Salivary Gland Cancer: Facts about Staging and Symptoms

Salivary gland cancer facts

*Salivary gland cancer facts medically edited by Charles Patrick Davis, MD, PhD

Salivary gland cancer is a type of head and neck cancer that involves abnormal (malignant) growth of salivary gland cells.
Factors that increase the risk of salivary gland cancer include older age, radiation therapy to the head and neck, or exposure to cancer-causing chemicals at work.
Symptoms and signs of salivary gland cancer include painless lump(s) in the area of the ear, cheek, jaw, lips, or mouth and/or fluid draining from the ear, trouble swallowing, difficulty opening the mouth, numbness or weakness to the face, and/or facial pain.
The following exams and tests are used to detect and diagnose salivary gland cancer: physical exam and history, MRI, CT scan, PET scan, ultrasound, endoscopy, and biopsy of tissue suspected to be cancerous.
The prognosis for salivary gland cancer is variable and depends on the size of the tumor, the type of cancer, the type of salivary gland tissue involved, and the patient's age and general health.
CT and MRI scans are usually done to determine if salivary gland cancer has spread to other tissues.
Salivary gland cancer cells can spread directly to adjacent tissues or spread to other organs by going through the lymphatic system or through the blood.
Salivary gland cancer has four stages: stage I being confined to the salivary glands and is 2 cm or smaller; stage II is larger than 2 cm but not larger than 4 cm; stage III has spread to a lymph node or to soft tissue around the affected gland; and stage IV has spread further.
Three types of standard treatment are used for salivary gland cancer — surgery, radiation therapy, and chemotherapy — some patients may receive more than one type of treatment.
Staging affects choices of therapy; the higher the stage, the more likely the patient will require multiple and more aggressive therapies described above.

What is salivary gland cancer?

The salivary glands make saliva and release it into the mouth. Saliva has enzymes that help digest food and antibodies that help protect against infections of the mouth and throat. There are 3 pairs of major salivary glands:

Parotid glands: These are the largest salivary glands and are found in front of and just below each ear. Most major salivary gland tumors begin in this gland.
Sublingual glands: These glands are found under the tongue in the floor of the mouth.
Submandibular glands: These glands are found below the jawbone.

There are also hundreds of small (minor) salivary glands lining parts of the mouth, nose, and larynx that can be seen only with a microscope. Most small salivary gland tumors begin in the palate (roof of the mouth).

More than half of all salivary gland tumors are benign (not cancerous) and do not spread to other tissues.

Salivary gland cancer is a type of head and neck cancer.

Neck pain

Salivary Gland Cancer Is a Type of Head and Neck Cancer

Head and Neck Cancer Facts

Cancers of the head and neck are identified by the area in which they begin: the oral cavity, salivary glands, paranasal sinuses and nasal cavity, pharynx, larynx (voicebox), and lymph nodes in the neck. Cancers of the brain, eye, thyroid gland, scalp, skin, muscles, and bones of the head and neck are not usually grouped with cancers of the head and neck.
Common symptoms of several head and neck cancer sites include a lump or sore that does not heal, a sore throat that does not go away, difficulty swallowing, and a change or hoarseness in the voice. Symptoms may differ according to the part of the head or neck that is cancerous.

What increases the risk of salivary gland cancer?

Anything that increases the chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Although the cause of most salivary gland cancers is not known, risk factors include the following:

Older age.
Treatment with radiation therapy to the head and neck.
Being exposed to certain substances at work.

What are symptoms and signs of salivary gland cancer?

Salivary gland cancer may not cause any symptoms. It is sometimes found during a regular dental check-up or physical exam. Symptoms caused by salivary gland cancer also may be caused by other conditions. A doctor should be consulted if any of the following problems occur:

A lump (usually painless) in the area of the ear, cheek, jaw, lip, or inside the mouth.
Fluid draining from the ear.
Trouble swallowing or opening the mouth widely.
Numbness or weakness in the face.
Pain in the face that does not go away.

What exams and tests are used to detect and diagnose salivary gland cancer?

