first two years. Diagnostic examinations, including CT scans, may be done to watch for any 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 the oral cavity (mouth) and the salivary glands receive radiation treatment. 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 (moving a paralyzed vocal cord to improve voice, for example) may be necessary after removal of a large skull base tumor. Exposure to direct sunlight on affected skin is to 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, 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. Find out more about common terms used after cancer treatment is complete. Current Research
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 the different treatment approaches, especially the use of concomitant treatment (combining 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 bolster, 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 regarding 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 these findings will develop. To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now. Learn more about common statistical terms used in cancer research. Questions to Ask the Doctor
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.
Patient Information Resources
In addition to Cancer.Net, there are other sources of information about this type of cancer available online. Cancer.Net maintains a list of national, not-for-profit organizations that may be helpful in finding additional information, services, and support. As always, be sure to talk with your doctor about questions you may have about information you find about this disease. View organizations that offer information on this specific type of cancer. |
