Treatment

The treatment of salivary gland cancer depends on the size and location of the tumor, whether the cancer has spread, and the person’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. Head and neck cancer specialists often form a multidisciplinary team to care for each person, and an evaluation should be done 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.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove 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 section.

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.

Descriptions of the most common treatment options for salivary gland cancer are listed below.

Surgery

Surgery is performed in nearly all cases of salivary gland cancer, often as 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). The type of surgery depends on the 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, 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, this procedure may find a tumor during a seemingly routine endoscopic surgery for what is believed to be chronic sinusitis.

Neck dissection. A neck dissection (lymph nodes in the neck are removed) 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.

Depending on the location, stage, and the subtype of the cancer, some people may need more than one operation to remove the cancer and to help restore the appearance and function of the tissues affected. Reconstructive (plastic) surgery may be used to replace normal tissues and nerves that have to be removed to eliminate the cancer. Surgery is typically followed by additional treatment, most often radiation therapy. Sometimes, it is not possible to completely remove the cancer during surgery. In these cases, doctors will recommend other treatment options. 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.

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. The implant is left in place for several days while the person stays in the hospital.

A new 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, radiation therapy can be the main treatment for certain types of tumors or if a person cannot have surgery or decides not to have surgery. It is most often used in combination with surgery, given either before or after the operation. It may also be given along with chemotherapy. Proton radiation therapy may be used in instances where a tumor is located close to structures of the central nervous system (brain and spinal cord).

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, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning treatment.

Radiation therapy to the head and neck may cause the following side effects: redness or skin irritation to the treated area; dry mouth (xerostomia) or thickened saliva, from damage to salivary glands; bone pain; nausea; fatigue; mouth sores and/or sore throat; dental problems (usually preventable); painful 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; buildup of earwax, which 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. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. Some people may receive chemotherapy in their doctor's office; others may go to the hospital. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a specific time.

Chemotherapy is seldom used in the initial treatment of salivary gland cancer. Combined treatments of chemotherapy with radiation therapy are used as part of clinical trials to research the effectiveness of the combination. For salivary gland cancer, chemotherapy is most often used in advanced cancer or to treat symptoms. Some chemotherapy drugs are available in clinical trials that may treat cancer at an earlier stage, or hope to cure the cancer.

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 if any may be permanent. In general, chemotherapy may cause the following side effects: 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; open sores in the mouth; this condition coupled with a low immunity can lead to infections.

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.