The following procedures may be used:

Physical exam and history: An exam of the body to check general signs of health. The head, neck, mouth, and throat will be checked for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. For salivary gland cancer, an endoscope is inserted into the mouth to look at the mouth, throat, and larynx. An endoscope is a thin, tube-like instrument with a light and a lens for viewing.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
- Fine needle aspiration (FNA) biopsy: The removal of tissue or fluid using a thin needle. An FNA is the most common type of biopsy used for salivary gland cancer.
- Incisional biopsy: The removal of part of a lump or a sample of tissue that doesn’t look normal.
- Surgery: If cancer cannot be diagnosed from the sample of tissue removed during an FNA biopsy or an incisional biopsy, the mass may be removed and checked for signs of cancer.

Because salivary gland cancer can be hard to diagnose, patients should ask to have the tissue samples checked by a pathologist who has experience in diagnosing salivary gland cancer.

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Salivary Gland Cancer
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What is the prognosis for salivary gland cancer?

The treatment options and prognosis (chance of recovery) depend on the following:

The stage of the cancer (especially the size of the tumor).
The type of salivary gland the cancer is in.
The type of cancer cells (how they look under a microscope).
The patient's age and general health.

What tests are done to determine if salivary gland cancer has spread?

The process used to find out if cancer has spread within the salivary glands or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following procedures may be used in the staging process:

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

How does salivary gland cancer spread in the body?

Cancer can spread through tissue, the lymph system, and the blood:

Tissue. The cancer spreads from where it began by growing into nearby areas.
Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if salivary gland cancer spreads to the lung, the cancer cells in the lung are actually salivary gland cancer cells. The disease is metastatic salivary gland cancer, not lung cancer.

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What are the stages for salivary gland cancer?

The following stages are used for major salivary gland cancers:

Picture of salivary gland cancer tumor sizes Pea, peanut, walnut, and lime show tumor sizes.

Stage I

In stage I, the tumor is in the salivary gland only and is 2 centimeters or smaller.

Stage II

In stage II, the tumor is in the salivary gland only and is larger than 2 centimeters but not larger than 4 centimeters.

Stage III

In stage III, one of the following is true:

The tumor is not larger than 4 centimeters and has spread to a single lymph node on the same side as the tumor and the lymph node is 3 centimeters or smaller.
The tumor is larger than 4 centimeters and/or has spread to soft tissue around the affected gland. Cancer may have spread to a single lymph node on the same side as the tumor and the lymph node is 3 centimeters or smaller.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC as follows:

Stage IVA:
- The tumor may be any size and may have spread to soft tissue around the affected gland. Cancer has spread to a single lymph node on the same side as the tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters, or has spread to more than one lymph node on either or both sides of the body and the lymph nodes are not larger than 6 centimeters; or
- Cancer has spread to the skin, jawbone, ear canal, and/or facial nerve, and may have spread to one or more lymph nodes on either or both sides of the body. The lymph nodes are not larger than 6 centimeters.
Stage IVB:
- The tumor may be any size and may have spread to soft tissue around the affected gland. Cancer has spread to a lymph node larger than 6 centimeters; or
- Cancer has spread to the base of the skull and/or the carotid artery, and may have spread to one or more lymph nodes of any size on either or both sides of the body.
Stage IVC:
- The tumor may be any size and may have spread to soft tissue around the affected gland, to the skin, jawbone, ear canal, facial nerve, base of the skull, or carotid artery, or to one or more lymph nodes on either or both sides of the body. Cancer has spread to distant parts of the body.

Salivary gland cancers are also grouped by grade. The grade of a tumor tells how fast the cancer cells are growing, based on how the cells look under a microscope. Low-grade cancers grow more slowly than high-grade cancers.

Minor salivary gland cancers are staged according to where they were first found in the body.

Recurrent salivary gland cancer

Recurrent salivary gland cancer is cancer that has recurred (come back) after it has been treated. Recurrent salivary gland cancer may come back in the salivary glands or in other parts of the body.

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What is the treatment for salivary gland cancer?

There are different types of treatment for patients with salivary gland cancer.

Different types of treatment are available for patients with salivary gland cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Patients with salivary gland cancer should have their treatment planned by a team of doctors who are experts in treating head and neck cancer.

Your treatment will be overseen by a medical oncologist, a doctor who specializes in treating people with cancer. Because the salivary glands help in eating and digesting food, patients may need special help adjusting to the side effects of the cancer and its treatment. The medical oncologist may refer you to other doctors who have experience and expertise in treating patients with head and neck cancer and who specialize in certain areas of medicine. These include the following:

Head and neck surgeon.
Radiation oncologist.
Dentist.
Speech therapist.
Dietitian.
Psychologist.
Rehabilitation specialist.
Plastic surgeon.

Three types of standard treatment are used:

Surgery

Surgery (removing the cancer in an operation) is a common treatment for salivary gland cancer. A doctor may remove the cancer and some of the healthy tissue around the cancer. In some cases, a lymphadenectomy (surgery in which lymph nodes are removed) will also be done.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Special types of radiation may be used to treat some salivary gland tumors. These include:

Fast neutron radiation therapy: Fast neutron radiation therapy is a type of high-energy external radiation therapy. A radiation therapy machine aims tiny, invisible particles, called neutrons, at the cancer cells to kill them. Fast neutron radiation therapy uses a higher-energy radiation than the x-ray type of radiation therapy. This allows the radiation therapy to be given in fewer treatments.
Photon-beam radiation therapy: A type of radiation therapy that reaches deep tumors with high-energy x-rays made by a machine called a linear accelerator. This can be delivered as hyperfractionated radiation therapy, in which the total dose of radiation is divided into small doses and the treatments are given more than once a day.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Radiosensitizers

Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

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How does staging affect treatment options?

Stage I salivary gland cancer

Treatment for stage I salivary gland cancer depends on whether the cancer is low-grade (slow growing) or high-grade (fast growing).

If the cancer is low-grade, treatment may include the following:

Surgery with or without radiation therapy.
Fast neutron radiation therapy.

If the cancer is high-grade, treatment may include the following:

Surgery with or without radiation therapy.
A clinical trial of chemotherapy.
A clinical trial of a new local therapy.

Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage II salivary gland cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you.

Stage II salivary gland cancer

Treatment for stage II salivary gland cancer depends on whether the cancer is low-grade (slow growing) or high-grade (fast growing).

If the cancer is low-grade, treatment may include the following:

Surgery with or without radiation therapy.
Radiation therapy.
Chemotherapy.

If the cancer is high-grade, treatment may include the following:

Surgery with or without radiation therapy.
Fast neutron or photon-beam radiation therapy.
A clinical trial of radiation therapy and/or radiosensitizers.
A clinical trial of chemotherapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II salivary gland cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.

Stage III salivary gland cancer

Treatment for stage III salivary gland cancer depends on whether the cancer is low-grade (slow growing) or high-grade (fast growing).

If the cancer is low-grade, treatment may include the following:

Surgery with or without lymphadenectomy. Radiation therapy may also be given after surgery.
Radiation therapy.
Fast neutron radiation therapy to lymph nodes with cancer.
Chemotherapy.
A clinical trial of fast neutron radiation therapy to the tumor.
A clinical trial of chemotherapy.

If the cancer is high-grade, treatment may include the following:

Surgery with or without lymphadenectomy. Radiation therapy may also be given after surgery.
Fast neutron radiation therapy.
Radiation therapy as palliative therapy to relieve symptoms and improve quality of life.
A clinical trial of radiation therapy and/or radiosensitizers.
A clinical trial of chemotherapy.

Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage III salivary gland cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you.

Stage IV salivary gland cancer

Treatment of stage IV salivary gland cancer may include the following:

Fast neutron or photon-beam radiation therapy.
A clinical trial of chemotherapy with or without radiation therapy.

Check the list of NCI-supported cancer clinical trials that are now accepting patients with stage IV salivary gland cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you.

Treatment options for recurrent salivary gland cancer

Treatment of recurrent salivary gland cancer may include the following:

Radiation therapy.
A clinical trial of a new treatment.

Check the list of NCI-supported cancer clinical trials that are now accepting patients with recurrent salivary gland cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you.

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